Accountability

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What to do!? On-Line Physician Bullying.

I’ve been to this great APA meeting, great that is, because of the people!  Wow!  The fellow attendees, the exhibitors, the speakers – just, WOW.

I’m going to try to share content with you but it will take me time.

bully

For today, “Are You a Sitting Duck Online?,” reminded me of our earlier discussions on the doctor-patient relationship and a previous post, on July 11, 2012, that went like this:

Hello Friends.

Please tell me how I’m doing on this.  Just out,

Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice

This is important to me as I treasure both my medical practice and our community, connection, exchanges on-line.   I don’t want to do anything that jeopardizes either, nor the implication that if I did, that means I would have mistreated a patient.

Thank you for this, what I call, a “good problem” to have – the joy of medical practice and participation in social media/networking.

So many of you resonated with this and engaged.  I am still super grateful.  I’d love to continue with you in further discussion and with your comments!

For me, one of the many reasons I was so excited about this recent talk at the APA is because of the mucho online stuff connected to my name that affects my patients and the dynamics in our patient-doctor relationship.

In my practice, these are just a few sites that have wrong information (demographics) on me:

  • healthgrades.com
  • vitals.com
  • betterdoctor.com
  • ucomparehealthcare.com
  • insiderpages.com

They didn’t ask to clarify my demographics.  They didn’t ask me if I wanted them to become an on-line reference on my behalf.  They use my practice information to drive “eye-balls” to their site so they can get advertizing money and more.  They impose incorrect information about my practice, knowing that in so doing, I will be pressed, (I call it bullied,) into contacting them with my correct information.

If I don’t do this expensive effort, (money, time, emotional expense – all in limited supply, to correct what they post incorrectly,) patients will continue to tell me that they couldn’t find my contact information.  When they Google me, instead of my website coming up, these other sham pages pop up.

Some patients call dead numbers or even drive to incorrect locations to find treatment.  Instead of whomever is behind these websites being held responsible, the medical providers are.

These are the notes I took from my colleagues, as I heard them say.

Unfortunately, I was late to the meeting so I missed two of the four speakers.  Even so, this is worth it.

Dinah Miller M.D., Author of “Shrink Rap” and writing regularly for Clinical Psychiatry News.

Dr. Miller told us about the difficulty of “patient” (or nonpatient, i.e., sham-patient) reviews online.

Who can review the physicians?

  • your patients
  • Friends and lovers
  • enemies
  • trolls – a negative internet stalker

Every practitioner has an idea that they are a pretty good doctor.  So it isn’t easy for any of us to hear otherwise ;).  After getting unsolicited feedback from a person who took the time to write a comment on a site that listed her, a site that listed her profile without asking her, Dr. Miller chose not to play the victim.  She decided to call “Health Grades,” and with her persistence, they took her information down.

On “Vitals” – she got an answering machine with a person’s voice mail and no name and number.  So she called CEO, Mitch, who stated she wasn’t able to take her profile down.  She didn’t ask to open herself up to trolls.

Dr. Miller asks, what shall we do, as physicians?

  • do nothing
  • write a response
  • try to call the company

There are many whose livelihoods depend on public opinion.  For example, waitresses/waiters – many lose their jobs if they get even one negative reviews.

The practitioners in the group responded with resonance with Dr. Miller’s ideas.  They also had thoughts that if left alone, the democratic process would win out over time, truth would come out and such.  (Maybe the nearby statue of Liberty played into our thoughts :).)

Paul S. Appelbaum, MD, Dollard Professor of Psychiatry, Medicine & Law, Columbia University

Principles that Might help physicians Identify Constructive Responses

  • Responses should be Effective
  • Practical
  • Compatible with medical ethics
  • Positive rather than negative consequences

Problematic Responses by Individual Physicians

  • Request removal by website – typically declined.  Saying you’re writing a public article on it might help.
  • Contact the patient who wrote a negative response to request removal – Patient not likely to remove response, many patients post anonymously, most websites won’t allow patients to remove them
  • Flood site with fake positive reviews – deceptive, embarrassing if discovered, ? inducing a person to rely on a statement that may be used to their detriment (fraud)
  • sue patient for libel – identify patient might be difficulty, people have a right to their opinions – would have to prove statements untruthful and not merely opinion, $$ in money/time/and emotion

Encourage Satisfied Patients to Post Reviews?  We could refer to a firm to do this.  $$

Some sites, similar to “Vitals” offer the option to the practitioner to respond to a posted review.

Negative Reviews:

If we do respond – how?  We don’t want to come across arrogant or insulting.  We fear violating patient-doctor confidentiality. In the end, we recognize we don’t have the last word.  We may respond with a soft word of concern.  “If you would call my office, I’d be happy to schedule at no fee to speak with you about this and see if I can help.”

Can Patient Reviews Be Controlled?  There once was a company that tried this.  “Medical Justice” developed a form that gives control over of copyright of all reviews to MD.  – Didn’t work.  See article, “Company tries to stifle online reviews with patient ‘gag orders’.”

Another idea is that medical practitioners help themselves by coming together to develop an internet ombudsman.  This would be a medical/mental health professional not involved in care of patient.

  • Independent (unrelated party) investigation of physician about the case.  A successful investigation may give a third party opinion.  There’d have to be a reason for the world to trust this opinion.

It is difficult for healthcare professionals to protect themselves from inaccurate complaints about their care.

Positive Reviews

Does it put undue pressure on the patients?

A sign in waiting room perhaps.  Make the information available w/o practitioner knowing if they have or have not commented.

There is a dissonance between the position of being a business person that says we must practice democratically and compete fiscally, yet stay in congruence with what tradition holds us to.

The issues addressed in the talk weren’t specifically about being bullied by sham-websites, but it included that idea, along with other difficulties physicians are experiencing in the rapid transition of 3000 years of tradition as a healthcare providers to spending the majority of their time serving patients first to now, the reckless $ burden of running a media vulnerable business.

In the practice of psychiatry, a traditionally extreme-private practice, this is dissonant to many.

Q:  How do we treat the extremely delicate practice of psychiatry as a business when we are held to currently minimally defended standards like this?  Please speak out and let it flow!  We need to hear from you!  …and, Keep on.

Self-Care Tip:  Deal with internet sham-sites and reviews in a method that is consistent with Me, and temperament, while doing the least damage to oneself. It will be better for oneself as well as others.

 

Lupita Nyong’o Speech on Beauty – W-O-W! And, thank you.

“…and my mother again would say to me you can’t eat beauty, it doesn’t feed you and these words plagued and bothered me; I didn’t really understand them until finally I realized that beauty was not a thing that I could acquire or consume, it was something that I just had to be.”

This woman gets us. Friend to yourself. Keep on.

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Self-care is Not Selfish But You Might Feel Alone

Social circles of Influence

Many times I feel like a stranger because I don’t want to do what they want.  

Pilot was perplexed and sad. 

This is familiar to me.  There are lots of these times.  When I was a kid I didn’t know to call feeling like a stranger, “normal.”  I didn’t know I wasn’t alone.  I thought feeling like a stranger was qualified bad.  In the older Me, part of Me knows.  The rest of Me is conflicted.

Talking about self-care is like that sometimes.  I don’t know yet how to consistently teach others without hurting them.  

Self-care is not selfish, I say, but it doesn’t make sense.  

They hear me and the long anticipated enemy they knew would come suddenly wears my face and uses my mouth and voice.  People look at me in horror.  I watch their faces blanch and despair, as if they know they are holding a fork and knife to defend against magic and they will die a martyr’s death.  

No.  It’s not like that, I say.  

But they don’t hear more.  They crouch in a thicket.

Researcher, Jennifer Walters, describes how social influences such as team-based competition leads to a healthier BMI (basal metabolic index) and weight loss.  We may say, “Um, yah!?!” as if everyone knows that from Biggest Loser.  But just like holding an apple looks like crunchy food to Mary, John see’s a projectile.

It must be researched.  It must be said.

We don’t believe that taking care of Me is selfless.  We are scared.  To love ourselves means being alone and feeling the stranger.  Taking care of others “first” intuitively tells us that we are connected and right. This is a distortion.

I argue that this intuition to care for others first is not our friend.  The intuition to care for others first is not friendly when it is driven by fear of being alone, fear of being the stranger.   At some point in the timeline of selflessness to selfishness we find that we cannot.  We have ruined and thereafter cannot care, serve or do much for anyone but take. Now we, without getting consent from those same others, are in a place of being served.  We didn’t ask our loved one(s.) 

Would you like to take care of my wasted self?

We didn’t ask if it was ok with them that they be put in the position of now being our own caregivers. To answer their wants before our needs is a trick on them, an exchange for us taking care of them now for them taking care of our needs later when we cannot.  But we didn’t ask. We didn’t make a transparent negotiation.  If they knew we were taking care of their wants before our needs or wants, if we knew, would we un-crouch, step out, hear and consider?  However, we responded before we felt alone.  We gave before we felt the stranger.  We didn’t ask, we didn’t consider and now we cannot.

Growing healthy involves the sometimes happy journey towards a knowing that giving to self long enough becomes someone who gives to others; long enough a stranger to grow familiar.  And it isn’t selfish.

Caregiving for others starts with caregiving for Me.

Question:  How does becoming your own friend separate you from those you want close?  How do you survive feeling alone long enough to know that you are not?  When the stranger becomes familiar, does it make that time and difficulty worthwhile?  Please tell me your story.

Self-Care Tip – Remember, self-care is not selfish, even when you feel alone.

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Personalizing Gossip; It Starts And Ends With Me

“Crying,” by Galway Kinnell

Crying
Crying only a little bit
is no use. You must cry
until your pillow is soaked!
Then you can get up and laugh.
Then you can jump in the shower
and splash-splash-splash!
Then you can throw open your window
and, “Ha ha! ha ha!”
And if people say, “Hey
what’s going on up there?”
“Ha ha!” sing back, “Happiness
was hiding in the last tear!
I wept it! Ha ha!”

I remembered this poem after visiting my friend Paul’s church when Paul told me that at least three of the people there asked him, in one way or another, if I had a disability. Poor Paul.

I’m pretty sure Paul was embarrassed but aside from that and my own begrudging unfortunate shame response, I have to say it made me laugh a lot. (I work with many labeled “disabled” and respect them. This community comment doesn’t come with the knowing of who is behind a simple word like “disabled.”)

Awesome!

I smiled at Paul’s daughter and she smiled back. What fun laughing with her. Apparently it was just that. My laugh.

Loud and disinhibited. (Laughing more.)

In high school a particular peer thought the same. In movie theaters when something hits that note, I have seen the looks. I have had sufficient opportunities to decide what to do with my laugh.

When weighing the risks and benefits of a “loud and disinhibited laugh,” the laugh has won out for Me. I get so much from it. Such pleasure of claiming that moment, that smile, that air passing through me and the intimacy.

Come join me! – “Ha ha!” sing back

One of the funniest kids I've met while travel...

Image via Wikipedia

It doesn’t mean happiness. For me, it is part of presence. Happy or not happy, and that brings me pleasure.

My sweet friend Paul is a sensitive guy in ways that I am not wired to be. He is so beautiful. I know how he cares about the people around him. I know he respects them and considers their thoughts. It is not so much that he would ever be ashamed of me, abled or disabled. Rather he cares and said these things because in his consideration, perhaps if I was more aware then I would make a different choice about the risks and benefits of my laugh. He doesn’t know that I am informed. I have decided with knowledge.

There is no way he would know this about me. No one could. It was, as always, a statement those church folk made that was mostly about them and not me. That is universal. We all say things that are more about Me than anyone or anything else. It’s friendly to remember this, to Me and them.

“Happiness was hiding in the last tear! I wept it! Ha ha!”

Self-Care Tip: To not personalize what isn’t personal, start and end with Me.

Question: What helps you remember that what people say is about them more than about you? Even when those people think they are talking about you? How do you

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Victim to Emotions Versus The Friendliness In Accountability

Thin layer chromatography is used to separate ...

Image via Wikipedia

It’s just hard!

It is hard.  Do you feel like a victim?

Yes I do?  It’s hard when they are making you feel this way and no one gets it unless they are here fighting against both sides like I have to.

Juanita’s self-perception and emotions; suffering is special and specific to Me, I am chosen to suffer, I am alone in my suffering and I am helpless, were carried by the air particles through our room.

In 1910, Russian botanist Mikhail Tsvet used water to do this to plant dyes.   The water in the plant dyes carried the pigment, separating them for his needs.  This is now called chromatography and we use it to determine what makes up a particular flavor or scent, to analyze pollutants, to find traces of drugs in urine, and to separate blood proteins.  You might remember doing this yourself as a child in the simple science experiment with a marker, a couple drops of water and a coffee filter.

Juanita’s son also knew about chromatography, I could tell.  He may not have called it that with words, but he did call it out with his body, his eyes and the muscles around his lips told me as I watched that the emotions had made their way over to him and that he was bringing them inside.

Some people call emotions contagious and others may describe them as spreading.  No one thinks they don’t travel.  No one thinks they remain stationary.  In fact, if we were to reduce everything in the known world, living and nonliving matter, and expand our thoughts into a large large amount of time, we’d agree that nothing is stationary.  Furthermore, everything is changed by the influencers in its universe.

Juanita’s son knew this even if he didn’t cognitively piece it together.  He was taking in his mom’s emotions and they were making their changes on him.

What I asked Juanita was if it mattered in the end.  She’s still left with herself, regardless of where things came from.  We’d like to think others should take care of us, at least not do damage to us, but if they don’t or if they do, in the end, we are left with ourselves.  All these perceived degrees of abuse she suffered – what now?

Saying we are left with ourselves, accountable to ourselves and should take care of ourselves is not making any statement about the condition of our connections with the world around us.  It’s just talking about Me.  Sometimes we perceive how others take care of us, sometimes we don’t.  The same goes with feeling alone and so forth.  But that isn’t about accountability to ourselves.

I would have liked to have said the same thing to Juanita’s son but couldn’t.  I hope he learns it from watching his mother.  If he or mom gain insight into this and can act on that insight, wonderful.  If they cannot do one or the other though, I’d bet there’s something biological going on and need to take care of themselves by looking for medical help.

Question:  How do you perceive accountability to yourself being different from where the problems drift towards you from?  Or from how you have been changed by problems?  Please tell me your story.

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Self-Care is For Everyone, Regardless of Circumstance

Freedom from Want (painting)

Image via Wikipedia

Self-Care Tip #166 – To do self-care, believe that self-care is for you as it is for everyone.

How do we explain self-care to someone still in a deprived situation?  Deprived of freedoms the rest of us assume:  access to water, time, many choices, and so on.  Some time ago we talked about self-care being ours because we have freedom.  Because of democracy, we are free.  Because of those who fought and still fight for our rights, we are free.  Because of our essence, we are free.  We compared it to the Gettysburg Address of all things, and even when writing the blog-post, I was surprised that the correlation was so natural and right.

Carl, our dependable kind cynic, commented on the post Taking Care of Yourself is The Best Part of Your Treatment Cocktail:

Many I know can’t just do what they want to do.  Chained.  Chained by drudgery of work.  (You do not quit at the iron mill to become a poet, not in this economy.)  Chained by responsibility as family supporter.  Limited time and finances.  Limited by age or illness.  The best these people can do is try to find some brief periods of quality hobby or playtime.  Some have the tenacity to survive in spite of, as I did.  But facing the realities profoundly inhibit wellness, and depression deepens and immobilizes us on the worst days.

Many days I try to distill what self-care is and what it means, and it seems to change on me or grow another way just when I think I’ve got it.

…It is accountability for “Me” now and in the future.  It is not accountability for my past, for chaos or for the choices of others.

Image via Wikipedia

…It is freedom.  Personal freedom to say, “This is my body that God gave me and I will choose to take care of it.”

…It is working hard to do what is in the best interest of “Me.”  It is knowing these things may not come easily or naturally or by chance.  Self-care does not mean doing what is selfish or not in the best interest of others.

Is everyone free?  I think we’d all agree, no, in an immediate sense such as, “Freedom from want,” or freedom from mental illness.  But perhaps we might wonder together and even agree about an eternal sense of freedom that is unchanged by circumstance.

Should everyone work hard at taking care of himself regardless of circumstance?  Yes.

Is everyone accountable to himself?  I’d say it depends in which paradigm we’re talking about.

However we answer these questions, I don’t think we really have a chance at self-care for “Me” if we don’t believe it is for everyone everywhere.

Questions: What do you say?  How do you define self-care?  What about those who are limited and chained, as Carl described?

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Self-Care is Freedom, is Democracy, is Because We Are Accountable

authenticsociety.com

Self-Care Tip #159 – Be accountable for and to yourself.

It was about 100 degrees Fahrenheit, which in my part of the world is considered hot.  But in Washington D.C., I considered that temperature general anesthesia.  I was breathing it in and trying hard to remain alert.  Just when I thought I could hold out no longer, I saw him.  Big and expressive, the long form of Abraham Lincoln was there, surrounded by loud irreverent people.  My brother and I were wiping sweat out of our eyes trying to keep track of our kids.  We wanted to read the Gettysburg Address for our kids, and found ourselves screaming.  The kids could barely hear the words above the disinterested rabble around us.  Despite all this, I was choking; a weepy, sweaty, nearly anesthetized but free American.

Four score and seven years ago our fathers brought forth on this continent a new nation, conceived in liberty, and dedicated to the proposition that all men are created equal.

Now we are engaged in a great civil war, testing whether that nation, or any nation, so conceived and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this.

Just down the corner from Lincoln is a president’s list of sites to see, informers and reminders of who we are and where we came from.  However, none of them were “my Lincoln” experience.

But, in a larger sense, we can not dedicate, we can not consecrate, we can not hallow this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us—that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion…

A couple of days ago, writing the post about how stress intersects with medicine, I remembered “my Lincoln.”  It may seem like a stretch at first but take a minute.  Self-care is a way of saying, “I am free.”   In places where life is cheap, almost without value, self-care is not much of an option.  It is because of freedom that we can extricate the meddling fingers, the invasions, and be the keeper of our own private spaces however we choose to.  It is because of freedom that we can tell people that although my brain is ill and although I take medication, I am equal. Saying that is self-care.  Saying that is possible if we take that freedom to keep our own accountability for our own selves.  Accountability is not the same as blame.  Having accountability for our freedom is not the same as being at fault for what came before freedom, nor our current conditions.

—that we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.

If you’re not accountable to your inner self, if you’re only accountable to your actions, or you’re only accountable to what others determine and define about you, than you are not free.  You are blamed.

Accountability is such a tender privilege.  We might lose it if we forget who we are, where we came from and our rights to freedom.  Democracy is self-care.

Question:  How do you see the relationship between self-care and your freedoms?  Please tell me your story.