Medical Overbilling and Abuse

Wealthy private equity investors, the poor, the government and medical practice. It's not a beautiful thing.

Information Asymmetry

PsychVictim in the UK tweeted about this article on the patient's right to see his NHS medical records. Sadly, it does very little good if you're a psych victim like Mary and me because it contains this one little escape hatch for psychiatrists:

...The exceptions [to receiving your complete medical records] are if it is believed information in the records would cause serious harm to your physical or mental health...

So even if you want to see all of your medical records, you can't if the shrink "believes" the records would cause harm. The patient's problems began with what the shrink "believed". And even after surviving and wanting a full accounting of the experience, the patient is still going to be victim to what the shrink "believes." What a patently unfair situation.

 I've had experience with this sort of thing in the US.

The last time I got ensnarled with the bureaucracy that is psychiatry they got me hooked up with the SSI gravy train. I guess they want a person to be as dependent as possible on their largesse.

I went through an interminable appeals process.

 One time I was sitting with my lawyer to go into a hearing. I looked down at my file as he was leafing through it and I was absolutely astounded at some of the things the drug peddler had written about me. 

In one note, he had written "patient shows no response to medication" and that this was a historic and ongoing issue with my case. Of course, he had been continually telling me, like a broken record, that I needed to take his drugs for the rest of my life.

He had also placed a personality disorder on my Axis Diagnosis that he had never bothered to share with me. I immediately have to raise me hand and ask, "How can I know what you think my problems are if you don't talk about them?"

I got the SSI, but I also went back to school and got a job.

I told the Social Security Administration that I had got a job, but they sent a couple more checks and then stopped. Nothing more was said about it and I assumed everything was OK, but a year or so later I got a repayment notice. I appealed pro se and asked to see all the files in my case. I was given a very thin sheaf of papers that was nothing like the thick filing that had been used to get my SSI. The thin sheaf of papers had very little detail whatsoever.

What the shrink had said in the thick file was in no way damaging to me. I'd figured out the stuff he said years ago.

However, if he had more open and honest about my diagnosis and what he actually thought, we might have shaken hands and agreed that I never had to darken his door step again. I might have parted ways with psychiatry on good terms with a clean break. I might not have hung around him as long as I did, taking delight in punching his buttons and watching him squirm and mocking him as he reacted.

But all he wanted to do was engage in a game of informational asymmetry, to be less than candid and to withhold information. And as the wikipedia entry points out, transactions based on asymmetrical information tend to end badly.

As long as psychiatry maintains this paternalistic attitude that only it knows what's in the patient's best interests, I am sure psychiatry will continue to have problems with its victims.

"...the whole difficulty in our public problems is that some men are aiming at cures which other men would regard as worse maladies..."

From the Old School:

Now we do talk first about the disease in cases of bodily breakdown; and that for an excellent reason. Because, though there may be doubt about the way in which the body broke down, there is no doubt at all about the shape in which it should be built up again. No doctor proposes to produce a new kind of man, with a new arrangement of eyes or limbs. The hospital, by necessity, may send a man home with one leg less: but it will not (in a creative rapture) send him home with one leg extra. Medical science is content with the normal human body, and only seeks to restore it.

But social science is by no means always content with the normal human soul; it has all sorts of fancy souls for sale. Man as a social idealist will say “I am tired of being a Puritan; I want to be a Pagan,” or “Beyond this dark probation of Individualism I see the shining paradise of Collectivism.” Now in bodily ills there is none of this difference about the ultimate ideal. The patient may or may not want quinine; but he certainly wants health. No one says “I am tired of this headache; I want some toothache,” or “The only thing for this Russian influenza is a few German measles,” or “Through this dark probation of catarrh I see the shining paradise of rheumatism.” But exactly the whole difficulty in our public problems is that some men are aiming at cures which other men would regard as worse maladies; are offering ultimate conditions as states of health which others would uncompromisingly call states of disease. Mr. Belloc once said that he would no more part with the idea of property than with his teeth; yet to Mr. Bernard Shaw property is not a tooth, but a toothache. Lord Milner has sincerely attempted to introduce German efficiency; and many of us would as soon welcome German measles. Dr. Saleeby would honestly like to have Eugenics; but I would rather have rheumatics.

- G. K. Chesterton, What is Wrong with the World

It's all fun and games and then you're dead

From the wikileaks dump on Stratfor, The Stratfor Glossary of Useful, Baffling and Strange Intelligence Terms (pdf). This is almost as fun as The Devil's Dictionary by Ambrose Bierce.

One of my favorite Stratfor definitions:

empathy-- Thinking about the world the way the other guy thinks about the world. Essential to both operators and analysts. Both have to put themselves into the other guy’s shoes to figure out what he will do next. Definitely not about warm fuzzies.

I just love Frank. He writes so well and does it so prolifically. I have neither the patience nor the inclination.

I particularly liked this post about general health and diet and exercise.

I didn't get started on the diet and exercise thing until ten years ago. It's made a world of difference in how I think of myself and how I feel. Weight training is just as hypnotic and entrancing as the drugs I used to do. It's also made me look a lot better and it's kept off the 110 pounds that I lost. I would recommend it to anyone.

I left a comment on Frank's post that was wildly off-topic, so I'll repost it here. After all if a person's going to make OT comments of novella length, maybe he needs to get his own blog. lol:

I’m very confused as to what constitutes the difference between schizophrenia and a psychotic episode. I’ve personally had four psychotic episodes.

With the first one, I was examined by the college psychiatrist, who then drove me in his car to be examined by a psychiatrist at a local hospital. I didn’t stay at the hospital. The college shrink took me back to campus. He said I needed to flush the speed down the toilet, stop the drinking, beg forgiveness of the people I’d pissed off and take some Xanax, which as far as I could tell didn’t do shit.

With the second one, my parents took me to the hospital, but the hospital sent me home after three days with a script for Haldol, which I liked much better than the Xanax. I took it as long as it worked and got me high. After it stopped doing anything at all, I quit.

The third time I ended up in the hospital again. They sent me home after three days because I seemed to enjoy the Thorazine which they gave me along with the prolixin decanoate injections. I got buzzed on that stuff for several months and then it stopped doing anything, so I quit.

If you’ve not noticed a common thread to these three episodes, I was never committed for any of them.

The fourth time was entirely different. They committed me to two separate 90-day outpatient commitments and forced me to take Risperdal and Depakote, which as far as I could tell did absolutely nothing in the mental functioning department. I’ve refused to have a thing to do with mental health after that. And that was 17 years ago.

Like I say, I was always really confused as to what constituted the difference between psychosis and schizophrenia and what it means to “recover”. I guess it’s whatever the shrink says it is.

Speed Freaks

Copyright Troll Alert

This is absolutely over the top.

The American Psychiatric Association are acting like copyright trolls over the DSM and the people who would want to examine the DSM 5 approval process.

Ms. Chapman's blog here.