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The Other Doctor (TOD) and I have different approaches when it comes to seeing patients who are associated with existing patients. If TOD has “X” for a patient, he will not see X’s spouse, children, siblings, etc. Even distant relatives are declined.  I take the opposite approach:  I subscribe to the ‘Family Physician” style of shrinkdom in which the doctor sees relations to appreciate all that’s happening at home, work, and family.

My style as a drawback I have to retain patient confidentiality. This is no small task. I have to remember who said what. Mr. R sometimes asks me will I see their spouse, child, parent, coworker, or friend. This is a compliment as he must feel good about my services to ask me for such. I explain yes I am willing but on the agreement despite my attempts to keep boundaries inevitably I will bungle.  I give an example of asking Mr. R about so-and-so only to see him raising his eyebrows and asking me how do I know about so-and-so as he hasn’t ever brought it up. Inside (I explain) I am thinking “Drat, it was Mrs. R who told me that”.  If Mr. and Mrs. R don’t mind these human mistakes then make it so.  I don’t remember a time when this dissuaded them from both seeing me.

Getting different views and perceptions of what’s happening can be curious. The missus comes in with remonstrations about the mister. A few weeks later when I see the mister I ask how are things at home he replies oh everything is fine really no matters.  Is one of them ‘right’ and the other ‘wrong’? Are both ‘true’ from a subjective point of view? I have to maneuver around these Roshoman moments all the time.

The ‘family practice’ style of psychiatry has a harder issue than merely keeping tabs on who gave me what or different points of views. I wrestle with ‘secrets’ the other one doesn’t know but ought to. The Other Doctor doesn’t have to contend with these matters, which is probably why he does not do the family practice approach. Recently I had a new patient who was horribly depressed in his relationship. He felt stifled to speak up his partner about the many miseries in their marriage. A few days later I saw his partner who remonstrated his partner the new patient is depressed but he can’t figure out why when all is so well at home and they are groovy.  I remember a case I saw the mister who was having hook ups unbeknownst to his wife my other patient.  Do I tell her?  I am allowed to break patient confidentiality if there is an immediate threat to self or others. If someone says they plan on killing themselves this weekend but don’t tell anyone you bet your knickers I am going to call someone. However what if they are voicing thoughts of suicide without immediate plans or intent and the spouse doesn’t know. That’s not as clear.

As for complaints about the other, I often sense A is telling me things as A doesn’t trust B is forthcoming with me. I try to get A’s permission for me to talk to B. When they so no, I point out how the heck am I supposed to bring up something?  Often I have to find some way of discussing a topic with B without letting on I know the scoop because A said so. Once in a while B smells a rat; I remind B this happens when A and B see the same shrink.

You would think these matters would be enough for me to take TOD approach. I too should tell folks I won’t see their friends, family, and coworkers – but they don’t. The benefits of seeing the bigger picture outweigh the drawbacks.

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March 2019

Spo-Reflections 2006-2018