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When I wrote the post Medical Records, I was waiting on a third batch of records to arrive.  I've had that batch for quite some time, but never managed to write about what I learned from reading it.  On my first read-through, I laughed hysterically.  For example, at the line "Smiled inappropriately several times during the interview when talking about suicide and substance abuse."  Gee, you think maybe because I was nervous?!  I've been seeing my current therapist since May and she's still waiting for the day when I'm comfortable enough to hold a conversation without being sarcastic and cracking jokes.

There's also a note of "laughed when asked to sign a safety contract".  By this point, I've lost track of how many I actually signed, and how many times I laughed and said signing was pointless.  Initially this was because the contract relies upon a willingness to pick up a phone and call for help if having suicidal or self-injurious thoughts.  I knew I would never, ever pick up the phone.  Eventually I did call once, on a lunch break from work, to discuss the fact that I had a strong urge to cut myself.  Did that 5-minute call help?  Actually, yes.  Am I at all confident in my ability to call again?  No, especially considering my failure to call somewhere between nagging suicidal thoughts and the overdose that occurred days later.

Another example of the hilarity was a 3-page Emergency Services Assessment that managed to note not once, not twice, but thrice that I had walked in with a number of suicide methods written on my arm.  This was actually more of an intellectual exercise (or, as the inpatient psych APRN noted, "an academic thought") than anything else, but the on-call therapist (who I wanted to talk to about feeling stuck with my current therapist) fixated a bit on the content of my "self-decoration".

I'm also a bit enamored of the phrase "Risk for not taking medications as prescribed."  I've never quite been sure if that is a risk they consider specific to me, or simply a product of statistics about my diagnosis.  At the time this particular report was written, I had a couple of instances of taking leftover pills that were no longer prescribed, but had not yet experienced the 5-day stretch of willfully skipping my medication.  So perhaps they were leaning more toward statistics at this point, although my own stupid behavior would account for this risk assessment in the future.

The most informative portion of these records was an update to my Adult Needs and Strengths Assessment (ANSA).  This assessment has to be updated every 6 months, so this was my second time having it done.  I was curious as to how it turned out, because I was not actually involved with the production of this assessment.  My therapist did it herself based on information from past sessions, because on the date it was due she was too busy dragging me back to the inpatient unit.

ANSA

My reaction to this assessment was a sudden increase in depression.  Each need on the assessment can be ranked 0 = no problems, 1 = history/mild, 2 = moderate, or 3 = severe.  At the time of my original assessment, there were 5 needs ranked at level 2, and everything else was 0 or 1.  I went into this assessment expecting about the same.  I thought there might be a couple more at level 2, simply because my original assessment was based on 90 minutes with a stranger.

Reality was cruel.  Two needs (Depression and Interpersonal Problems) had leaped up to level 3, and I now have a whopping ten at level 2.  So my full list of needs to be addressed (as prioritized by my therapist):

Suicide Risk
Depression
Self-Injury
Other Self-Harm (Recklessness)
Criminal Behavior
Decision-Making (Judgment)
Medication Involvement
Impulse Control
Interpersonal Problems
Social Functioning
Family Functioning
Recreational

I noted on one of my diary cards that I felt sadness because "ANSA update was depressing."  In therapy I continued that by saying "All those needs exploded everywhere."  Before my therapist could even try to reassure me, I commented that I knew it was a matter of them being needs this whole time, just that they hadn't been recognized yet at the time of the original assessment.  Does this make me feel any better?  Not so much.  It doesn't change the harsh reality that there is so much to deal with in therapy that I will probably never go more than a week without it.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/14/ansas-to-my-questions/. Please comment there.
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medical-records

In an online bipolar support group, I recently posed the following questions:
How many of you request copies of your medical records? If you do read them, how do you feel about what you read?

I have requested records three times (and received them twice...still waiting on the third batch).  The first time was in March, immediately out of my first stay in the IPU.  Aside from general curiosity, I wanted some specific information that had not been shared with me: my exact diagnosis and the results of my first-ever blood tests.  I got my answers, and a few moments of humor, and a few other moments of being really annoyed.  For one thing, my appearance when I arrived at the IPU was described as "bizarre".  I showed up clean, in dressy clothes and full makeup, and just happened to have purple hair.  This is not bizarre.  In fact, it was quite pretty.

I also was annoyed that every time someone did an assessment of my intelligence, they wrote down "average".  The staff members who have seen me over the long term would definitely laugh at the thought of me being average.

A few months later, in late May, I submitted a request for everything added since that first batch.  The day before they arrived, my therapist told me she had been notified of my request in case she had any concerns.  I would still receive the records either way, but she did tell me she was concerned that as a people-pleaser I may read things as criticism that weren't intended that way and become upset.  And possibly injure myself in response.  She made me promise that I would talk to her about anything in my records that upset me.

I tried not to be upset by anything.  I knew my reactions were irrational.  However, some things kept nagging at me, so when I next saw her I told her we needed to discuss it.  Most of my concerns were things she couldn't really address since it was about other people's notes.  The only thing I was bothered by in her notes was that she refers to me by name instead of as "the client" like my former therapist did, and I got a reasonable explanation as to why that's done.

Last week I stopped in to submit another request, this time for the past 4 months worth of records.  Aside from being a longer time period, it is also one that was quite eventful, so I'm expecting a very large stack of papers, including:

  • Updated Adult Needs & Strengths Assessment (ANSA)

  • Updated treatment plan

  • 2 inpatient nursing assessments

  • 2 inpatient physicals

  • 2 admission notes to the inpatient unit

  • 2 discharge notes to the inpatient unit

  • 21 inpatient shift notes

  • 7 visits with inpatient psychiatrist/psych APRN

  • 3 visits with regular psych APRN

  • 21+ visits with regular therapist

  • 1 visit with therapist's supervisor

  • 1 visit with on-call therapist

  • 1 phone call with a different on-call therapist


In fact, I won't say "including".  I don't think I've missed anything, so if there are additional pages beyond a few more times seeing my regular therapist between now and when the records are printed, I think someone should take me out back and shoot me.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/10/25/medical-records/. Please comment there.

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