Friday, April 12, 2013

Your Privacy and the Psychiatric State

I wrote some weeks ago about Thomas Szasz, M.D., and his many books about the fallacies of modern psychiatry. Dr. Szasz is known for his stance on individual rights and the separation of state from medicine, particularly psychiatry.

We are entering a new era in the potential for government to control you via your physician. The HIPPA Act is ostensibly about Privacy and Portability. The problem is that those are mutually exclusive. Either you have privacy, OR your medical information is portable. Perhaps you are one of those unlucky few whose test results have gone to the wrong physician or whose bill has arrived at the wrong address due to mix-ups in computer-managed records. Perhaps your physician's records have been hacked, and your medical record leaked into the wrong hands. This is but the tip of the iceberg. You might also be someone who has been refused health or life insurance because long years ago you visited a doctor for some symptom. The symptom turned out to be benign and is long gone, but the permanent record that followed you around is not.

These days, a new threat to life, liberty, and medical care has arrived in the form of gun control. I know, this is a weird topic for a psychologist to take on, and I am not presenting a stance for or against in this blog. However, I feel strongly about your privacy, and the new reality is that if you have ever been on a psychotropic medication, this is now on your permanent, electronic medical record. And the government has sent a recommendation to physicians that they query the presence of guns in your home. The inevitable conclusion? Your medical record thus becomes the vehicle by which your rights can be taken away. One must ask, what other way might be found for your personal medical information to be used to your detriment? What other rights are at risk when your physician records the answers to non-medical questions and when everything you tell her and everything she discovers or speculates about you is placed in a permanent, electronic file?

This is a slippery slope. Many drugs are assigned to the category of psychotropic including sleeping pills, stimulants, and anti-seizure medications. Be careful what you request of your physician. When it comes to strictly psychological distress versus seizures or other organic illness, my stance, is, as it has always been, to opt for psychotherapy instead. In addition, use a therapist who does NOT file insurance, thus preventing your treatment from showing up in your health record. Control your private information. Do not answer non-medical questions. Do separate medical from non-medical issues. Your general physician is not qualified to determine if you are clinically depressed nor have a phobia, nor to treat these symptoms.

In truth, the recommendation to head to a psychologist rather than your family doctor or internist is not as self-serving as it might seem. Research shows that for psychological distress such as phobias, anxiety, depression, and PTSD, psychotherapy is more effective and longer-lasting than medication. And indeed, for many types of chronic pain and digestive distress, hypnosis combined with other psychotherapeutic modalities is the treatment of choice. In the long run, despite paying the upfront cost for psychotherapy, you save money and time, get well faster and for the long term, avoid unpleasant side-effects, and keep your medical record clear of things that might cost you dearly in the future.

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