Friday, April 25, 2008

Dial P for Patient

I just spent four days at Green Acres, covering a colleague’s vacation. One of my private practice clients asked, with a suspicious tone, whether the weeks I occasionally spend there are for “tune-ups”—she thought court ordered, perhaps. No, nothing so intriguing as that. Just helps pay the bills. And remind me why I left.

This week I was thinking about the elusive concept of “privacy” and “confidentiality” in a mental hospital. If you’re sick in a "real" (medical) hospital, it’s unlikely that any of your fellow patients will know anything much about you, unless you go out of your way to tell them. They probably won’t even know your name, let alone your diagnosis, prognosis, familial situation, etc. This, to my mind, is how it should be (and, I believe, how it is legally supposed to be-- attorney readers, feel free to chime in.)

But it ain’t like that at Green Acres. There’s no way that the other 23 patients on your ward will remain ignorant of your identity—your full name will be posted in any number of public places, and nurses and ward techs will shout it down the hallways. If you’re diligent and make it a priority, you might stand some chance of having your particular mental problem remain at least moderately under wraps—but it’s unlikely. Within a week everyone on the ward will know that you tried to [slit your wrists, kill your mailman, cheat on your wife, insert other personal event] and that [your kids are living with your ex-husband, you are pleading Not Criminally Responsbile, your wife threw you out, insert other fallout]. A large number of crazy people will very soon know more about your secrets than most of your family. Sure, you could just refuse to associate at all with your “peers” (as they are called), but then you will bring on yourself a lot of “interventions” designed to increase your “sociability”. Refusing to attend group-therapy treatments tends to prolong your stay at the hospital…

So now what happens when someone—let’s say, your ex-husband—hears that you’re at Green Acres and phones the hospital switchboard trying to reach you? Well, due to Confidentiality, the operator will neither confirm nor deny that you are at the hospital. Instead, the operator will give the caller the number for the ward “Patient Phone”, and suggest you call there. There is Patient Phone on each ward, in a small alcove on the main hallway. It has all the privacy of a payphone at LaGuardia. Staff are forbidden from any dealings with the Patient Phone—it is for Patients Only.

So anyway, you call the PP. The phone in the hallway rings. Maybe it’s snack time, and no one answers. (There will be three staff sitting ten feet away at the nursing desk staring at the phone, but they can’t answer it.) Or maybe one of the self-designated Helpful Phone Answering type patients will be hanging out nearby, just hoping for such a call. For many patients it gives nice sense of self-worth if they can do something useful like going to fetch a “peer” and tell them they have a phone call. But, this inclination to help can and often does spill over into curiosity, or nosiness. I have had family members of patients phone me in my office to inquire, e.g., “who that was who answered the patient phone, and had all kinds of personal questions to ask me before he would go get my brother” (I don’t think the Switchboard explicitly impresses on people, when they give out the PP number, that the person who answers will NOT be a staff person…) Then, moving along to ever worse cases, there are the patients who find the ringing of the phone bothersome, and simply lift the receiver and hang it up. Or, next, the ones who find a phone call coming from “outside” to be an irresistible opportunity to alert someone (anyone!) to the horrible crimes they are experiencing at the hands of the staff, the poison that is in the water, the drug-dealing, the ritual sacrifices that happen every night on third shift. Or, the phone-answerer might start “sharing” the personal information he’s learned about the patient being sought… or might start INVENTING personal information, or bogus messages (“Antoine? Aintoine…ain’t you her ex-husband? Yeah, man, she said you can go f---k a goat. She said you can just keep the kids, she don’t want them anyway. She’s with me now, get it pal?” etc.)

You laugh (maybe) but this is what happens. It’s sad.


Anonymous Anonymous said...

I had a problem along these lines in my last hospitalization. Nursing students from my school visit the hospital twice a week. No one warned me. I saw some people and bolted to hide in my room. Was trapped hiding there not wanting my classmates to see me. The staff thought it perfectly reasonable for me to have to hide from them while they were there. They refused to restrict the students to a more remote area to help me maintain my confidentiality.

4/25/08, 8:00 PM  
Anonymous Anonymous said...

yeah....Another patient decided to tell my Dad that I ODed on Sudafed. I was trying to keep some shread of dignity. That sucked

4/26/08, 10:11 PM  
Anonymous Anonymous said...

During a recent "tour of duty," there was a woman with some delusion about the phone. Try talking with someone with someone standing over you, yelling.

4/26/08, 10:14 PM  
Blogger Backdated said...

That's incredible, and really unfortunate. What are the policy alternatives? I'm trying to imagine a system that would permit patients to receive the phone calls they want, while protecting their privacy. I guess staff could be responsible for answering the phone, and patients who are lucid enough could advise as to whether they didn't want to hear from certain people/have those people know they're in hospital?

4/26/08, 11:16 PM  
Anonymous Anonymous said...

This post hits the nail on the head. Try repeatedly running into co-patients who know way more about you than you'd ever like to admit in a social setting outside the hospital. I'd just like to ignore the fact that I'd ever met this kid before but he always seems to want to joke about our days in the looney bin! But if you skip "group therapy"'ve just earned yourself a longer stay.

5/18/08, 4:24 AM  
Anonymous Anonymous said...

I have yet to figure out the ban on cell phones. A patient knows who is calling and can decide if they want to answer it or not and none of the other patients even have to know there was a call!

5/18/08, 4:25 AM  

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