Thursday, September 18, 2014

Dr; Is there any blood test I can do? Me: No & Yes

I get to hear this question or it's variants every now and then.

Imagine the scenario in my consultation room when someone walks in quite agitated about something, speaks to me at length and then asks for my opinion. (The secret terminology for this process is called History and Mental Status Examination!)

I proceed to tell the noble soul that his condition fits a particular diagnosis. That is; if there is a diagnosis in the first place.

The diagnosis could be Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder or one of the types of Schizophrenia. And then there are so many other categories too...

Then I begin to talk about the treatment options. Medication and Psychotherapy in various combinations...

Sure enough; I am asked...

Is there any blood test that can prove Bipolar or Schizophrenia?

Do you suggest any CT scan or MRI scan of the brain.

My answer is - No !

Mark my words. There is absolutely NO standard diagnostic blood test yet for most psychiatric disorders.

Also; there is generally NO physical abnormality that a typical CT or MRI scan can pick up.

You say... So; then; doctor how did you diagnose my condition?

My answer would be that we psychiatrists base our diagnosis on "cluster of symptoms". Not just one symptom but a cluster of symptoms.

And I get my knowledge of your symptoms through my conversation with you. Through the observation of your behavior... As well as the details supplied by a reliable near and dear one.

Above all; I don't believe in unnecessary investigations. But then sometimes investigations are important to a psychiatrist.

Monday, September 15, 2014

A Cute Appendix

This poem was sent to me by a surgeon friend. 

It is true that as a Psychiatrist; I don't deal with an appendix but I deal with humour :)

Therefore; it finds place on my website. Hope you enjoy it.

If not; forward it to any of your friends who are doctors. I am sure they will love it.

Here it goes...

Once there lived an appendix,
as cute as one can be.
Ileum and caecum right and left,
in the middle lay she.

Darling of the abdomen,
she was slim and pink.
With a very narrow lumen,
and lymphoid cells within.

Not one knew her functions,
some said she stayed for free.
Free-loader some called her,
but others let her be.

Along came an appendiculolith,
handsome they say was he.
Riding through the gut on stools,
and love it had to be!

Plump and red she grew with love,
yet more love showered he.
Their love irked some around,
but the peritoneum couldn't let them be!

They say that day was grim,
as no day shall ever be.
He covered his face with a mask,
and a gown in green wore he.

The taenia coli showed the way,
and at their junction the lovers found.
Crushed thrice and ligated,
only a stump will ever be found.

Now weeps the whole abdomen,
and says their love was deep.
Paralytic ileus has been agreed upon,
to honour the lovers in their sleep.

Friday, September 12, 2014

The Limits Of Client Confidentiality

In my previous post; I discussed how confidentiality is sacred "dharma" for clinical practice.

A Counselor or Psychiatrist can not be a tale-bearer.

But is confidentiality an absolute right? Something which has no limits.

Well... That does not seem to be the case.

Let us consider what the latest legislation in India called the The Mental Health Care Bill 2013 says.

Let me reproduce Clause 23 in full so that we have a 360 degree perspective.

Here it is...

(1) A person with mental illness shall have the right to confidentiality in respect of
his mental health, mental health care, treatment and physical health care.

(2) All health professionals providing care or treatment to a person with mental illness
shall have a duty to keep all such information confidential which has been obtained during
care or treatment with the following exceptions, namely:––

(a) release of information to the nominated representative to enable him to fulfill
his duties under this Act;

(b) release of information to other mental health professionals and other health
professionals to enable them to provide care and treatment to the person with mental

(c) release of information if it is necessary to protect any other person from harm
or violence;

(d) only such information that is necessary to protect against the harm identified
shall be released;

(e) release of information in the case of life threatening emergencies where such
information is urgently needed to save lives;

(f) release of information upon an order by concerned Board or the Commission
or High Court or Supreme Court or any other statutory authority competent to do so;

(g) release of information in the interests of public safety and security

Self explanatory. Isn't it?

Thursday, September 11, 2014

Four Reasons Why My Clients Insist On Confidentiality

Every now and then; someone will say the following to me when they first see me...

That is - "Doctor; please keep this strictly confidential."

And I understand that completely.

After all; these are things they can't share with family members and even close friends.


First... However; well intentioned your immediate circle; they have subtle, almost unconscious agendas which becomes a wall towards your full disclosure to them.

Second... Friends & family may not have what we call the "clarity of distance".

Third... You may not want your near and dear ones to feel guilty about what is happening to you.

Fourth... Some of us perceive tremendous hurt in our most intimate relationships. The last thing we want to do is flare up matters by talking more.

And hence the request for strict confidentiality and my assurance of the same..