Removing diagnosis from medical records

[CaptainWalker (Russell Lutchman)]

@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

@Herystote

Doesn’t these two examples above apply similarly to a person interviewed meeting the criteria for detainment. However, once in that position - the staff all can see that this person hasn’t got a mental disorder to the extent they lack capacity or insight. So, it would prove that the assessment team did not do an appropriate job in making sure that the person being sectioned had a disorder that was warranted. It shows a flaw in what they have done. A mistake.

How can the patient then prove that the original assessment or interview conducted or reported by a person in a professional position that got them sectioned was wrong?

The current context of your questions is about 'removing diagnosis from medical records’ and about the lopsidedness of ‘countering the diagnosis’.

My mind leaps back to two cases I was involved with:

1. 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 ‘bright idea’ that ‘Asperger’s (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. Here’s the rub: the diagnosis of ASD was erased by the non-NHS facility and now TRS (treatment-resistant schizophrenia confirmed). Hence patient swiftly ‘ejected’ back to NHS. Then he’s in my care. I’m dumbstruck as to how ASD is on and then completely erased - with no cogent rationale - after probably £1 million or so spent on the case of ‘your taxpayers’ money. The patient’s NR was in a mess and fumin’ (as they say in ‘scouser’ 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. Don’t ask - it’s 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).

2. The next case was a female patient - a few years later in the NHS - that I inherited on 5 psychotropic meds. What’s the diagnosis? Complex PTSD - ‘after all it’s complex’ a lay person might think so ‘give her meds’. 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 - don’t ask. Then said psychiatrist re-diagnosed ‘Mixed Personality Disorder’. 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 else’s opinion) and my Tribunal report went off. P and her father were fumin’ (long story). P’s 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. What’s the patient’s capacity for that lot?

What’s 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? ‘Some say’ (not the Styx) that it’s different. I say the principles surrounding diagnostics and diagnosis in psychiatry are the same, as in every other branch of medicine. Some don’t believe me obviously. Is Diagnosis in Psychiatry More Art Than Science? – Investigative Psychiatry

@Herystote

I don’t 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.

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 ‘reasonable body of medical opinion’ 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 doesn’t matter what the majority says.

@Herystote

If the opinion is/was unfounded - then can’t the patient provide medical evidence to counter the diagnosis?

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 £500 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 that’s related to application of the ‘least restrictive principle’ and misapplication of ‘equality legislation’. 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 ‘with lots’. Why? The CQC don’t know what’s what - the patient don’t know what’s what - even MDT’s surrounding the psychiatrist don’t know what’s what. And the GMC won’t find out what’s what cuz they sit there waiting for complaints to land in their laps - not being an inspectorate.

What ever happened to Martha’s Rule? NHS England » NHS announces 143 hospitals to roll out ‘Martha’s Rule’ in next step in major patient safety initiative)