[heartwithwings]

(My first post!) Okay so I have an EDNOS and my Pscyologist refered me to a psychiatrist with in the same practice to get medication. I went to him and durring our first (and last!) session he told me to stand up and turn around so he could see my body. It was humiliating. He also tried to open a envelope in my file that contained photos of my at various weights that I had brought for my t. He didn't ask permission, he asked what it was and then just started to open it. My T taped and stapled it shut so he couldn't get in. He really tried hard to get into it. I was shcked. He didn't ask if he could see them and he told me to get up and turn around so he could see me. Seriously? I have an eating disorder! My body is bad penough as it is.
I told my T I would never see him again and why. She said I have to see him again and tell him why, if I want my case transfered. No way. I don't know what to do. I feel like my t thinks I am over reacting, but I mean c'mon! I was in swim suits in those pictures! It was a huge deal for me to show her. What should I do?

[Elli-Beth]

I would explain why you want transferred again see they can see there's a good reason. You have a right to be treated with respect! Explain it just like you explained it here, because you did a great job wording it in a way that makes your point clear and strong.

[WePow]

I agree that you have a right to be shown respect. Can you see someone else? Someone with a bit more tact?

[WikidPissah]

Agree. You deserve respect.

I told my T I would never see him again and why. She said I have to see him again and tell him why, if I want my case transfered. No way. I don't know what to do. I feel like my t thinks I am over reacting, but I mean c'mon! I was in swim suits in those pictures! It was a huge deal for me to show her. What should I do?

Where are you trying to get transferred to? Can you find another med doc that can help you with that.

I understand how humiliating those photos are for you, and to have someone spin you around and look at your body...that would set me well over the top. I really hope you can find a more compassionate med doc.

[Can't Stop Crying]

So sorry this happened...not all pdocs are so insensitive

[Omers]

I don't even have an ED and I woulda been pissed! I get why you don't want to go back but also why in a lot of clinics you "have to". Maybe you could write a formal complaint to get the transfer rather than seeing him again? I would put it in writing to the director of the clinic and CC him and your T?
Although... I can be a bit of a bull in a china shop at times.

[elliemay]

If I read your post correctly, in order to get the transfer you have to go back to this psychiatrist and tell him why. Is that right?

If so,then it may be that the only way out is through. That's kind of counterintuitve to me to have to go back to person you are unhappy with, but whatever I guess. Can you make the request in writing to him?

I work with a lot of physicians. They do tend to be straight and to the point. It's kind of understandable because in order to treat the symptoms, they actually have to see the symptoms. Of course, there are much better ways to handle it, but I have to wonder if he could have seen the pix in the envelope he might have been better able to see what was happening and less apt to expose you to that horrible "stand up and turn around".

In my state, there are exceptions to the privacy rules and one of them is when disclosure of the information is necessary and prudent for treatment.

Make absolutely no mistake here, I think this physician's actions are way out of the norm, but I also have to think that you do want an adequate and effective treatment. It's likely he was trying to find a way to get that treatment for you, but he burned (no torched!) the bridge required to get it to you.

I would do what it takes to get a transfer. Even if that means going into his office and telling him how his actions made you feel. I know this is not your responsibility, but it may help him to be more respectful of other patients with EDs.

[sittingatwatersedge]

Originally Posted by elliemay

It's likely he was trying to find a way to get that treatment for you, but he burned (no torched!) the bridge required to get it to you. .

including opening a VERY sealed envelope that was not intended for him? That's a blatant invasion of privacy. This is aside from the fact that he acted like an insensitive jerk toward the client.

Heart - I would so love to hear that yr T is going to "champion" this for you, and see to it that you see someone else (above him, if necessary). Maybe that's just a fantasy, I don't know your situation. but it seems to me that T should be on your side BIG TIME and not leave you to suffer through dealing with the jerk. just my $0.02
I send you this respectful hug

[SpiritRunner]

I'm so sorry, this sounds so hurtful, unkind, insensitive, tactless, even, dare I say, not so ethical! You do deserve respect....you deserve to see someone who will treat you with respect.

[sunrise]

Welcome to PC, heartwithwings. I have never heard of a policy that you have to terminate with a provider in person. Although I don't think this pdoc treated you well at all, I am even more disturbed by this policy of having to terminate in person. It seems like you should be able to do it by canceling your appointment in a phone call to the clinic secretary. I think it may border on unethical to require you to be there in person against your will. You sound a bit traumatized by your encounter with this guy and it would be unethical to subject you to that again. It is my understanding that if a person terminates with a provider they are not supposed to contact you again to try to convince you to come back. That sounds kind of similar to this. This man should leave you alone. You are not obliged to see him again. If he wants to understand why you won't return, perhaps you could give your T permission to speak to him and explain.

I think the experience with this man trying to open the envelope of photos in your chart illustrates how our medical records are not really safe or private or protected. If it were me, next time I saw the therapist, I would request the envelope back from her. She has seen the photos and should be able to document them in writing in your chart. They do not need to remain there.

When this psychiatrist asked you to get up and turn around so he could inspect your body, did you comply?

If for some reason, they force you to see this man again to terminate, and you agree to do it, you could bring someone along with you for moral support and protection. You could even write out the words "I am terminating" on a piece of paper, sign it, and have whoever accompanies you to the appointment hand it to this man.

I would also try using the word "unethical" if they try to force you to see this pdoc. See what they say.

[Perna]

Hi, heartwithwings, welcome to PsychCentral. I cannot imagine how hard it is for someone with an ED to get treatment, especially from a doctor who wants to treat the body, which seems to the patient, the "problem".

I am not sure I understand your therapy setup. I believe you are saying that there's a practice with X number psychologists/therapists and Y number psychiatrists/medical doctors all working together, in the same office/building?

Your psychologist/therapist sent you with your one file with everything in it to the psychiatrist? Why did she not take out the pictures you gave to her (and give them back to you since she had seen them?)? I would ask her why you had the impression the psychiatrist would not want to see them, since, as elliemay pointed out, they would be helpful to him. Did you say anything to him as he was trying to open the pictures; tell him you would prefer if he not look at them and how you felt about them? If you did not say anything to the psychiatrist, it is impossible for him to know exactly how you feel or what is going on; he did not know you or your concerns and if you did not tell him, he did not have anything to go on. I know it is embarrassing to have a doctor look at your body but I do not think he asked you to stand and turn for giggles, but because he needed to see the extent of your physical problems. You are an individual and he wants to treat you, the individual, not just anyone with an ED.

I would ask your therapist why you were led to believe she sealed the pictures so he couldn't see them but yet she left them in the file he has every right/need to see and/or didn't discuss what the appointment with the psychiatrist was likely to entail. If you are satisfied with her answers, then I would have her help you construct what to say to him to be referred to another psychiatrist ("I misunderstood what our appointment would be like and had a very disagreeable personal experience and would like to start again with someone else as I was angry and upset after seeing you last week and do not think I would be comfortable if I continued to see you."). I don't think the psychiatrist had enough information to have treated you any other way but I think your psychologist/therapist could have prepared you better for seeing him!

[lovelygirl]

First, welcome to PC and thanks for posting!

Speaking as a nurse practitioner in training who is exposed to a ton of discussion about ethics in collaborative care, I find myself distressed by this chain of events. To my mind (and those of other health care professionals), an effective provider-patient relationship hinges on some key principles, among them being informed consent and respect for the patient's dignity.

Regarding informed consent, I don't see that that was in place here. My sense is that you went into the pdoc appointment under the impression that it would be a conversation and that it would not involve a physical examination. That is not an unreasonable assumption, given how most psychiatrists practice. You ethically had a right to be informed that the visit would entail some degree of physical as well as psychiatric examination, and what the nature of that physical examination would be. You also had the right to consent to or refuse that examination--and then be informed of whatever consequences would take place as a result of this office's policies.

Regarding respect for the patient's dignity, I cannot imagine a single one of my instructors conducting a physical examination of an ED patient, in the context of a psychiatric consult, by asking the patient to stand up fully clothed and turn around. First, there's nothing clinically valuable about that. You're not really getting any accurate information about the patient's health status as it relates to her ED. If the provider truly needs to assess the patient physically (for instance, in the case of anorexia nervosa, to determine cardiac stability or electrolyte status), that would require a physical and lab workup. Second, it's undeniably intrusive, period (especially in the absence of informed consent, see above).

Consent is tricky with EDs, though, because if a patient is sick enough (meaning arrhythmias, electrolyte disruption, altered consciousness), they may need emergent care whether they want it or not. But given that this seems to have all been on an outpatient basis, I don't see that emergent violation of informed consent played a role here.

These are my two cents just on the clinical ethics aspect of your dilemma, for what it's worth as you think about how you want to respond.

The terminating in person thing is just bizarre to me. Can you say more about who exactly is requiring that? Is it a written policy somewhere? If so, can you locate it? Or is this coming from your T verbally?

I didn't really follow the chain of events around the photos, but obviously the physical handling of them was clumsy at best, and combined with the other issues, you're certainly not wrong to wish to choose another provider.

As others have suggested, is there a medical director, someone over both these providers' heads, to whom you can send a letter? I did that once and it actually worked out well. If you go that route, you have to be respectful and very specific about the events that were unprofessional and why.

Please keep us posted and let us know if you can clarify more or would like other advice! Take good care of you.

LG

[elliemay]

Originally Posted by sittingatwatersedge

including opening a VERY sealed envelope that was not intended for him? That's a blatant invasion of privacy. This is aside from the fact that he acted like an insensitive jerk toward the client.

Oh make no mistake, I'm not defending him at all! He acted like a total jerk. I'm with the other poster that if all possible I would try to get those pix back into your possession and out of your record. I think that may end up being the only way to keep them out of view to those who would have a legitimate (or not) reason to look into your records.

What did your therapist say about including those pix in the transferred record?

[heartwithwings]

Thank you everyone for your help! To clear up some questions...
I go to a practice where there are 2 Pdocs, 2 Psycologists and a number of councelors. My Psycologist that I see once a week told me that If I wanted to get my case transfered to the other doc I would have to have a meeting with him. I havn't seen this in writing, just verbaly.
I am a CNA and I agree that his behaviors were unethical! he could have done a visual "exam" when I walked in the door, he didn't have to have me stand up. I am a very young college student and I went on my own to get help. My parents don't know, so no one is making me go... and am seriously thinking abut "quitting" if my therapist continues to to be ...against me.
I complied with his request and didn't say anything when he tried to open the pictures. That is part of what I am working on in threapy: being a door mat!

thank you for the warm welcome everyone!

[sunrise]

Originally Posted by heartwithwings

My Psycologist that I see once a week told me that If I wanted to get my case transfered to the other doc I would have to have a meeting with him. I havn't seen this in writing, just verbaly.

This is the part that seems very unethical to me. I can see it would make you not want to see your therapist again. Please don't let her get away with this. I understand about being a doormat. How about writing on a piece of paper that you don't want to see this pdoc again because of how he treated you and handing it to your therapist? At the very least, she should provide the clinic policy in writing so you can see this isn't just something she is trying to force you to do because she believes it would be good for you (which is what I think may be going on). I hope you will stand your ground on this. It is completely WRONG for your T to force you to see this pdoc again. Even if there is a policy, she should be ADVOCATING for you.

Good luck. Please check back.

[heartwithwings]

There is no way I am going to see the that Pdoc again. I just wont take medication if that is the case. I'm going to the T tomorrow. The more I think about it the more frustrated I am with her lack of support. I hope this turns out okay... I need this to be ok