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Psychiatry & Psychology--General/Uneasy about wife's psychiatrist care

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QUESTION: My wife was prescribed sertraline, lorazepam and trazodone by a psychiatrist she had one video chat with for complaining about a variety of mental health issues. After an hour or so "therapy session" the psychiatrist told my wife she was giving a few mild medication that didn't have any side effect.. The psychiatrist also said to me that it would be fine if there was no one around to check in on my wife during the first few weeks of starting these medications, after I expressed my concern that I was concerned she might hurt herself if she was left alone (I am in the army and was suppose to go on a month long training exercise the day after my wife was prescribed these meds). And she then called my commander and disclosed specific information about my wife's therapy session; even though we only asked if she could recommend that I stay back from the training so I could watch my wife during the first couple of weeks of taking these new medications. The whole thing just seemed (at least) very unprofessional to me. My question is, did the psychiatrist make any mistakes? If yes, what were they? And Did she do anything illegal? Thank you for any help you can offer.

(Also yes my wife signed a confidentiality form at the beginning of the session saying everything said during the session would remain confidential.)

ANSWER: military doc, or civilian?

---------- FOLLOW-UP ----------

QUESTION: My wife and the psychiatrist are civilians.

Answer
OK, Brooks, thanks for your questions. You asked, "My question is, did the psychiatrist make any mistakes? If yes, what were they? And Did she do anything illegal?"

First, it would be really impossible for anyone to answer these questions without full access to all documents and other information. Second, only a psychiatrist would be an expert for judging the mistakes of another expert, and only a judge/jury could opine on whether someone did something illegal.

That said, I can make some general comments:

1. it would be extremely rare (I've never heard of it, ever), for a healthcare professional to guarantee 100% confidentiality, in perpetuity, in all circumstances. All of us know that, in some cases, we are legally required to breach conf. In other cases, we are permitted to breach (without patient authorization). I know that some patients believe that conf. is 100%; in such cases, we try to educate them on our requirements and the limits of conf.

2. Although conf. could be limited by state law, I do know that HIPAA permits providers to provide information to various law enforcement and military purposes.

3. I know that providers sometimes use telehealth services, for a variety of reasons. I would not categorize such a thing as somehow unethical of 'less than' an inperson session. You don't mention why you did not go to the doctor's office, but you know that the patient has a choice about which doctor they seek services from.

4. All medications have side effects, of course. Depending on the med and amount, the level of side effects could be minimal. Prescribing doctors should give the patient an informational sheet that describes the effects and side effects of the meds (among other info). This should be a part of the informed consent process, and the patient should authorize the prescription, in writing.

5. If you had asked the doc to "recommend that I stay back from the training", you would have had to have signed an authorization for the doctor to provide this information to your commander. If you did not, then (apparently) you expected the doctor to violate confidentiality. That would not make any sense, so it is likely that you authorized the communication.

6. I'm unclear that starting psychotropic meds would require someone to visually observe the patient (24/7) for 2 weeks. I've never heard of anyone needing observation, even for one day, so I'm not sure why you think that would be medically indicated. Even if it were, I don't think that it would require a 'specific' person to do the job. That could likely be handled by just about anyone - friends, family, neighbors, social workers, etc.   

So, not sure if I've answered your questions to your satisfaction (or liking). It's hard to do with only limited information. I do hope that my answers will be useful to you in some way.

Psychiatry & Psychology--General

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Bruce Borkosky, Psy.D.

Expertise

any related to psychology, especially related to forensic psychology

Experience

15 years as a licensed psychologist, 15 years in private practice. My practice began primarily doing individual and group psychotherapy, is now devoted to assessments, but I occasionally do take on clients in therapy.

Organizations
American Psychological Association

Education/Credentials
B.A. psychology, B.A., music, Ohio Wesleyan U., 1978 MCS, computer science, University of Dayton, 1984 MA, psychology, Miami Inst. of Psychology, 1991 Psy.D., psychology, Miami Inst. of Psychology, 1993 post doctoral training in Neuropsychology, Fielding Institute, 1995-1997

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