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Medical Report: "Probable Personality Disorder...". Defamation?
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16-03-2016 3:40am#1
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After much discussion and lenghty posts, op should note:
1. Get legal advice to bottom out if you are interested
2. Simplistic Analysis but very likely not defamation as 'right thinking' people wouldn't think less of you with personality disorder
3. No doctor in Ireland will fell another doctor come crunch time
4. Medical advice confidential and you gave the consent for publication. Yes not re content I know, but zero impact
5. Defamation actions are EXPENSIVE. Very expensive. Be prepared to take out the cheque book to lodge bonds. Not no foal no fee on this one like your PI claim.
Thanks. "Get legal advice to bottom out if you are interested"? Sorry. Does. not. compute?
Yes, a defamation case would be expensive, that is why I may wait until after the settlement. Yes, I gave permission for the use of my medical records in writing the medical report and the medical history section of the report should contain diagnosis. I have NEVER been diagnosed with any psychiatric illness or a personality disorder. What it is, is an opinion, it is a hypothesis and one which if passed to third parties could reduce my standing in the eyes of others (explained below). A "probable personality disorder....." is not a diagnosis. And I'd contend that as such has no place in the medical history of a medical report. A diagnosis of a personality, may, and even that is debatable but a "non-diagnosis", no.
I would have to strongly disagree with your second point, there is information from a very many sources, professional sources, not Joe down the pub, which explains that being labeled as having a personality disorder attaches a societal stigma to the individual, can affect employment opportunities, can lead to discrimination and can lower the person in the eyes of his or her peers.
I'll quote verbatim from just two examples, the first is from a UK based organisation which deals with people with actual diagnosed personality disorders, their families and mental health and medical professionals. The second is from a respected Canadian academic:
1) "Giving someone a diagnosis of personality disorder is highly controversial. This is in part because of the stigma surrounding this label which can lead to discrimination. In addition, some people find the diagnosis insulting and unhelpful."...."Personality disorders (PD) are extremely controversial diagnoses, provoking heated debate among people with personal experience of these diagnoses, mental health staff, researchers and policy makers".
emergenceplus.org.uk/what-is-personality-disorder/94-diagnosis.html
emergenceplus.org.uk/what-is-personality-disorder/92-why-are-personality-disorders-controversial-diagnoses.html
2) "While the mental health professional generally has beneficent motives and an honest belief in the DSM diagnoses assigned to clients, such diagnoses may yet be defamatory when communicated to third parties. Mental health diagnoses invariably lower the individual’s reputation in the eyes of the community. At the same time, DSM diagnoses are but one out of a myriad of possible interpretive frameworks.
DSM descriptors for the client’s distress thus cannot be said to capture the essence of the client’s personhood. When a diagnosis is published as if it captured a definitive truth about an individual psychiatric client, it is, in that important regard, inaccurate. That is, such a communication meets the criterion for a reckless disregard for the truth or an honest belief but without reasonable basis insofar as it is considered to be anything more than a working hypothesis. Hence, in certain cases, DSM labeling may constitute defamation."
"For instance, should an individual be regarded as untrustworthy and manipulative as a function of their ‘borderline personality’ diagnosis, this may affect employment prospects".
behaviorismandmentalhealth.com/wp-content/uploads/2013/09/Reification-of-Psychiatric-Diagnoses-as-Defamatory-Implications-for-Ethical-Clinical-Practice.pdf0 -
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If it is, I would love my GP or solicitor to explain how *probably* having a personality disorder or personality traits (which everyone has) is relevant to being struck by a car as you cross a pedestrian crossing leaving you with a spinal fracture and other injuries.
Even were it established that I did have a personality disorder, I would still fail to see the linkage. As it stands right now, they don't even know but what releasing such info to third parties could do is affect my standing in the eyes of others. It shouldn't but given human nature it would.I have had pre-existing lower back pain for the last couple of years, made worse now specifically in a certain area. Also ankle pain - now worse, knee pain - which had cleared and is now back, elbow pain - worse since accident. I have had MRI's.
I do suffer from depression from time time and made this known to my solicitor and the Gardai and ambulance crew. Nothing to hide on that front. The accident caused a spinal fracture, now healed or healing. Currently attend physio, may, or do, have "hyperalgesia" and "allodynia" according to physio. Also weakened left leg muscles, could be direct result of impact according to physio. Physio has said the accident has made my existing pain worse and could be in increased pain for months to come - on top of the pain I already experience, which according to the physio could be both neuropathic and orthopaedic.
As a physio who has also had to deal with medicolegal claims, based on the above information then the GP is doing no wrong by including the Psychiatric opinion. You need to understand 2 things:
1) The medical history provided has nothing to do with verifying your claim. The GP isn't doubting you were hit by a car or any of the events that entailed.
2) You don't need to have a concrete diagnosis for everything included in a medical history. I can record that a patient scores highly on a depression scale and has depressive symptoms. There is no diagnosis there, but it's absolutely pertinent because it influences my treatment options and outcomes and its 100% something I should be reminded of every time I deal with that patient.
About your claim, a psychiatric opinion from an expert consultant about a possible mental condition is almost certainly relevant to any claim you may have about chronic pain arising from the incident, especially since you had pre-existing chronic pain. This is because of the established link between mental health and pain perception (see 'Yellow flags' in back pain). It's actually standard to include information on depression, anxiety, acopia etc. for any medicolegal claims.
Your argument is that you don't want it reduce your standing in the eyes of the other parties, but unfortunately that alone isn't sufficient to omit a medically relevant piece of information from a patient history. The fact is that
A) The opinion reflects a clinical judgement, based on assessment which was correct at the time it was made
As someone with pre-existing chronic pain, a medicolegal claim and previous depressive symptoms, and pertinent information on mental health is relevant. 0 -
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A medical professional's opinion going to be difficult to counter unless you can prove that it was maliciously expressed or incorrect to the point of negligence. All they have to show is where this opinion was derived from and perhaps have a second professional back them up.
There is also the defence of qualified privilege which may apply in this case, since the information has only been shared with someone entitled to see it.
Fuzzy alludes to it, but the fact that you're making such a big deal out of this...is not normal. Are you allowing your dislike of your GP to cloud your judgement? Perhaps you should find another GP, show them the report and ask them if they think it's appropriate.
Thanks but as I just explained to another poster, a psychiatrist can make an assessment using DSM 5 criteria. This was not done, if it were there would not be a "probable" and the actual personality disorder, if it existed at all, would be listed. Another way to prove that the assertion is incorrect would be to get a second opinion. I would be more than happy to undergo an actual DSM 5 assessment. It is not a simple test, it is based on weeks, if not months, of face to face afaik. I may look into that. It could well come back and say: total fruit cake, ha...or it may come back, "clean", if it did it would show that the hypothesis was incorrect. If I do go for it I will omit to tell that I already have a "probable" as I wouldn't want to unduly influence or skew the process, of course. You know what, I have a feeling there would be a very good chance it would come back, "clean".....
No offence but I think it is perfectly normal to want to protect the image others in society have of you. I try and write detailed OP's, provide info and background, not two liners. Nobody wants to have a stigma attached to them, and as I have shown this is what a label of "personality disorder", is. In this case even a probable relays the same "message". I mean seriously, who the hell wants the stigma of being labeled with a personality disorder...or even a probable one! Nobody. My GP, yes, I wouldn't say we have the best of relationships, might be moving, might be for the best - they are all out to get me [joke]
On qualified privilege, you could be onto something there. I have heard of it. Did law many years ago at UCC, flunked, as did more than half the class (makes me feel better when I add that ) I wasn't the only eejit, lol. But I would go back to even before that may kick in, I would question the very nature of an opinion which gives a half baked analysis and comes up with "probable personality disorder"? Was it too difficult to know for sure? Did they try to find out? Couldn't they be bothered to do an actual accurate DSM 5 assessment? Why "probable"? Then they also threw in "probable....personality traits", when I saw that I was thinking, WTF. So, I checked it out and you what, everyone has personality traits, it might as well have said "he breathes air" Why not "x personality disorder", an actual assessment. That I could probably live with, diagnose it, make it real and certain one way or the other, I may not like it, would seek a 2nd opinion, but could live with it. But now I am dealing with a hypothesis not an diagnosis.
And I honestly think a hypothesis has no place in a medical report. A diagnosis, okay, but a hypothesis, no.0 -
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Anita Blow wrote: »As a physio who has also had to deal with medicolegal claims, based on the above information then the GP is doing no wrong by including the Psychiatric opinion. You need to understand 2 things:
1) The medical history provided has nothing to do with verifying your claim. The GP isn't doubting you were hit by a car or any of the events that entailed.
2) You don't need to have a concrete diagnosis for everything included in a medical history. I can record that a patient scores highly on a depression scale and has depressive symptoms. There is no diagnosis there, but it's absolutely pertinent because it influences my treatment options and outcomes and its 100% something I should be reminded of every time I deal with that patient.
About your claim, a psychiatric opinion from an expert consultant about a possible mental condition is almost certainly relevant to any claim you may have about chronic pain arising from the incident, especially since you had pre-existing chronic pain. This is because of the established link between mental health and pain perception (see 'Yellow flags' in back pain). It's actually standard to include information on depression, anxiety, acopia etc. for any medicolegal claims.
Your argument is that you don't want it reduce your standing in the eyes of the other parties, but unfortunately that alone isn't sufficient to omit a medically relevant piece of information from a patient history. The fact is that
A) The opinion reflects a clinical judgement, based on assessment which was correct at the time it was made As someone with pre-existing chronic pain, a medicolegal claim and previous depressive symptoms, and pertinent information on mental health is relevant.
Thanks for your answer, it is appreciated - even if in parts I can't say I necessarily agree. "Your argument is that you don't want it reduce your standing in the eyes of the other parties, but unfortunately that alone isn't sufficient to omit a medically relevant piece of information from a patient history....". I think it could be, as you have two rights clashing. My rights and "their" rights. They have a right to disclosure, but disclosure to what extent? I have a right to privacy and the protection of my character, but to what extent?
Is a wide ranging, undefined "probable", which covers personality disorders of all types, is undefined, and also includes personality traits as the supposed expert psychiatrist can't even decide if I have a personality disorder in the first instance, a relevant piece of information, given it's wide scope, it's lack of for want of a better word "structure" and "certainty" - I would suggest, no, it is not enough to trump my rights. If they had an actual diagnosis that said "x personality disorder", but it doesn't say that, in fact it actually says it doesn't knwo if I have a personality disorder or simply personality traits - and EVERYONE has personality traits, you, me, everyone....I get the feeling it was written by an intern, not an expert.
Couple of days ago I contacted an advocacy organisation in the UK, they have said it is complex, are consulting over it and will get back to me. We will see what happens, maybe nothing, maybe something, you can never know. What I do know is that I cannot simply lie down and allow such an uncertain half baked piece of information to potentially tarnish my character.
Anyway, my physio has said he thinks I may have, or do - can't recall which - have something called hyperalgesia (which I don't fully understand, have read on it but it is a little confusing) and allodynia (again, a little confusing). Because I had chronic pain when the car hit, there are neurons flying all over the place and causing additional pain. Or something along those lines! Increased pain as a direct result of the accident could persist for months
Thanks anyway. 0 -
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The GP doesn't have a right to disclosure, it's their professional responsibility. Likewise, you don't have the right to withhold pertinent information during a medicolegal case. You can't pick and choose what information to disclose, you have to be honest.Thanks for your answer, it is appreciated - even if in parts I can't say I necessarily agree. "Your argument is that you don't want it reduce your standing in the eyes of the other parties, but unfortunately that alone isn't sufficient to omit a medically relevant piece of information from a patient history....". I think it could be, as you have two rights clashing. My rights and "their" rights. They have a right to disclosure, but disclosure to what extent? I have a right to privacy and the protection of my character, but to what extent?
First, interns cannot make a diagnosis or conduct outpatient psych consultations. You would've been seen by a Registrar or Consultant who have many years of experience. It does say probable, and the judge is capable of judging the merits of a 'probable' diagnosis rather than a concrete one. It doesn't change the fact that a psychiatric doctor made an honest clinical judgement based on an assessment, and that this is relevant to medicolegal proceedings.Is a wide ranging, undefined "probable", which covers personality disorders of all types, is undefined, and also includes personality traits as the supposed expert psychiatrist can't even decide if I have a personality disorder in the first instance, a relevant piece of information, given it's wide scope, it's lack of for want of a better word "structure" and "certainty" - I would suggest, no, it is not enough to trump my rights. If they had an actual diagnosis that said "x personality disorder", but it doesn't say that, in fact it actually says it doesn't knwo if I have a personality disorder or simply personality traits - and EVERYONE has personality traits, you, me, everyone....I get the feeling it was written by an intern, not an expert.
I don't need a formal diagnosis of anxiety disorder, acopia etc. to include in my medicolegal note that a patient is anxious and could be contributing to their condition.Anyway, my physio has said he thinks I may have, or do - can't recall which - have something called hyperalgesia (which I don't fully understand, have read on it but it is a little confusing) and allodynia (again, a little confusing). Because I had chronic pain when the car hit, there are neurons flying all over the place and causing additional pain. Or something along those lines! Increased pain as a direct result of the accident could persist for months Thanks anyway.
And both of these conditions have huge psychological components for which any information on psychiatric co-morbidities is extremely relevant. Infact it would be negligent for the GP to not mention any psychiatric conditions or previous contact with psychiatric services because I can assure you, that GP would be in serious trouble with the IMC for witholding that information in any medicolegal proceedings. This isn't defaming you to the community as it's not being broadcast publicly. It's a very specific medicolegal proceeding which requires you to disclose relevant medical information in exchange for justice.0 -
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