soprano"s episode

[Rpre19]

Hey, did anyone see the soprano's this past sunday? At one point the name of melfi's pt (soprano himself) was revealed at a dinner party with a bunch of psychiatrists. Wouldnt this be a HIPAA violation, let alone it being completely unethical??

Also, Melfi quickly dropped tony as a pt (after 7 yrs of therapy) after reading a study about ppl w/ anti-social PD actually getting better at manipulation & criminality through psychotherapy. here's a (very unscientific, i.e. entertainment) article where psychiatrists are upset by the episode

so the whole confidentiality violation was disturbing, but it is the sopranos after all. I loved it. cant wait til the finale
either way the sopranos is a great show👍

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[Rpre19]

oops, here's the link for the article


http://tv.msn.com/tv/article.aspx?news=264475&GT1=7703

 

[apoptos]

One more reason to prefer The Wire.

No, I don't think its a violation of confidentiality just to state that someone is your patient.

 

[golfpropsychguy]

One more reason to prefer The Wire.

No, I don't think its a violation of confidentiality just to state that someone is your patient.

If you bring up the patients name and its obvious that everyone knows who the patient is, like if I were to tell a bunch of friends that my patient is "John Gotti" I think it would be pretty unethical...

 

[Therapist4Chnge]

Both things were completely unethical. It is one thing to be in an office setting, and need to consult for something (still not ideal, but it happens), but at a dinner party....no way. And her completely cutting him off, and REALLY weak attempt to 'refer'. I'm sure both still happen though.

-t

 

[PsychMD2100]

Apoptos,

Revealing the identity of any of your patients is ABSOLUTELY unethical.

At our hospital, if you call the ward and ask to speak to a patient or the doctor taking care of a patient, the nurses have a rehearsed script that they recite from memory. It essentially says that they can neither confirm nor deny the identity of a patient; however, if such a patient is present, the message will be forwarded onward.

There's such a stigma attached to mental illness that simply revealing that a person is undergoing mental health care is a violation of trust in the therapist-patient relationship.

You should know better.

 

[strangeglove]

I believe the standard is that the patient's identity can only be disclosed to those persons directly involved in the patient's care. Therefore, while one may talk about specific nonidentifiable aspects of a patient at a dinner party, one may not disclose information that would reveal the identity of this patient, even if all of the guests are psychiatrists. Melfi's therapist guy was definitely out of line. I've heard that many people have complained to their therapists about this episode, presumably because they were outraged by the breach of confidence and are wondering whether their psychiatrists might do the same thing to them.

 

[blanche]

Hey, did anyone see the soprano's this past sunday? At one point the name of melfi's pt (soprano himself) was revealed at a dinner party with a bunch of psychiatrists. Wouldnt this be a HIPAA violation, let alone it being completely unethical??

Also, Melfi quickly dropped tony as a pt (after 7 yrs of therapy) after reading a study about ppl w/ anti-social PD actually getting better at manipulation & criminality through psychotherapy. here's a (very unscientific, i.e. entertainment) article where psychiatrists are upset by the episode

so the whole confidentiality violation was disturbing, but it is the sopranos after all. I loved it. cant wait til the finale
either way the sopranos is a great show👍

yes, i was wondering what people thought about that also!! specifically, i was wondering whether that literature that they referred to actually existed.

i also wondered why dr melfi dumped tony as a patient:
1) because of the theory they discussed (criminals 'using' therapy for their own manipulations)
2) she felt tony had violated the relationship too many times (missed appts, et cetera)
3) she feared for her own safety after it was revealed publicly that she was the therapist for such a high profile pt who had many enemies

i know i'm probably reading into it too much, but it seems that throughout the series, the references to the medical field have been pretty accurate. i love how the series started with tony visiting a psychiatrist, and it appears that it will end with the ending of this relationship.

 

[Anasazi23]

I find HIPPA to be entirely destructive. I don't submit my practice life to the complexities of this fabricated and artificial creation of lawyers.

I'm being provocative, but many, many other doctors feel the same way and more.

 

[apoptos]

You should know better.

Oh, um...yeah.
It is unethical, and it is a violation of policy, and certainly you don't want to go announcing such things to magazines and the merely curious.

That said, in the context of this Sopranos episode, it's as Eliot says: "we're all professionals here." If a policeman or doctor approaches you about a patient you wouldn't respond "I can neither confirm nor deny the existence of this patient." You would say, rather, as the patient's doctor I cannot disclose any information about his care. That's the nature of confidentiality amongst the nurses and on the ward; everyone is someone's patient. What difference does it make which doctor?
Do you see what I'm getting at? By not saying anything (and she doesn't) she admits to being his doctor anyway. And as events unfold we're forced to interpret Melfi & Eliots interaction as a professional consult, because ultimately she takes his advice.

 

[Therapist4Chnge]

I find HIPPA to be entirely destructive. I don't submit my practice life to the complexities of this fabricated and artificial creation of lawyers.

I'm being provocative, but many, many other doctors feel the same way and more.

THIS would make for some interesting discussion.

I happen to agree, something that started off as a very different entity...became a monstrous mess.

-t

 

[Doc Samson]

Oh, um...yeah.
It is unethical, and it is a violation of policy, and certainly you don't want to go announcing such things to magazines and the merely curious.

That said, in the context of this Sopranos episode, it's as Eliot says: "we're all professionals here." If a policeman or doctor approaches you about a patient you wouldn't respond "I can neither confirm nor deny the existence of this patient." You would say, rather, as the patient's doctor I cannot disclose any information about his care. That's the nature of confidentiality amongst the nurses and on the ward; everyone is someone's patient. What difference does it make which doctor?
Do you see what I'm getting at? By not saying anything (and she doesn't) she admits to being his doctor anyway. And as events unfold we're forced to interpret Melfi & Eliots interaction as a professional consult, because ultimately she takes his advice.

I completely disagree. Eliot was extremely unprofessional in raising the subject in a non-supervisory setting (a dinner party that happens to be attended by a bunch of doctors is NOT automatically a professional setting - just ask the IRS if you try to write-off any meal attended by another physician). Melfi was unprofessional in engaging him in any discussion about a patient with others present. Eliot is Melfi's supervisor - the professional consult had already taken place - raising the content of that consultation in a social situation is unethical and grounds for censure by the board. HIPAA is a bunch of crap, patient confidentiality and privelege is the basis of our profession.

 

[PsychMD2100]

Agree with Doc Samson,

Apoptos, have you graduated from med school yet?

By the time you get your MD, you should know better that a patient's identity and secrets are not social fodder. As Doc Samson alluded to, confidentiality and privilege are the foundation of our profession.

Most of my friends are doctors and we go out quite a bit. If I ever bring up a case, I never associate it with a name or anything that can remotely be used to identify the patient. I don't talk about my patients when I'm in social settings.

Your analogy of the ward is an entirely different setting. It's a closed environment with licensed professionals consulting with one another in the course of patient care. I don't see the connection between the ward and an entirely social dinner party.

Finally, if a random police officer or a random doctor asked me about a patient, I really would tell them that I could neither confirm nor deny that I was caring for that patient. By Lorraine Bracco not responding, it still would not be an "answer". The only time I would tell the cop details is if the patient gave me his/her consent or the cop had a court order. The only time I would tell the doctor is if he/she was directly involved with care for the patient.

If you're still not absolutely clear about these first-year med student concepts, you should review the APA Ethics Committee website:

http://www.psych.org/psych_pract/ethics/ethics_opinions53101.cfm

 

[apoptos]

apoptos, have you graduated from med school yet?

No...! You can all breathe easy, I haven't even been admitted yet.
I'll just thank you for schooling me.

 

[Therapist4Chnge]

......I could neither confirm nor deny that I was caring for that patient.

Depending on your setting, you may have to say this a lot! Earlier this week I heard a person say this like a broken record (the pt's family kept calling for information, and there was no release of information form)

-t

 

[Rpre19]

i was also pretty disturbed that melfi dropped tony like that & to be honest i didnt buy it...it just didnt jive with how she practiced in the past. she's always been professional, even after she had to hide out & see pt's from the motel on the side of the road when the guys found out tony was seeing a psychiatrist. So all of a sudden she defers her judgement to this putz eliot??
--yes i'm entirely too involved

& i agree that HIPAA has, in many cases, become been a roadblock in effective communication and treatment. Does anyone know if it is eligible for revision at any point?

 

[Rpre19]

also, no one at the table admonished eliot for his actions, except melfi. a table full of bad examples...

 

[mgdsh]

You do realize that this was the 2nd to last episode (as you've acknowledged), and you saw many key characters die off during the episode (and also during the previous few). This is just simply Melfi's way of 'dying off.'

I really get the feeling that the Sopranos wanted to end the series sooner than later. It is after all a drama, yet towards the end here, everything has evolved rather quickly.

I'm not sure if they ran out of ideas or what, but you would have assumed/imagined that there would have been a little bit more plot behind the ending aside from phil and his crew just 'getting pissed off with tony.'