396: Her Doctor Failed Her – Privacy for Youth in Psychiatry, Suicidality Assessment, and Advocating for Your Past Self

Hello, friends!   In today’s episode, we tackle a profound listener question that may resonate with many of you. A listener who survived a suicide attempt at 13 is considering reaching out to the pediatric psychiatrist who assessed them during their hospitalization. They feel that the presence of medical students during their assessment was inappropriate and impacted their honesty. They’re seeking guidance on how to provide feedback and advocate for their younger self.   As always, you can send me questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode396   Links:   https://www.nami.org/advocacy/   https://www.patientadvocate.org/

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Question:

Hi!
I’m a listener of your podcast am currently struggling with making a decision or contemplating even what I can do, so I guess I’m looking for a little guidance if you might have an opinion on the matter?

I recently requested the medical records from a hospital visit I had a few years ago. I was 13 and attempted suicide, ending up being admitted for about a week. Recently I’ve been thinking about how during the psychological assessments I had the pediatric psychiatrist and how from the first time I met with him he had a trail of medical students behind him. I understand that the hospital I was at is a teaching hospital, but I feel that due to the context and matter of the assessment it was not appropriate for the medical students presence. Of course the doctor gave me the option to ask for them to leave if I wanted. However, I was so young and in such a vulnerable state that I did not feel comfortable advocating for myself and I didn’t have anyone else to do so. Looking back I think that the sensitivity of the context should have made the psychiatrist rethink involving medical students, especially because their presence can impact the honesty of answers, and definitely did in my case. Being asked “why did you try to kill yourself” in front of a group of students was probably one of the most uncomfortable and terrifying situations I’ve been put in.

Considering the possibility of reaching out to the pediatric psychiatrist to give personal feedback and advocate for my younger self, I requested my medical records so I could get the proper information related.

I’m not quite sure what to do next, do you have any thoughts or comments on the matter?

Episode Transcript:

All right. Hello, friends of all varieties. Thank you for joining me today. This is episode three 96. Thank you very much for having patience with me last week. I did not put out an episode and it’s pretty funny cause I warned you about the potential of that happening right before that. So thank you all for understanding.

I’m back this week, excited to be here. Before I get into the question for this episode, I wanted to share a few updates with you personal updates and such. So if you’re not interested in hearing about all that, Totally fine. Just skip forward a bit. But yeah, I wanted to address sort of like the world right now.

It’s really fucking hard out there right now. And you know, everybody, we all have our own stuff that we deal with. Internally every day. And then of course the state of the world right now is very intense and very emotional and scary and sad. And it’s just fucking hard. Like I said, so I just want to remind you guys that there are many ways to be involved [00:01:00] in the causes that matter to you.

Right? I say this because I know I’m talking to a particular type of audience here. Some people out there serve their purpose out on the front lines of whatever is going on. Not everybody can do that. Some, you know, do their part by trying to spread information and educate people. Others do so by simply having challenging dialogues or having strong personal boundaries with the people in their lives.

Others do so by resting and by staying informed and by waiting for their moment to engage in the best way that they can and in the ways that they are capable of. It’s very easy to feel super guilty right now. And honestly, a certain amount of that is appropriate, right? Guilt can motivate you to face inconvenient truths and to take action where it’s needed.

But too much guilt isn’t helping anyone, right? You can only do what you can do. So let the circumstances drive you to do what you can, but try not to be unrealistic with yourself either, because that’s not going to help. So in the [00:02:00] interest of kind of chilling out, getting on the same page here and focusing on what we’re going to be talking about in this episode, just for these moments that I have you, let’s take a nice slow breath together.

Okay. We’re just going to take one. We’re going to breathe in. We’re going to hold it for a moment and we’re going to exhale out entirely. Okay. So breathe in with me,

hold it and out.

Thank you. Okay. So onto a couple other updates. I had talked about it on the show previously, but I think I’m going to start doing interviews again. I want to, so if you have people that you would like me to interview on the show, if you’re not familiar with what my interviews are like, you can go way back, go to duff the psych.

com and look at some of the older episodes. I was doing them for quite a while and interspersing them with the Q and A’s and deep dives. But it’s been, A good amount of time and I want to start doing them again. So if there are people that [00:03:00] you would like me to have on the show, please let me know. You know, if you’re doing it on social media, feel free to tag them, et cetera, because I need some people now I need some guests and I have a few that are in the works, but definitely I’m open to ideas.

And I just wanted to say, there may be some growing pains as I get back into it, both from the logistical technology side and the personal side on technology side, you know, I’m going to be trying out different types of software. I’m using one right now and a software called Descript, which is a really big podcasting, you know, platform.

It’s a, it’s a whole app that does many different things and I’ve never used it before. So hopefully this episode works out okay. But of course, when, when I’m doing interviews, there might be technological hurdles and stuff like that. But on the personal side, you know, I stopped doing interviews on the show because at that time, family life and life life made it just too difficult and unpredictable.

I remember there was a very distinct moment where I was doing an interview with somebody who was trying pretty high profile [00:04:00] and somebody that I was really excited to talk to. And this was going to be a good thing to share with you guys, the audience, and also just for the show and for me in general, but I had to stop midway through.

I had to literally interrupt this person talking about their husband. Unloving themselves because I, there was a family emergency, there was a family issue. I was like, I’m so sorry, I have to stop. And we were never able to reconnect. So, you know, with the kids now being older, being in school every day, there’s definitely more stability and more predictability in my life.

So I’m hoping that that helps. Another thing to share that I don’t know that I’ve really spoken to a lot is that interviews were also starting to become pretty anxiety inducing for me. For those of you that have followed me for a long time, you may remember there was one day, probably around five years ago, maybe more, I was doing a live stream on Facebook and I had like a little baby panic attack on the air or, you know, on the live stream.

I tried to play it off as a coughing fit. Like I blanked out and [00:05:00] I was like, and I just kind of tried to play it off because I was like, Whoa, this is happening right now. And there are people watching me. There was a good amount of people on the live stream. Truthfully though, I totally blanked out. I have that feeling of just a rush of physical anxiety symptoms.

My face felt hot, all of those sorts of things. And I eventually was honest about it with, with you guys, which was good, but ever since that time. If this is how anxiety works, your brain takes one instance and it goes, Ooh, let’s latch onto that. And so ever since that time, I definitely had way more performance anxiety in speaking type situations.

The Q and a podcast in this format is different because it’s not live. It doesn’t, you know, require a lot of pressure. I can always go back and edit something, mistakes. Otherwise, but in situations like I remember giving talks during the pandemic virtually to groups of, you know, professionals or organizations for my day job and my mouth just being bone dry and me feeling like, like you, if you go back and [00:06:00] watch the recordings, which you guys can’t, but if I do, I can like hear like me not having any breath at the beginning and then eventually easing into it.

You know, and the same thing for doing summits, live streams, et cetera. I’ve definitely struggled more with anxiety since that moment more than I ever had before when it comes to those sorts of situations. So yeah I think that I have come to a much better place with it. I’ve, you know, not let that hold me back from doing many things.

Obviously it’s a factor, but I haven’t let it hold me back from doing other sorts of talks live and online, all sorts of stuff. But I think I’ve come to a place of more tolerance for my anxiety and acceptance for it. And also previously during those moments that stick out, I wasn’t yet on Lexapro. And I remain on Lexapro, which is an SSRI medication, which helps to reduce the body reactivity and just the overall anxiety.

So I’m hoping that I will do just fine. I’m hoping that things are going to be fine for the interviews. I’m sure they will be. But all this [00:07:00] is to say, I’m excited to jump back into the world of interviewing. I feel a little bit nervous about it. Not too bad, but definitely a little bit. So when I eventually do this and I start releasing episodes with interviews, I would just really, really, really love your support.

That’s all I’m saying. Anyways, that is a lot of personal updates from Robert. Let’s go ahead and jump into the episode proper. I have one question for you, but it’s, it’s a little bit longer. So here we go. The question reads, hi, I’m a listener of your podcast and I’m currently struggling with making a decision or contemplating even what I can do.

So I guess I’m looking for a little guidance. If you might have an option opinion on the matter. I recently requested the medical records from a hospital visit I had a few years ago. I was 13 and attempted suicide. Ended up being admitted for about a week. Recently, I’ve been thinking about how during the psychological assessments, I had the pediatric psychiatrist and how from the first time I met him, he had a trail of medical students behind him.

I understand that the [00:08:00] hospital I was at is a teaching hospital, but I feel that due to the context and matter of the assessment, it was not appropriate for the medical students presence. Of course, the doctor gave me the option to ask them to leave if I wanted. However, I was so young and in such a vulnerable state that I did not feel comfortable advocating for myself, and I didn’t have anyone else to do so.

Looking back, I think that the sensitivity of the context should have made the psychiatrist rethink involving medical students, especially because their presence can impact the honesty of answers, and definitely did in my case. Being asked, why did you try to kill yourself in front of a group of students was probably one of the most uncomfortable and terrifying situations I’ve been in.

Considering the possibility of reaching out to the pediatric psychiatrist to give personal feedback and advocate for my younger self, I requested my medical records so I could get the proper information related. I’m not quite sure what to do next. Do you have any thoughts or comments on the matter?

Thank you. And I apologize for the essay. So thank you for this. This is a really good question. I really, really appreciate you being open about [00:09:00] your suicide attempt and what transpired afterward. What you’re describing is an interesting situation and one that I’m sure some other people can relate to.

It’s unfortunately somewhat common for young people to feel like they don’t have agency or a voice in medical situations, especially in psychiatry, right? There’s a huge power dynamic in psychiatry. And, you know, you have that situation of what feels like the learned doctor, right? The one with that education and power and say, so versus what can feel like the helpless child and that can be so strong at times, like what you described, I can remember being one of the students that you mentioned, right?

I was not in medical school, but during my training as a psychologist, I had to do hospital rounds and I was that person following around the doctor during those rounds. And sometimes being on the sidelines while somebody is being assessed for something like suicidality, it can absolutely be awkward, even if it is handled well.[00:10:00]

And in your situation, it doesn’t feel like it was handled too well. Right? You make a very good point about the fact that even though you were presented with the option to have them leave, you hardly had a choice. You were 13, and that’s a lot of pressure to be under when you’re already not in a great headspace.

Of course, you didn’t think to advocate for yourself in that way. Who could expect you to?

At a teaching hospital, you are going to run into situations like this because they need to get that firsthand experience and see the doctor work somehow. But this is where bedside manner and respect comes in. I want to talk about what this could look like, but really quick, let’s take a break and talk about our sponsor [00:11:00] today.

So, as I said, the situation that you’re describing does not sound like it happened as smoothly or with as much care as it could have. Can you imagine how it may have felt differently if the doctor came in first with you just alone and they were gentle with their explanation of what they would like to do, that they would like to [00:12:00] have some interns observe because it’s valuable to see how these things are discussed.

But, If you want to say no, that’s totally okay. This often feels too private. So I don’t want you to feel pressured. Think about it for a second and I’ll be back to check in. Right. Can you imagine if that were the case? You know, it’s a subtle difference, but it could have been the difference between you saying, I don’t think so.

Or yes, on the other hand, maybe you would have felt more comfortable and allowed them to be there, but it wasn’t presented in that way. You also phrased the doctor’s questioning as, you know, why did you try to kill yourself? And if that’s anything close to the questions you were asked, actually asked the doctor totally fucked up with or without the interns.

So there’s multiple layers here. Again, imagine, you know, instead of saying, well, why did you try to kill yourself? If they were like, Hey, listen I’m here. I’m sure you have mixed feelings about you being here because of what just happened. I just want you to know I’m here to help if I can. Hi, my name is Dr.

Duff. I’m a psychiatrist here at the hospital. [00:13:00] I want to understand a little bit more about what happened. I already know the actual event that sent you here, obviously, but I’m more interested in knowing what led up to that and how we might be able to help you move forward, right? Like something like that would have been probably way better for you.

I’m obviously not perfect at bedside manner and about these sorts of situations, but it just takes a little bit of care to make a big difference in that regard. I’ll be the first to say that some doctors just suck with bedside manner and have no business interacting with patients that are in vulnerable situations.

I have a personal example. I remember my wife had a miscarriage the first time that she was pregnant. And so I remember being at the hospital with her this is while we were living in San Diego and we went to the hospital, the doctor, you know, ran some tests, et cetera, came back and he was so cold and had no bedside manner whatsoever.

He said something to the effect of the fetus stopped growing at X, Y, [00:14:00] Z weeks. And then he just kind of stood there and watched us grieve. Obviously we were upset, crying, et cetera. And he just sort of stood there and didn’t provide any. Kind of comfort didn’t provide any human element to it. Just sort of watched us and so yeah This is obviously a very different context, but I know what it can be like when a doctor doesn’t put any person care into it I’m sorry for the kind of treatment that you got from this doctor And it sounds like it was a similar situation to what I was just describing where it could have gone a lot better You’re wise also to point out that your answers could be different due to the fact that he was observing you and that other people were observing you.

This is absolutely correct. It’s actually something we know about in psychology and it’s called the Hawthorne effect. This means that people tend to respond differently when they are observed by somebody. And this is another reason that it would make sense for the doctor to check in with you beforehand and be aware of the fact that if they just storm in there with a [00:15:00] bunch of interns, they could get an unrealistic report from you.

And that doesn’t help any. So I’m really sorry this happened to you. I’m sorry you had this experience. You deserve to be treated with more respect and more dignity than that, even if you were young. Doctors also have an ethical responsibility to provide care and to avoid harm, especially for young people.

You know, training is important, but there’s a priority list, and training should never get in the way of providing good care. So let’s now get into the meat of what you’re asking here. You said you’re considering the possibility of reaching out to this pediatric psychiatrist to give personal feedback as a means to advocate for your own, for your younger self.

I think that’s super brave and super meaningful that you have a desire to do this. You clearly didn’t have the support that you deserved back then as evidenced by you saying that you didn’t have anybody to advocate for you. You’re thinking about how you now, as an adult presumably, can [00:16:00] heal this younger version of you that’s still hurting for that.

Prior to reaching out to the psychiatrist, I think it’s important for you to think deeply about what it is you want to achieve. What is your desired outcome? Do you want acknowledgement of wrongdoing? Do you want to change how they’re treating other patients in similar situations at that hospital? Do you simply want to express your feelings and give yourself some degree of closure?

I’m not questioning your motives here. I’m not saying you should not do this, just asking you to get clear about what you would like out of this, because this can help you communicate and move forward in a way that’s actually consistent with what you want to happen. I will say that even if you don’t end up sending something to the psychiatrist, writing a draft or a few drafts and getting the records that you mentioned can go a long way toward helping you process what you’ve been through.

Even if you decide that you don’t want to send something, I would still encourage you to write out a letter as if you were speaking directly to that psychiatrist [00:17:00] and using that as a platform to express yourself and advocate for that younger version of you. If you have a therapist or other supportive people in your life, reading it out loud to them can be an amazing way to make sure that your message is clear and or give you a more sort of live platform to process these feelings that come along with writing it, whether or not it gets sent out.

Now, if you do decide to move forward and send a letter to the psychiatrist or an email, whatever format, You’re going to need to manage your own expectations. You may get a response. You may get no response. The doctor may or may not even still be at that hospital, though, obviously you could research that.

If you do get a response, it could be empathetic, or it could be one that essentially blows you off and makes you still feel that sort of power differential. So this is where I come back to asking, what is your intention? If you don’t get a response, but your goal was simply to do your part and try to reach out, then that’s okay.

If you want to make sure that [00:18:00] real change happens and you want to dig your feet in and make sure that there’s something that’s going to shift from this, then it probably wouldn’t be okay for you to get a non response. So it’s important to know what you want out of this. You also have other options, right?

If you’re trying to make a more tangible impact, for example, you could talk with the head of psychiatry at that hospital, or you can talk with the head of clinical training at that hospital and discuss your situation with them. If you’re unsure about the best course to take, it could also be helpful to reach out to patient advocacy groups like the National Alliance for Mental Illness, NAMI, or the Patient Advocate Foundation.

These are a few. There may be other ones that are more local for you that you can look up. Just look up, you know, patient advocacy groups in your area. And they could have advice about ways to gain support or actually affect change in the healthcare system given your experiences. And of course, if you’re struggling with a [00:19:00] traumatic reaction to what you’ve been through, please seek the help of a therapist to find productive and safe ways for you to work through the traumatic memories and what you’re holding on to.

Overall, I think your instinct is great. I think that taking an active approach to advocating for your past self is a solid way to heal from the pain that you’ve been through. If I were to suggest an order of operations, it would be first get your records and review them. Then think about your intentions and write a draft.

You can process that draft more by reading it out loud by yourself with your support network. And then from there, you could contact the hospital and ask about the best way for you to express concerns about the way you were treated back then and the concerns you have about, you know, training and how that was handled.

After that, you might have a better idea about if and how you would like to communicate with a psychiatrist. There’s a chance that things are no longer being done that way or there’s a chance that the hospital leadership would be really glad to know about this issue so [00:20:00] they can consider changing policies to prevent similar situations.

Like I said, you have a great instinct and I’m so glad that you’re feeling strong enough to consider this. Whatever you do, I’m sorry for what you’ve been through, and I’m proud of yourself for sticking up for yourself now. So that’s what I have for you. I really, really appreciate you writing in. And to everybody listening, thank you for listening.

This has been episode 396. You can find the show notes at duffthesack. com slash episode 396. And take great care of yourselves. I’ll see you for the next one.

Bye.

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