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Do psychiatrists have interns? Or junior partners? If so would they record a session and play it back for the intern for a teaching tool?
Posts: 1275 | Registered: Mar 2004
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Pyschiatrists are medical doctors. You must intern in the field of psychiatry in order to become a medical doctor in that specialty. Rules of patient confidentiality to not allow fot any sharing of information unless the patient is informed and signs a permission form. In that case, as long as the patient is willing, a doctor can share information with his/her student. It is far more common that this line of communication will happen the other way, however. When an intern sees his/her own patient they will have to inform the patient that they are an intern and may need to share the information with their mentor. Still, patient consent is required.
Posts: 3567 | Registered: May 2003
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P.S. Psychologists, who have Ph.D.'s instead of M.D.'s, also have interns in the clincial field and it works the same way. The difference between a psychiatrist and a psychologist is technically simply that the psychiatrist can prescribe drugs and the psychologists can't. In actuality, psychiatrists almost never do anything EXCEPT prescribe drugs and it is becomming quite common for patients to see both a psychiatrist and a psychologist for serious problems and the two will confer with one another. The psychiatrists monitors the drugs and the purely medical side of things and the psychologist does the more typical counseling sessions that you see on TV that are usually wrong. Posts: 3567 | Registered: May 2003
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Like, don't they do that through hospitals mostly? I mean, rather than sending an intern to somebody's private practice or something like that, which would seem weird for any kind of doctor, but particularly for a psychiatrist.
I mean, the way you asked the question sort of made it sound odd.
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In the United States, HIPPA (um... lemme see if I can get this right... Health Information Portability and Accountability Act - don't ask me why it isn't HIPAA) laws have become quite stringent regarding sharing of patient information. As example, Nurse A treating a patient may not share that patient's information with Nurse B unless Nurse B is directly involved in the patient's care. This applies to mental health issues as well. A friend of mine works for a state correctional facility, and the mental health people there cannot, by HIPPA law, even share with the state when they feel there is information they have that implies the parent may be a danger to their children. This is an unfortunate gray area in the relatively new HIPPA laws, and one that the courts will be battling with for some time to come. Christine has the correct answer to your question - only with patient consent will a doctor be allowed to share information with a student.
The HIPPA act requires clinics and hospitals to be proactive at protecting patient information. As example, hospitals might have to put screens on their staff's computer monitors to prevent people from viewing information from the side, health care records must be stored under lock and key, staff must be HIPPA trained... a lot of elaborate little regulations have gone into place with this federal law.
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Another question - what if a child is removed from parental custody? Until a replacement guardian is found, the state officially assumes "custody" of the child. The child may be placed with foster parents - who may, or may not be a relative, but the state is still considered the "guardian" and foster parents must receive permission from the state for things like traveling out of state, etc. And the state would be very involved in the child's medical care.
Chris, if you could elaborate a little more on the circumstances by which the child would be removed (was it child abuse?), then I could speak with a little more certainty. There will be a variety of responses from state to state, with each state having a specific agency involved in a "removal" from custody, but essentially the local equivelent of CPS - Child Protective Services - will be involved.
If your story is set in a different state, you could type in the state name and the words "child abuse report" and pop up the governmental body that oversees removal of children from homes, and from there know a little more about the name of the agency who would be involved in your character's life.
Removing a child from the parents would have a big impact in your story - both emotionally for the child and all the governmental red tape that the characters would have to deal with.
[This message has been edited by Elan (edited May 25, 2005).]
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Elan, often it is called HIPAA (Health Insurance Portability and Accountability Act of 1996), which I believe is its proper name. The name is sometimes given as HIPPA (Health Insurance Portability and Privacy Act of 1996).
HIPAA has a privacy provision, but I don't think the word privacy is in its proper name. I could be wrong, HIPPA came along just as I was getting out of the healthcare game.
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Survivor, you may be right about that. In fact, I would highly suspect you are. I had difficulty answering the question, too, if you could not tell from my elaboration of what, exactly, a psychiatrist is. But past understanding privacy laws and understanding the differing roles of psychiatrists and psychologists, I am no expert in how the medical doctor training process works. I only know that there is a required internship AND residency, for that matter, and that these types of people run around at hospitals associated with schools all the time. On the other hand, if this has to do with a child being protected by the state, my guess is they won't be sending them to a private doctor (too expensive). In that case, you're probably ok. Posts: 3567 | Registered: May 2003
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Basically I was envisioning the psychiatrists coming in at the end of the story.
The first part of the story, would be a first person account given by the child. The father is physically abusive and the mother while not abusive is chemically dependent and out of it most of the time. In the end of his account, the child contemplates killing his father, comes close, and then dials 911 instead. I've hacked almost through the first part already.
But what I was thinking in the ending, the second part, in third person, is the intern or junior psychiatrist is playing a tape of the session for his mentor. The first person account was the recording. And the two discuss it.
There is a strong speculative element in the story, but its irrelevant for the discussion and dismissed by the psychiatrists as delusion.
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So, we're talking more along the lines of that scene in T2 where the gaggle of psychs is looking in on Sarah Conner, miss paranoid delusions of grandeur? Something like that?
The rules get bent all the time. The tighter they are, the less seriously people take them (unless you start lopping off heads to get the message across, and that's not gonna be happening).
Put the kid in the psych wing of the local university hospital, put him under state custody, and the doctors in charge can do pretty much whatever they please. It probably won't please them to tie him up with rubber hoses and throw cheetoes at him, but they could if they really wanted to.
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It's been a while since I've seen T2, and I only saw it once. The Governator isn't on my list of favorite actors...
Posts: 1275 | Registered: Mar 2004
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That might be because he isn't an actor. He's a special effect turned stand-up comedian. I have no idea whether he's any good as a governor, but he was great at everything else he's done (including outrageous public womanizing), so it wouldn't surprise me if he's a decent politician.
I do sort of wish that Hollywood would stay the hell out of politics, though. I mean, obviously it's going to be a while before we see Arnold in a new movie, which is bad. But even though that's the extreme case, the same principle applies to the entire industry. When actors/directors/producers spend all their time on politics, they aren't delivering what we supposedly pay them for.
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That's why I'm saying, I would prefer that entertainers stay out of politics.
I don't have any strictly formal difficulties with news organizations dabbling in politics, though I think they should at least be honest and open about it. But we have some kind of strange situation in this country where entertainers, who by and large should at least appear to be politically neutral, openly tout their own crank solutions to national ills. In the meantime, news organizations, who should above all admit their own agendas, go to great lengths to decieve the public about their own motives.
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Increasingly, when a report is not what one faction or another wants to hear, that faction claims bias. And that accusation puzzles the opposing faction who feel the exact opposite.
Unfortunately this often creates a pressure to lean one way or another to quell such talk.
[This message has been edited by ChrisOwens (edited May 27, 2005).]
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Psychiatrists and psychologists are not like Catholic priests. If there has been indication of the patient hurting someone, being hurt by someone, or contemplating self harm or have information of someone harming someone else the mental health provider is obligated it to report it to the legal authorities.
Psychoanalysts are a different stripe from psychiatrists as well in that after residency (and a psychoanalyst will first be a psychiatrist) they must go through their own psychoanalysis. But it is almost certain that a ward of the state will not be going to a psychoanalyst. That is more the old model of a Freudian psychiatrist. I'm sure they still make them, but they are no longer seen as the shamans they once were. At least by me.
P.S. I don't wish to give the impression with that that I don't favor talk therapy over or in concert with drug therapy. I think drug therapy alone is not as good. The usage of mental health not to treat the ill, but to enhance the well is more what bothers me than any specific method.
Anyway, the history of this person's entry into the mental health care system means their therapist might make reports to a social worker (and most talk therapists are M.S.W.s) Is it necessary that the primary therapist be a superior to the person being included?
[This message has been edited by franc li (edited May 29, 2005).]
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