An Open Letter to the Department of Psychiatry, American University of Beirut Medical Center
Dear AUBMC Department of Psychiatry,
This is an open letter from a former patient. The intent of this letter is to expose the unethical treatment of patients in your department due to violation of doctor-patient confidentiality, which is especially crucial when it comes to mental health, and to urge you to take vigilance in future in enforcing confidentiality policies.
Patient information ought to be confidential and protected, except in cases where patients pose a risk to themselves or to others. Even then information should be disclosed only as needed, ie on a ‘need-to-know basis,’ as referenced on the AUBMC website.
Why then was information relating to my health and wellbeing regularly reported by my doctors to my father simply upon his asking? Why did this occur repeatedly in the five years (2007 to 2012) in which I was an adult outpatient visitor to the Department of Psychiatry? I never signed a release form permitting this. So why was my right to confidentiality routinely and progressively violated?
These are the effects of such unethical medical conduct:
1) The doctors who gave my father personal information about my life and health were unknowingly giving a violent and abusive parent weapons against his mentally ill daughter. I was held accountable in various ways for being ill and for not telling him that I was ill.
2) Since this happened from the beginning and was a recurring process, I had no reason to trust my doctors. How does a psychiatrist help a patient that has no trust in their help? I was supposed to be able to seek refuge in a medical field designed to help people like me. Instead, I was given every reason not to trust the healthcare professionals in your department to care for my health.
3) Because I had no trust for my doctors, I could not take the risk of telling them about my father’s abusive nature in attempt to get them to honor confidentiality. How did I know they wouldn’t tell him that I described him as such? The chance of that happening was extremely threatening to my emotional and physical well-being. The only avenue I could think of to get my doctors to start honoring confidentiality was so risky I could not take it. I should not have had to even consider asking for something that was my absolute right.
4) I was not able to speak to my psychiatrists about the trauma in my everyday life because it related to my father, and thus they were missing information that was crucial to treating me.
5) I had to resort to pretending I was well and lying to the doctors I could not trust, and thus not receiving adequate treatment if my symptoms happened to relapse.
In addition to the above, the psychiatrists in your department did not once question the narrative my father fed to them, in my presence, the first day I was brought to the office. They did not see me alone and ask me if what my father said was true, did not ask for my consent or confirmation of my father’s assessment of my mental capacities except superficially in his presence. In fact, they expressed agreement with my father’s assessment of my character and actions and passed moral judgments upon me and shamed me for them as I sat there. Setting aside that judging and shaming a mental health patient is possibly the most counter-productive thing to do, their doing so was based on a mere assumption. They did the most unsafe thing they possibly could: They assumed my father was honest and did not for a moment entertain the possiblity that he could be a prime manipulator. They valued that assumption over discovering the truth about and ensuring the wellbeing of their patient.
My father went with me to every visit for the first several months. Not once was I able to speak outside of his presence. I could not ask to speak to my doctors alone because he would punish me for such a request once I got home. My doctors should have made that request themselves. It was their responsibility. It was their job. By the time I started seeing them alone, I had no reason to trust them.
For years, your department caused me unspeakable damage and anguish. Although I was a highly educated and competent adult working on a graduate degree and who taught at the university level, I was treated like I had the mental competence of an infant. Even children are taken aside and asked if such-and-such event really happened.
I urge you to regulate and enforce doctor-patient confidentiality in your department. I urge you to allow and require that patients accompanied by other people see their doctors alone and speak for themselves. I urge you to honor the Hippocratic Oath and your own policies. I urge you to make sure that nothing like this ever happens again.
I also feel compelled to make the point that the above behavior is entirely consistent with cultural norms and ideals privileging paternal access to information and decision-making as some perceived right over patient personal autonomy, especially when it comes to women and female children. I urge you as a department to refuse to condone behavior that values Lebanon’s cultural norms of patriarchy, especially when they contribute to abuse and misogyny, over your medical duties. Should your doctors personally subscribe to patriarchal norms in their private lives, that is their business. If and when these biases leak into their medical practice, this becomes wholly unacceptable and is an indication that they do not have the reservation and judgment fit to be mental health care providers.
I have since moved to the United States, and my father’s attempts at control followed me to my new psychiatrist’s office. Except this time, his phone calls never got past the secretary, his emails were deleted unanswered, and his spying and stalking was met with horror and a sense of protectiveness by my psychiatrist and therapist.
Never again will I accept anything less than that. I hope you can maintain the same standards for your practice.
A Patient Demanding Medical Standards