Poll: What is wrong with me?

After a week of severe pain and going to work with a fever, I was finally told that I “look like death” and bribed into going to the doctor.  So I went to Urgent Care (cause it was Saturday afternoon by the time I got around to going).  They sent me to the ER because I needed imaging done and looked too hellish to wait until Monday.  So I got the kind of “cool” ultrasound that would make Scott Walker proud, told that I had fibroids and an infection, given antibiotics, and a ridiculous bill.  I took my pills and followed up with my doctor.  I was miserable for many days.  I was tired, depressed, confused, and feverish.

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So that was many weeks ago.  However said pain has not gone away.  I went back to doctor and was told “There’s no reason for you to still be experiencing pain.”  And I was sent on my way.

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So, since there is no reason for me to still be in pain and everyone keeps telling me this is in my head, I’m left wondering what the hell is wrong with me.

After consulting with my circle of people (which happens to include many therapists of different orientations as well as people who read too much), my options have been widdled down to:

Factitious Disorder
Conversion Disorder
Existential Crisis (Samuel Beckett style)
Hysteria (a la The Yellow Wallpaper)

To help you along, my symptoms include:

Feeling that someone is stabbing a knitting needle through my left ovary
Exhaustion
Ennui
Self-Loathing
Staring blankly at things without realizing that people are talking to me
Desire to read a lot of Murakami

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Your input is appreciated.

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Love/Hate Relationship with Electronic Medical Records

When I first posted this, I realized it was too serious for me.  So I decided to add a ponderous Bowie.

When I first posted this, I realized it was too serious for me. So I decided to open it up with a ponderous Bowie.

I recently started my Pre-Doctoral Internship.  Much like my previous training site, I’m in the Community Mental Health (CMH) world.  Unlike my previous site, I have Electronic Medical Records! (EMR)

I am actually excited about this fact because paper record keeping was absolute shite at my old training site.  Things got lost, accidentally shredded, or re-done a thousand times because it had a minor error.  Everything was constantly a mess.  Intake appointments were up to 3 hours long and required over 50 pages of documentation, most of which had to be hand-written.   Even after that 3 hour intake appointment, there was at least 2-3 more hours of cleaning up and re-checking paperwork before it could be sent off and *hopefully* approved for billing.  You can imagine how exhausting this was for both the staff and the clients.  And of course none of that paperwork time was billable.  So a 40 hour work week for staff (therapists, respite workers, case managers) would usually consist of maybe 15-18 billable client hours (I know this because I’m obsessed with counting and quantifying things and looking at charts of things).  It took up to 3 months to get feedback on this crazy paperwork.  If things did not get into the record immediately, there were often massive miscommunications between members of the treatment team.  A psychiatrist would change a client’s medication and the therapist would not know about it for weeks.  A client would skip therapy or skills or job training and the psychiatrist would know nothing about it.  Crisis alerts for clients were often mis-filed or not provided to the client until days later.  If paperwork expired and we weren’t on our toes about exact dates and made sure to schedules ourselves a few extra hours to update paperwork on the plucked-out-of-thin-air medicaid-demanded dates (all of which were different between treatment plans, evaluations, updated consent forms, etc), we lost billing, meaning we lost the only funding that keeps the doors open to the only mental health resource available to most of the people we served.

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Overall, it interrupted treatment.  It interfered with the ability to provide treatment.  So much time was spent completing paperwork and ensure that medicaid would pay for the work that was done, that client need often had to be put aside for the time being while we made sure we were compliant with governmental demands.  And of course when client charts or information got lost, it was always the one with pre-existing paranoia ideation.  Serendipity, bitches.

And this was not because of poor management of the site.  They honestly did the best they could trying to stay on top of everything.  But it honestly felt like every month or so medicaid was demanding more documentation.  We were overloaded, understaffed, and underfunded for what was placed on the agency.  Because of these outrageous demands, we were forced to keep relatively small client loads, which lead to an overflowing waitlist.  This means that both adults and children with mental illnesses, developmental disabilities, trauma, and other problems demanding mental health care were forced to wait up to 6 months for services.  This includes people released from the hospital following a suicide attempt.  People with active psychosis.  And those with a history of violence and aggression.  These are all people that are in desperate need of care, low-to-no income, and are struggling to meet the demands of their daily life.  However, they are all also people who had the potential to succeed and contribute with the right help and resources.  Many of them are children and adolescents whose potential you could feel if you could just get them and their families in the door and on your caseload.  This is the story of many CMH’s out there.

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Oh, and did I mention that, because CMH is so underfunded that nearly every staff member has to travel between multiple sites and rarely has a consistent schedule?  So communication between treatment providers is difficult to say the least.  A CMH psychiatrist (that’s the one that prescribes meds but does not provide skills training or psychotherapy) may work at 4 different locations throughout the week and see upwards of 50 clients per day (10-15 minute appointments).

So, my at my new site we have EMR.  Which is so much more convenient.  Everything is right in front of us on a single website, from Treatment Consents to Intake Assesssments to communication forms between treatment providers.  Because everything is in one location, you get alerts for when things are coming due.  If a client misses an appointment, the entire treatment team can be alerted immediately.  Rather than 3 hours, intakes are about 1 hour.  I have constant access to everything in my clients’ records, no matter what office I’m at, or even if I’m doing a home or school visit.  It is infinitely easier to get my work done and move on to focus on my clients’ needs.  I can instant message my supervisor or other member of a client’s treatment team the moment there is an issue or just to alert them to progress made.  A client can review their records easily with me and helps fill out progress notes, which feels more open and honest, and opens to door to discussions about how they view the therapy and their progress.  If a client’s medications get changed or they are assessed by the crisis team, I know immediately that a change was made to their record.  It’s golden.

Unfortunately, the Orwellian in me cannot fully embrace this.  Being CMH, it is a government agency, funded primarily by medicate and overseen by the Health Department and everything that goes with that.  I’ve been on a bit of a paranoid kick myself lately–how could you not be in America right now?  I’ve been following the NSA/Manning/Snowden stories and I’ve been appalled by what I’ve been reading.  How much information is viewed and stored about people.  How many emails and searches are read.  There is no guarantee that any of my emails are secure and everyone that comes in the door is made aware that their information is reported to various agencies.  Most clients, though, are in too great of a need to worry about confidentiality and governmental information gathering.  How do I explain confidentiality to a client when I know that nothing is really confidential because it is being reported to various agencies.  There is nothing so great about out EMR that makes it hack-proof.  Do I think that the NSA really cares that much about a 15 year old girl’s depression?  No.  But the fact is, nothing about EMR really is secure.  But with the massive integrating of all of this information, is it really that outlandish to believe that this information could show up somewhere else in the future where it might hurt the person?  What if the 15 year old girl later decides to apply for positions in the Military or CIA and they have access to these mental health records?  Could that affect them?  I really don’t know.  I am being told that this information is secure and confidential, but to be honest even my supervisor does not sound that convinced of it.  What if I do have to write a report on a client having paranoid ideation regarding the government?  What if I have to email my supervisor regarding a client’s flight of ideas about militias and terrorism?  How secure and safe are these mental health records?  (Our voice mails also go directly to email)

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So, I am still torn over the EMR thing.  It is amazingly efficient and leads to better record keeping and communication within the treatment team and therefore more effective and ethical treatment.  However, I have significant concerns over confidentiality and how long this information is kept and for what purposes it can be used.  My fears being heavily influenced by the happenings within my country.

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What I learned at the ER…

So, last Monday I had to go to the ER because I’m mildly stupid and extremely clumsy.  Now, I am not a doctor going person.  The only doctor I go to is the Optometrist, because that’s more like a shopping trip for people who love glasses.  The last time I was at the ER was when I was about 2 or 3, which I obviously don’t remember but I assume a lot has changed since then.

So, I first learned that everyone talks very quickly and you’re not allowed to read anything you sign.  In fact, you’re lucky if they even tell you what you’re signing.  I first signed my Consent to Treatment, which I’m pretty familiar with thanks to my job.  So no problem with that.  After that was signed, I wasn’t really paying attention to what was going on, perhaps it was the blood loss that was distracting me.

Fast Forward to my discharge. I’m handed a bunch of insurance papers and such.  The woman at the desk mumbles something while she hands them to me.  I flip to the first page to figure out what is going on and what I’m signing.  The woman says “It’s insurance.  If you want your insurance to pay, you sign it.” I felt really pressured and ill-informed about what I was being given.

I went back today for my wound check/follow-up.  Once again, they take my ID and insurance and such and quickly take me back to do the check up.  But while I’m waiting for the docs, this guy comes in and says something hardly comprehensible about my insurance and when do I want to pay my co-pay?  He tells me the amount and I say I can pay before leave, at which time he offers to take my credit card then and there.  I’m really taken aback because I feel like that is an inappropriate offer.  I was fully cognizant and I’m well educated in paperwork and such, so I declined saying I’ll wait and I ask his name to make sure I remember.  However, I feel like people in this situation could be very easily taken advantage of.  I think it is inappropriate and far too easy to take advantage of someone in a medical office by taking their credit card.  It would be too easy for a staff member to steal the information or overcharge you.  IDK, but it wasn’t okay with me.  Then, when I go to leave and make my copayment, the doctor comes out and says “oh, wait, you need to sign this before you leave.”  Again, I ask what I’m signing.  His very disturbing response: “Uhh, I don’t know.   Hold on.  Oh, this is your wound cleaning instructions.  Oh, this just said that we explained to you how to take care of the wound.”  Even though he actually didn’t do this, I signed it.  I wasn’t about to give him shit and cleaning a cut isn’t difficult.

In addition to not being able to read things, I would like to talk about the lack of informed consent for procedures.  As I said, I don’t go to doctors a lot.  My experience was pretty simple, clean, x-ray to check for class, clean, stitch, wrap, and go.  But even for this, they had to give me meds, local anesthesia and such.  But, other than asking if I had any allergies, I was never given any info about the medications I was being given.  I understand that I was in an ER, but again I was fully cognizant once I stopped bleeding, I was calm, I like to think I was pretty chipper for an ER patient.  But no one talked to me about what they were doing for more than 30 seconds, never was it asked if I was okay with what was happening.  The doctors and nurses were nice, but as far as Informed Consent, it was totally absent.

Last year, I also had to go to the ER with the bf, who was super sick.  They did SOOOO many tests on him!  Ultrasounds, CT scans, X-rays!  Shit son, they threw the whole battery at him.  What did this result in?  A bottle of antibiotics and an $8000 bill.  Never, at any point was he asked if it was okay to do all these tests or if he consented to them or even what they all meant.

I have been told (yeah, this feels like I’m going to tell you a myth about Leprechauns or something) that you can refuse certain treatments.  But, the catch is, they never ask you if you’re willing to do them in the first place.  Essentially, you have to jump up and down like a child or go on a rampage in order to get your medical treatment explained to you.

So yeah.  I am a better person now for knowing what being an adult hospital patient means.  It means being forced to sign things without being able to read them and having no understanding of what’s being done to you.  Oh, and for some reason, you can never see your medical file.  Doctors are really resistant to this for some reason, even though it belongs to you.  I really want to stress that:  YOUR MEDICAL FILE BELONGS TO YOU AND YOU HAVE THE RIGHT TO SEE IT WHENEVER YOU WANT.