Wednesday, November 2, 2011

on writing as physician

Somehow, writing takes on an almost hazardous tone, in the role of physician. HIPAA protects patient confidentiality even down to the seemingly mundane details. Are you scheduled for Wednesday or Thursday? Protected. Are you my patient? Protected. What are you being treated for? Protected. Etc. Sure the goal is to minimize the information leakage. And in the day to day running of a medical practice, you might see Joe Blog’s name on the sign-in sheet above yours because you arrived 30 seconds after him. Some of these security breaches are unavoidable. The point of HIPAA is to minimize them to the extent reasonably possible.

Guarding the sacred space of doctor-patient relationship, HIPAA cozies up, seeking to embody trust. Of course, trust isn’t something easily embodied, especially when it comes to mental health. And of course, HIPAA regulates only one side of the relationship—the physician’s side. It is a somewhat one-sided venture, since as patient, you can share whatever the hell you want about your health with whomever you choose. It’s your business, after all. The spirit of the law is to essentially regulate trust. Of course, information has to be shared sometimes, for insurance purposes, or to foster high quality care, and in a general way it can be shared for educational purposes, as long as it is divorced from any identifiers, with relevant details changed.
But following the spirit of HIPAA is easier said than done. Sometimes it feels paralyzing from the Physician side of things. A significant part of one’s life, one’s being, the core and soul of what one does every day, always needs to be sifted through a HIPAA sieve of perpetual censorship.  In constant flux, one vacillates, share this, not that.

Complicated by people’s perceptions, falsehood or truth matters not. As patient, you know not that one in four people has a mental illness. You know not that depression is the “common cold” of mental illness. You know not how many people have suicidal thoughts or intense anxiety. You know not that everybody bleeds this way, just the same. To you, these are the intimate details of your story—not humanity’s. And this is how, even amidst mutant sifted details on a blog, you might see yourself in the story. In the composite, with the humanity peering out through the words. Hey that’s me you are talking about. And therein trust gets snuffed out. The sacred space darkens, as it warps and twists into something a bit different.

Even if HIPAA hasn’t been thwarted at all, the fact that you think it might have been, undermines one of the most critical elements of the doctor-patient relationship. Next time, you might struggle to tell what needs telling. Because of a perception—a false one at that. Something uttered might snake its way into the ether regions of your story. Your experience of life. The words said might be lifted from context, or might be misunderstood as some personal message. Across my desk, this thought is sometimes both frightening and inspiring.

I’d love to write more directly about my healed patients. How they don’t really recognize themselves anymore. How so much of the old has slid away. How we’ve avoided mood episodes of deep darkness. Or just how life feels so different gliding through it with a homeopathic Gortex suit. I’d love to emote for hours on just how beautiful a person can be when healing via Tuberculinum,
Natrum Mur
and Nux Vomica.  These remedies and many others, foster an almost nostalgic feel in the prescribing physician. They are like old friends as Margaret Tyler used to refer to them. Even their names roll off the tongue and hang in the air, like the art that they make out of life. I suspect with my going on about remedies, I've waded away from the point. Which is simply that these miracles aren't exactly my stories to tell. Sure, I can tell unidentified snippets and fragments. Sure, I can tell pieces while ever conscious of my pet snake, HIPAA. And truth is, you probably won't believe me, anyhow, dear reader. For the stories almost sound made up. Hyperbolic. Ridiculously exaggerated. As Tim O'Brien once wrote, Fiction is often more honest than the truth, and the truth often rings false--something to that affect.  

In this case, the facts seem false. Such as the fact that somehow Patient C can’t remember the time when she didn’t have Problem X. All my life, she says in the intake. And there it is gone. Almost insulting. Can she really have had that symptom gone away in a few months with a few sugar pellets under tongue? I don’t think so. Can he really be feeling that much better? You must be exaggerating, Jenn.

Except that I try quite hard not to exaggerate. To be accurate. To understate. I lean so hard into that wind of transparency and attempted honesty that sometimes I think I might fall over. One of my mentors says I’m too honest.

And this puts things in a quandary when it comes to writing, in this role, as I see it. The intersection of HIPAA, transparency, and trust unfolds. I am left to struggle with the balance: how to reach toward the catharsis of writing. How to share the powerfully inspiring stories that remind me of the joys of being a physician, yet protect the sacred space of doctor patient relationship. Above all, I struggle in holding the sacred trust tightly enough so as to not drop it, yet loosely enough so that it doesn’t wrap around and strangle the very relationship it is supposed to protect. Easier said than done.