MH Records and continuity of care

[HIPAAHasOneP]

Maybe you are just asking the wrong questions. When was the last time you asked your dermatologist about the black/red thing hanging out down there? Maybe that hypothyroidism affecting dryness/libido at endo office? You never know when the business becomes the doctor's business.....

I've taken my clothes off at the internist's office and the dermatologist's office, yet they have never asked about a history of sexual abuse. (e.g. skin cancer screening). Patients are typically pretty vocal about letting you know when they don't want to do something. Remember that woman at Beth Israel who was forced to remove her clothing in the ER simply because she had a psych history? Knowledge about her psych and sexual abuse history didn't really help her out much. http://www.bazelon.org/In-Court/Closed-Cases/Sampson-v.-Beth-Israel-Deaconess-Medical-Center.aspx

Also, even though they ask that question at the gynecologist's office that doesn't mean the patient answers it honestly. Patients often feel more comfortable telling psychiatrists things they don't want other doctors or others to know. Regardless of whether it helps the patient or not the main concern is really did the patient understand and consent to it. If they understand and consent to information being shared, then all is well. If patients don't want particular information shared, then that should be respected which means they need to change the EMRs to allow for that.

Psychiatrists who are discreet in their documentation are doing the right thing.

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[sunlioness]

If I don't document, I don't remember.

Though sometimes perhaps you don't need to remember the nitty gritty details.

At the place I worked most recently and will be returning to, mental health notes were behind a wall. Non mental health providers could see the meds and that was about it. We didn't even add diagnoses to the problem list. Though I would delete diagnoses that other physicians had added to the problem list if I felt they were incorrect. (I deleted bipolar a lot).


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[smalltownpsych]

If I don't document, I don't remember.

Though sometimes perhaps you don't need to remember the nitty gritty details.

At the place I worked most recently and will be returning to, mental health notes were behind a wall. Non mental health providers could see the meds and that was about it. We didn't even add diagnoses to the problem list. Though I would delete diagnoses that other physicians had added to the problem list if I felt they were incorrect. (I deleted bipolar a lot).


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It is interesting that the mental health records are considered problematic, but the problem list from the FM docs has things like morbid obesity, genital warts, impotence, incontinence, vaginal discharge, herpes, prolapsed uterus, profuse anal bleeding. Usually all I put in the problem list is something like MDD or GAD. Even if I put in Borderline Personality Disorder is that really as bad as some of the other stuff. It is kind of weird how the mental is stigmatized over the physical. I actually feel more comfortable talking about my interpersonal stuff than that big boil on my backside.

 

[HIPAAHasOneP]

Yeah, it is a shame that there is so much stigma associated with mental health records. I read about a study where they found that patients with severe mental illness die 25 years earlier than other patients, and while some of the reason is probably due to lifestyle at least some of the concern is that psychiatric patients are not taken seriously when they seek treatment. That's a shame.