Below was a quote from Simon Foster (Sifo) in reference to patients attempting to amend their diagnosis on record in one of my posts.
If Mr Foster is reading this - can you explain this specific part.
Are you saying - I will try to paraphrase it correctly so I can grasp it better. Correct me if I have done this wrong.
So, if the patient can prove that the diagnosis was so out of line from a medical standpoint - that no other medical professional in the field could agree with it - this would enable the patient to have a greater chance to erase what is on record about them?
How would someone then prove that the diagnosis was out of line from a medical point of view?
I donât understand this part because any psychiatrist can share their opinions and write sounding medically coherent. e.g. Patient X has Bipolar Depression - they have exhibited mood swings and intent to harm themselves etc. Then another medical professional would think that sounds legitimate - because of the wording matching up with what would be thought of with someone with Bipolar.
But that doesnât really sound fair. If the opinion is/was unfounded - then canât the patient provide medical evidence to counter the diagnosis? That would make more sense in a court of law. Otherwise itâs lopsided. Because it doesnât show two sides of the coin - only one.
Medical records cannot be expunged of diagnosis. However, a patient can request under DPA (2018) to request any new information to be added pertaining to their diagnosis. Or another Dr can decertify a diagnosis and have this included in their medical records.
If anyone has caselaw to say that a diagnosis has been completely removed. Be interested.
In a related point I do think that diagnoses are seen as permanent when they are not - there should be reviews every few years to see if they are still relevant. They can also âpile upâ and have the person see themselves as very ill rather than not well diagnosed.
The process is not setup for the patient to be given a fair chance of winning - it is setup for the organisations running these processes to not take any accountability.
That is the fundamental flaw with all of this.
Unless the way these reviews and records are conducted or written; carried out in a way that is neutral, fair, clear, impartial, transparent with moderation - I feel done importantly in an open public way like in a council agenda meeting with different personnel - then, I can not see how even for a patient to have quarterly reviews to check if their diagnosis can be overturned, changed or see if it is relevant; if the very people giving these diagnoses are the ones making the decisions.
@Phoenix_1 , thanks for looking into this. I had missed the original thread but have now studied it for my educational purposes.
If I grasp the original context, your current questions emerged from
The current context of your questions is about 'removing diagnosis from medical recordsâ and about the lopsidedness of âcountering the diagnosisâ.
My mind leaps back to two cases I was involved with:
The adult patient in late 20s was not progressing in an NHS low secure facility after several months of treatment in detention for schizophrenia. As per usual, someone had a âbright ideaâ that âAspergerâs (ASD) ought to be rule out. The case was referred to a non-NHS facility. Their assessment confirmed ASD and the patient was swiftly transferred. There he spent 2 years more in detention and given various cocktails (of medication obviously). No progress. Hereâs the rub: the diagnosis of ASD was erased by the non-NHS facility and now TRS (treatment-resistant schizophrenia confirmed). Hence patient swiftly âejectedâ back to NHS. Then heâs in my care. Iâm dumbstruck as to how ASD is on and then completely erased - with no cogent rationale - after probably ÂŁ1 million or so spent on the case of âyour taxpayersâ money. The patientâs NR was in a mess and fuminâ (as they say in âscouserâ lingo - not that the patient or relative were scouser - I choose to say it in scouser.) So, I went through the case with a fine toothed comb. I spoke with the original assessor who had diagnosed ASD but was not part of the team who erased the ASD diagnosis. Donât ask - itâs complicated. Well, that assessor was as equally kerfuffled to the NR and I - and maintained ASD. But wait - the patient also had schizophrenia; well-diagnosed whilst considering borderland issues with ASD. So, this was a case of diagnosis of: ASD on - then off - then on again (by me).
The next case was a female patient - a few years later in the NHS - that I inherited on 5 psychotropic meds. Whatâs the diagnosis? Complex PTSD - âafter all itâs complexâ a lay person might think so âgive her medsâ. The patient previously was in a non-NHS facility for about 4 years. I studied their records. Complex PTSD was reasonably well founded against diagnostic criteria - but one problem - no one could get close to verifying the circumstances of any trauma or series of traumas. Personality disorder was diagnosed by a UK trained consultant psychiatrist on good evidence. But that was demolished by psychologists - donât ask. Then said psychiatrist re-diagnosed âMixed Personality Disorderâ. By the time P was transferred to NHS the diagnosis of PD had evaporated into thin air and did not appear a previous tribunal reports (while patient was months into the re-transfer to NHS). P had absolutely no knowledge - I checked carefully - that PD was diagnosed, and P was incensed by the thought of such a diagnosis. Well, I had to re-diagnose it based on the evidence (not anyone elseâs opinion) and my Tribunal report went off. P and her father were fuminâ (long story). Pâs lawyer sought to meet with me, did so and complimented the robustness of my report and diagnosis and advised that P would be withdrawing from appeal to Tribunal. So, in summary - this is another one like the above case: PD on - PD off - PD on (by me). As for the 5 medications (several unlicenced in use) - nobody including myself understood what the rationale was. Whatâs the patientâs capacity for that lot?
Whatâs the point of the above 2 cases? If the diagnoses in question were to be entirely erased from records then all assessments (botched or unbotched) would also have to be erased, along with valuable historical thinking and data.
What is psychiatric diagnosis? âSome sayâ (not the Styx) that itâs different. I say the principles surrounding diagnostics and diagnosis in psychiatry are the same, as in every other branch of medicine. Some donât believe me obviously. Is Diagnosis in Psychiatry More Art Than Science? â Investigative Psychiatry
This cuts to the Bolam test which is a defence - not a carte blanche - and shot down in 7 countries around the world. Not everybody knows that. In addition, what a âreasonable body of medical opinionâ would say is subject to Bolitho 1997 - where a judge will tell them all if necessary, of the need for logic - as the judge sees it. [Dissertation withheld - thank me later].
There is a logical and scientific process that is meant to apply to psychiatric diagnosis. So says the GMC about all forms of medical diagnosis. So, for me it doesnât matter what the majority says.
I wonder about what sort of evidence that would be? Expert opinion evidence - instructed by whom? Needs to be a court or tribunal. But these days one could get an expert to say whatever one likes at around ÂŁ500 per pop. I have direct knowledge of that phenomenon.
Wrongful psychiatric diagnosis is something that is happening all over the UK - and has been happening unchecked for the last 20 years at least. I see it every time I work AT some three different Trusts per year. The commonest is wrongful diagnosis of PD. Close on the heels of that wrongful diagnosis of anxiety disorder, PTSD, adjustment disorder and even bipolar. [Adjustment disorder for 15 years - how does that grab you?]
On the flipside there wrongful avoidance of diagnosis - far more uncommon - and a much longer story, but apparently thatâs related to application of the âleast restrictive principleâ and misapplication of âequality legislationâ. I kid you not!
In general patients - especially those who have/had been detained have a very hard time challenging their diagnoses. Wrong diagnosis quite often leads to wrong treatment. How about TRS being neglected for 2 years because the condition was thought to be personality disorder? Oh yes - so-called psychiatrists are getting away âwith lotsâ. Why? The CQC donât know whatâs what - the patient donât know whatâs what - even MDTâs surrounding the psychiatrist donât know whatâs what. And the GMC wonât find out whatâs what cuz they sit there waiting for complaints to land in their laps - not being an inspectorate.
Love your post. You donât understand (tic). Understand the big picture first: Itâs not really about properly diagnosing and treating people so that they get better and avoid risk of relapse. How dare I say that!? I dare and I do. Nobody can deny what I have witnessed over the last 30 years - but of course they can argue with my interpretation of what Iâve seen. [Sidebar: What does smoking have to do with causation of mental disorder, and increasing relapse rates? And what is the measure of success for smoking cessation programmes in mental health?]
Unless the way these reviews and records are conducted or writtenâŠ
Sounds good. In reality documentation is poor on those sorts of matters. Why? Whoâs doing the documentation? Is it consultant psychiatrist âdoes allâ? All such documentation must be of the highest quality (not just as lip service). You ainât finding anybody who will do the documentation properly and psychiatrists barely have time to read minutes of meetings. In one services some âadminsâ - did documentation. It was taking me to around 2 hours on average to correct the nonsense that was wrtten - poor grammar, vague stuff, missing important details, typos left right and centre. Thatâs been the a pretty similar story across many Trusts where Iâve worked. Your masters have no money to pay for high quality people. I wish I could give you some examples of what Iâm talking about but the rules (via the GMC) prohibit.
So what is it about? Based on my experience the system wants âthese peopleâ (aka patients) out of the way. There is a big financial machinery at work - that most people never see. Itâs likened to the billions that go into BigPharma advertising and propaganda and the peanuts of billions budgetted for and paid out for their wrong doing. Well, preserving the financial machinery is really what it is about - the patient becomes incidental - and a great âobjectâ for professionals to have long, boring and time-wasting meetings with a sense that theyâre making a real difference. The fantasy becomes better than reality.
So you talk about,
neutral, fair, clear, impartial, transparent with moderation - I feel done importantly in an open public wayâŠ
Your NHS has been talking about openness and transparency for the last 30 years. One thing is clear to me - actions speak louder than words. The overwhelming evidence from Public and other inquires, and many a whistle blower (such as Dr Peter Duffy), is that the macro-culture is âclosed shopâ, âcover-up-as-fast-as-possibleâ and deny everything. But wait - thatâs defended in the background by a ÂŁ68 billion piggy bank funded directly from the Treasurey in CNST. So your appeal for very nice things at a clinical level ainât happening any time soon within that macro-culture. Nobody has time for that. I do like your idea very much though. Unfortunately for me I live in a very difficult place called âREALITYâ - which some avoid because its harvests are often labelled as ânegativityâ.
I can not see how even for a patient to have quarterly reviews to check if their diagnosis can be overturned, changed or see if it is relevant; if the very people giving these diagnoses are the ones making the decisions.
Too right! Yes - psychiatrists are judge and jury in their own âdiagnostic courtâ. As much as I would like to see that changed - I know that there is no time, money and effort to be thrown behind such a move. Where is the manpower to do what we know is right and proper? When I find wrong diagnoses - I say in the records words such as âthe diagnosis of [blah condition] is wrong becauseâŠâ - with reference to evidence, lack of it and diagnositic criteria. That takes much time and effort. Why I do that is to ensure that the patient is put on the right path by a system that couldnât care less. Honestly thatâs how I perceive the system.
How has âall this stuff been happening?â At the moment the NHS is taking a bunch of quasi-pschiatrists - difficult to quantify because no one as yet as launched a FOIA request. The GMC couldnât care less until one of them is reported. The NHS is paying paying agencies for some who have very dubious experience and qualificaitons in psychiatry. How is that happening? Well, simple: the serious shortage of properly qualified UK consultant psychiatrists is not something that is given much oxygen. Oh no - they canât disclose all - thatâs not politically adviseable. Thatâs another thing - people are scared to refer to politics influencing quality of care.
What I have seen - and the evidence is in the records - is that those quasi-psychiatrists are doing their own thing with diagnoses and treatments. Nobody can challenge them - except at extreme risk to career, and safety. But wait - all this is happening right under the nose of your beloved CQC - and the law allows it! You canât win against such a powerful and corrupt system (and I havenât even started properly on that). The poor patient and their relatives truly donât know whatâs what.
Excellent points. The land of âShouldâ is a lovely place. Our masters are not at a level where they actually care whether diagnoses are correct or not. Where is the CQC? Somewhere else obviously.
Understand the big picture first: Itâs not really about properly diagnosing and treating people so that they get better and avoid risk of relapse. How dare I say that!? I dare and I do. Nobody can deny what I have witnessed over the last 30 years - but of course they can argue with my interpretation of what Iâve seen. [Sidebar: What does smoking have to do with causation of mental disorder, and increasing relapse rates? And what is the measure of success for smoking cessation programmes in mental health?]