So I went to the Adult Medicine Clinic at Upstate Medical Center, or whatever it’s being called this year. Periodically Upstate tweaks its name—and all its letterhead and signage, which costs about a million dollars—but who really cares and what difference does it make? It was Upstate Medical Center when it opened a bunch of years ago and that’s what it will stay until the locals die off. Occasionally the hospital administrators get the idea that changing the name will change how people perceive it. Bullshit. Save the money and stop changing the name, unless you’re going to change it to the Solid Snowball Center.
So I went to the Adult Medicine Clinic as a new patient and probably was seen by a clerk, a nurse, and a resident before the attending came in. The attending—and according to him, the boss of the joint—is Dr. Peter J. Cronkright. I will not make any snotty, lewd or disparaging comments about his last name. My personal policy is that I will give you a hard time about anything you have chosen, e.g., to become a physician, wear bowties or play the tuba, but I will not give you a hard time about anything you were born with, e.g., skin color, spinal bifida, or last name. There are limits and boundaries that I honor.
So everything was going smashingly well until Cronkright told me to sign the Upstate University Hospital Authorization for Release of Health Information Pursuant to HIPAA. I declined the pleasure. In the first place, neither the nurse nor the doctor told me to whom it would be sent. In the second place, there are all kinds of lies about my psychiatric diagnoses floating around in the ether. Let me tell you a couple of stories.
A woman went to the Emergency Room saying her leg hurt so bad that she couldn’t walk on it. The ER did its shtick—including but not limited to x-raying her leg—and then said there was nothing wrong with her. The woman had a major psychiatric history so the ER called a psychiatric consult. The on-call psychiatrist knew the patient, and knew that she was a major pain in the butt, but he was cool with that. If you are a good psychiatrist then pain-in-the-butt patients are routine and you develop skills in dealing with them. If you are Roger Levine, you just out-shout them.
So the psychiatrist does a comprehensive psych exam and concludes that there is nothing psychiatrically wrong with the woman, however, she’s got this leg thing going on, so he says, look, what I can do is admit you to psychiatry and then order a serious work-up on this leg problem. So she accepts, gets admitted, and the psychiatrist orders a consult. The medical consult says there’s nothing wrong with the patient, so the psychiatrist orders an orthopedic consult. The orthopedic consult orders an MRI and then says there’s nothing wrong with the patient.
So the psychiatrist goes back to the patient and says, look, I’m really sorry but I am also in a bind. I got no diagnostic code under which I can bill to keep you in this bed. I gotta send you home. The patient is pretty upset about this because her leg still hurts so bad that she can’t stand on it, but home she goes. Then she attempts suicide, which gets her another bed back in the hospital on inpatient psychiatry.
The psychiatrist is now standing in the nurses’ station rubbing his face and wondering aloud what the heck he should do next. A nurse says, why not order another x-ray? It’s cheap and you’ve got nothing to lose. So the psychiatrist orders another x-ray.
The patient has a broken leg.
If the patient has a psychiatric history then it causes such blindness in physicians that it takes three of them to see a broken leg.
Here’s another story: the patient started having somatic complaints, which means she said there was something wrong with her body. She repeatedly went to her primary care physician; whether she was referred to any specialists is unclear. Finally her PCP tells her that she’s having side effects from her psychiatric medicines. Well, she hasn’t got any really serious crazy diagnoses, so her psychiatrist takes her off all her psych meds.
Shortly thereafter, she ends up in the ER. The brilliant staff find her to be anemic and want to admit her, but she’s not exactly thrilled with the whole medical profession so she says she’ll just take her medicine and go home. One week later she’s back in the ER. Some bright resident decides to order a CT scan.
The patient has bone cancer from head to toe and dies a few weeks later.
The typical physician’s brain goes into complete shutdown when s/he learns a patient has a psychiatric history.
When I broke my leg and went to the ER requesting the fast-track, they put me in the rubber room, that is, the psychiatric observation room. It is a completely bare room that contains one stretcher and one chair. No television, sink, EKG monitor or oxygen—nothing. In one wall there is an observation window covered by a venetian blind. You go into an ER and even before you get out of the waiting room, they’ve called up your chart and know that you have a psychiatric history. They didn’t move me out of the rubber room until x-rays confirmed two fractures of my left leg.
Physicians have sacrificed their own emotional maturation in order to get through medical school and residency. They have so deeply buried all their own feelings that they cannot cope with anybody else’s feelings—ask their wives. They freeze to insensate blocks of ice when confronted by any patient with a psychiatric history. They become unable to function as physicians. Knowledge of a patient’s psychiatric history precipitates total cognitive failure in the attending physician.