Think before you disclose...

[paw655]

While I had not intended on returning to post, what happened at my consult, what the ortho said and did, is to me worth sharing in hopes that others won't set themselves up the way I did.

On the New Patient Health Form it asked if you were under a MDs care and for what - believing it is important to answer honestly I said yes, for bipolar disorder and depression. The form asked for medications, which I also disclosed (5 of them), and hospitalizations, which I indicated were only psych. I am used to health care professionals looking at my information, asking questions if necessary, or just ignoring it if it is not relevant (as it orthodontia).

The eval and all went well, and I agreed to the treatment plan. At the very end of the appt., I commented that sometimes I get anxious during dental appointments so I might want to get up and walk around, or reschedule if things felt really stressful. The ortho then asked directly my diagnosis (bipolar), and whether I was on anti-psychotic medication, and all my other meds. She said she needed to talk to my psychiatrist to "determine the extent of my psychosis" (which I'm not) because she was afraid I would have a manic episode in the office when there were children there and hurt them (I am not kidding, she said that). I said I didn't want her to talk to my psychiatrist - not because I didn't trust what he would say because he would protect me - but I was scared what she would do with any new information. She then told me if I didn't let her talk to the psychiatrist she would refuse to treat me, because "I need to know what kind of manic episodes you have, if you take your medication. What if you got so depressed you didn't come in for 8 months (my internal response - that's my problem, not yours). And there is literature that bipolar people in a manic episode have actually ripped their braces off" (my internal response - I imagine non-manic people have ripped their braces off, ,too). At this point I conceded and have signed consents for her to talk to my pscyhiatrist and my therapist, the latter of whom already knows the situation and is disgusted with the ortho in the first place so we will see what happens next week if/when she calls. Her closing line to me was "If I can't get the information I need, I 'll give you a referral to an orthodontist you might feel more comfortable with". Pretty ironic, since I had no problems with her til she started making assumptions about what having bipolar means. Seems she wasn't willing to own her part that she didn't want to treat a "mental case."

My point in this post. In reality, I should probably have never been honest about the bipolar in the first place, as it is very well controlled and has never been an issue beyond just serious depression. In telling her, she invoked her "mental images" of what someone with bipolar is like, such as being a threat to children in the office (which is just stupid) instead of just talking to me about it. It has no bearing on orthodontics, nor do my meds, and can invoke such prejudice that it absolutely was not worth it.

Maybe she is an exception, I don't know, but I am really upset. I am upset because I feel like I was "punished" for being honest, when in reality the problem is that she has jumped to conclusions about this particular mental illness. However, for those of you with a mental illness or a background of drug/alcolol abuse, or any other potentially inflammatory conditions, PLEASE, think twice before being honest on every and any form you complete. If it doesn't seem relevant to the service you are requesting, consider "a sin of omission" unless there are legal ramifications. I really liked this orthodontist a lot, and am quite sure everything would be just fine had I not disclosed the bipolar - now I'm not sure what to do except protect myself much better in the future.

[akabraces]

I am sooo sorry to hear about your experience, how absolutely horrible,
unprofessional, and inappropriate. It is hard enough being bipolar, one does not need to encounter such blatant ignorance and stigma. I always
write my diagnosis and hospitalizations on different doctors' forms, and have never had a problem, only understanding and compassion. So I am
very upset to hear that you had this nightmarish encounter. I think you were totally right to assume that she would receive your information like a professional, and she violated your trust in her.
Make sure you pamper yourself to feel better, you deserve much better
treatment, and I think I would not continue treatment with someone who
made such misguided, ignorant assumptions. That's really too bad...
Feel better and thank you for sharing!

[rsprouse]

Hi paw,

You have every right to be upset with your ortho. On one hand they were doing their job, but it sounds like they lack a little couth and courtesy. On the other it is imperative that you provide a thorough medical history including all medications that you are on and any condition that you have or had in the past. You should be open and honest and know that everything with your practitioner is in complete confidence. If you do not feel comfortable with discussing your conditions then you should seek a different provider in which you are comfortable. But leaving out information from your medical history can lead to catastrophic consequences. In the event of a medical emergency, the more information on your health history the better you can be treated. I had an OS rotation this week and one patient had a medical emergency. Knowing a complete history of the diseases and medications allowed us to treat the patient efficiently and there were no lasting problems. If the patient had left out medications or information we probably would have done things differently and there definitly could have been complications and the end result may not have been as positive. So in short, find another ortho in which you are comfortable and do not be embarassed or concerned about your medical history.

Best,
Rory

[Flora2006]

I agree with everything KK said. You need to find a new orthodontist. One that will treat you much better. Good luck!

[jcdamon3]

Hi paw655, I am glad to see you are back on the board I am disappointed that you didn't get your braces, since I thought you were getting them this week. I was wondering where you were!

At this point I conceded and have signed consents for her to talk to my pscyhiatrist and my therapist, the latter of whom already knows the situation and is disgusted with the ortho in the first place so we will see what happens next week if/when she calls.

This sounds very positive and I hope it all works out for you. Life can be a struggle. We can't expect ortho's to know everything about bipolar disorder and as I have said in other posts we are all pretty ignorant, unfortunately. Alot of people operate on fear -It's what we know best. Good luck to you and stay in touch.

[paw655]

Hi paw,

You have every right to be upset with your ortho. On one hand they were doing their job, but it sounds like they lack a little couth and courtesy. On the other it is imperative that you provide a thorough medical history including all medications that you are on and any condition that you have or had in the past. You should be open and honest and know that everything with your practitioner is in complete confidence. If you do not feel comfortable with discussing your conditions then you should seek a different provider in which you are comfortable. But leaving out information from your medical history can lead to catastrophic consequences. In the event of a medical emergency, the more information on your health history the better you can be treated. I had an OS rotation this week and one patient had a medical emergency. Knowing a complete history of the diseases and medications allowed us to treat the patient efficiently and there were no lasting problems. If the patient had left out medications or information we probably would have done things differently and there definitly could have been complications and the end result may not have been as positive. So in short, find another ortho in which you are comfortable and do not be embarassed or concerned about your medical history.

Best,
Rory

I''m gathering you are in the medical field, but what is an "OS rotation???" On medical matters, I absolutely agree on full disclosure, and have always told any new MD or attending at an ER about all my meds and diagnoses. For me, I am now leery in the "non-medical" arena. I am up front with my dentist, because there could be interactions with meds, but ortho is different. The problem here was not knowing in advance this woman was so ignorant...I felt I could fully disclose, as I have never been "burned" and this woman and the office staff were really great (until it all fell apart). If I do not feel I can disclose then yes, I do usually leave, but the problem comes in NOT KNOWING when it is safe to disclose especially when you are handed a "Health History" form that asks all kinds of questions that can trigger prejudice instead of compassion. The bottom line is, it isn't always safe to disclose, even in medical fields. It would be nice if everyone had a good understanding of mental illness, but the truth is they don't, and the stakes are very high in disclosing to the wrong person.

Sooo, I agree with you in theory, but in practice, it just doesn't work.

jcdamon3-
Thanks for the welcome. I took a little time off after the contentious locked thread issue. However, after today, I knew this was where I needed to be!

By the way, for those posters reading about this problem who are based in the US, after some research I have gotten verification that this ortho violated Section 302 of the Americans with Disabilities Act, which states:

"No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilites, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases, or operates a place of public accomodation"

Previously, Section 301, Definitions, states: "The following private entities are considered public accommodations for purposes of this title, if the operations of such entities affect commerce --...of a professional office of a health care provider, hospital, or other service establishment"

Any thoughts on what to do from here?

Allison

[dena]

PAW--I'm so sorry about that. That is awful. I do think you did the right thing, too, disclosing your situation. This ortho is just off her rocker.

I had an OS rotation this week and one patient had a medical emergency. Knowing a complete history of the diseases and medications allowed us to treat the patient efficiently and there were no lasting problems. If the patient had left out medications or information we probably would have done things differently and there definitly could have been complications and the end result may not have been as positive.

Rory, I'm glad you mentioned this...honestly this is the kind of thing I think of when I put down my medical history on forms...like just in case something would happen, someone would know enough to get good help, fast.

PAW--so, can you get a different ortho? I really think you should. You deserve to be treated so much better. Also, I think you should file a complaint...I assume their is some process for doing that with the state medical (ortho) board? In any event, you didn't do anything wrong and I hope you get out of this situation in a comfortable way.

[rsprouse]

I''m gathering you are in the medical field, but what is an "OS rotation???" On medical matters, I absolutely agree on full disclosure, and have always told any new MD or attending at an ER about all my meds and diagnoses. For me, I am now leery in the "non-medical" arena. I am up front with my dentist, because there could be interactions with meds, but ortho is different. The problem here was not knowing in advance this woman was so ignorant...I felt I could fully disclose, as I have never been "burned" and this woman and the office staff were really great (until it all fell apart). If I do not feel I can disclose then yes, I do usually leave, but the problem comes in NOT KNOWING when it is safe to disclose especially when you are handed a "Health History" form that asks all kinds of questions that can trigger prejudice instead of compassion. The bottom line is, it isn't always safe to disclose, even in medical fields. It would be nice if everyone had a good understanding of mental illness, but the truth is they don't, and the stakes are very high in disclosing to the wrong person.

Sooo, I agree with you in theory, but in practice, it just doesn't work.

Hey,

OS = Oral Surgery Rotation

The HIPAA forms that you signed before you even met with the doctor explain that your personal information and medical history are guaranteed to be kept confidential. Treating mental illness is a specialty in the medical profession and you only have minor exposure to it in dental school. To me it sounds like your orthodontist probably had a bad experience in the past and is scared to death of a repeat experience. It may have beeen an accident, something they messed up on, or a million other things. But the bottom line is it sounds like either a misunderstanding or they have some sort of baggage.

Medical consults are standard procedure in many cases before begining treatment and the ortho has every right to require one. If you have a problem with how you were treated I strongly suggest that you either find a new orthodontist in which you are comfortable or discuss how you feel with the doc and air all of your grievances in a calm and polite manner. There is a good chance that it was an honest mistake and you caught them on a bad day and they over reacted. Or if their attitude does not change you know that you are better off seeking treatment elsewhere.

Again, sorry that you felt so poorly treated, that is not a good feeling. I hope that you are able to remedy the situation in a manner that you feel is acceptable.

Best,
Rory

[ingyandbert]

Let's hope your psychiatrist set your orthodontist straight that having bipolar disorder does not make you a raving lunatic. I hope your psych makes your ortho feel about 2" high for making such ignorant statements to you. I'd definitely find a new ortho and I would tell that person exactly why you left the first one. That way, when the first ortho sends over your treatment records the new ortho won't be surprised to see what might be in them and will also be on notice that you expect to be treated respectfully. Good luck to you, I am so sorry this happened.

[paw655]

Rory,

Given you indicated an OS rotation, I am guessing you are in an advanced dental program, and it is great to hear from that perspective.

In all honesty, if she had said, "Allison, I don't treat a lot of patients with bipolar, would you mind if I called your psychiatrist to get a little more background about how best to help you' (i.e. onus on her, that the call is because she needs to learn more for her to do her job, not because, as I quote, "I need to learn more about your psychoses.). If she had said that, I would have consented immediately, without argument. It's not the idea of a medical consult I disagree with, it is her rationale, which may have just been ignorance, but is still inexcusable.

Regarding, HIPAA, HIPAA does NOT guarantee that my medical information will be kept confidential. HIPAA clearly states "A covered entity is permitted, but not required, to use and disclose protected health information (PHI), without an individual's authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures; (2) Treatment, Payment, and Health Care Operations;..."

I won't belabor the definitions of "Treatment, Payment, and Health Care Operations" but that includes "consultation between providers regarding a patient" such that the ortho would be able to share my mental health inforomation, even though irrelevant to treatment, if she felt like talking about it to a referring provider (like an OS doing the extraction) and very sensitive information would keep moving forward...

I realize I have been very litiguous about this issue. Let me share a little about why. I am a Licensed Clinical Social Worker and I work with children with autism and their families as part of a state program to provide intensive in-home services to keep children with autism out of institutions. Although I am supposed to focus with the parents on things like behavior modification, toilet training, etc. one of the things parents really need with is help getting their children services they desire or for which they are entitiled. In the US, this means I need to be proficient in two areas: the Americans With Disabilities Act (for when child is unfairly excluded based on diagnosis only without checking on actual level of impairment) and Individuals with Disabilities Education Act (pertains to Special Ed. rights). Equally important, though, is HIPAA, in that persons with and without disabilities need to really know the extent that their PHI can be shared.

With that in mind, I hope you can see that, as a Clinical Social Worker working with emotionally disturbed children, I am very, very reluctant to share information about my mental illness even to health care providers.

I have decided, though, on Monday, to call another orthodontist so I'll keep you posted.

[tronnie]

Sometimes we react to a situation to quickly. Maybe if you did not mind your ortho speaking with your doctor about you to confirm that you are fine and should not be treated any different than any other person in her office I feel it may have been just fine. Trust is a two way street and once its been established you would start a doctor-patient relationship.

Just trying to see it both ways. Good Luck! I hope to hear all things work out for you!

[Chocoholic]

Hey PAW,

Sorry to hear about your situation. Sadly many people don't know much about bipolar and jump to conclusions about it. I think your ortho was a bit overzelous and didn't state her intentions to you in very good way. And of course you're going to be offended at being spoken to like that. You might want to find another ortho or see what happens after your current one has spoken to your therapists. But if you feel the trust has gone, then it's really not going to help you.

Getting your braces is a very positive thing, but can be difficult at times and the last thing you need is someone making you feel awkward because of something else.

I hope everything works out for you - good luck!

[paw655]

Meryaten-Your post was very supportive and in no way troublesome to me. I liked the point you raised about money.

One of the other thoughts I had was if she had ever been diagnosed as bipolar and ignored it out of fear, so something like that. It's hard to imagine what was behind her reaction though.

Now, here's an interesting question. I have, in my posession, her digital photos of my mouth at various angles (I paid records fee), and her outline of at treatment plan. I have asked to be returned to me the impressions and panoramic xray so as to avoid re-doing those at the next ortho.

Given that I paid $300 for these things, and it would be very helpful to the next ortho - do I share it or not. If I do, I have to explain why I bailed after doing records, which might make the new ortho leery of my commitment. But, the truth is still pretty scary since the ortho community where I live is pretty small and even if I did not use her name, but used a female pronoun, it would be obvious who I was talking about because we have few female orthos.

So the question is back...to disclose the bipolar fiasco with ortho #1 when I get an appt. with ortho #2?

Thanks for keeping me grounded though this, everyone's support has been great.

[rockexrolloh]

I agree with KK. I'd start looking for a different ortho.
I have anxiety really bad and depression and my ortho never even mentioned it. It doesn't seem like it's her place to get all of that information from your psychiatrist.
It also doesn't seem like she really wants your business. If I were an orthodontist I would NEVER refer a patient to a different ortho. It doesn't make sense.
And honestly, if she upset you that bad, why would you want to go back? It's your money and your treatment.

[rockexrolloh]

Given that I paid $300 for these things, and it would be very helpful to the next ortho - do I share it or not. If I do, I have to explain why I bailed after doing records, which might make the new ortho leery of my commitment. But, the truth is still pretty scary since the ortho community where I live is pretty small and even if I did not use her name, but used a female pronoun, it would be obvious who I was talking about because we have few female orthos.

So the question is back...to disclose the bipolar fiasco with ortho #1 when I get an appt. with ortho #2?

Thanks for keeping me grounded though this, everyone's support has been great.

Paw, you could always tell ortho #2 that you just did not feel comfortable with her. I'm sure he/she would understand.