I wholeheartedly agree with the idea of etiquette-based care. I was shocked to read in my medical record the opinion of a resident to whom I had adressed my privacy concerns over my medical records being left out at the front desk--prior to the enactment of HIPA--a concern which now would be grounds for expensive legal redress. I was upset because it was a complaint I had made several times before, but I was nowhere near the level of emotion his comments suggested. I believe the remarks he entered into my medical record were unprofessional, and are evidence of a certain degree of prejudicial behavior.

As a consumer of mental health services, I have learned the importance of the phrase "buyer beware." I would like to put greater faith in psychiatrists, but too often their assessments are made in appointments of 15 minutes or less, which all too often do not include talk therapy. I fail to see how a quick series of rate-your-mood questions are scientific or evidence based. Further, if I am having a bad day, I have learned to hide emotion because the knee-jerk provider response to patient emotion is to increase medication. And God forbid I should complicate a provider's day because I choose to breastfeed and reject the chosen medication, one that just happens to be aggressively marketed and not available as a generic. I do not have the opportunity to challenge that provider's assessment of me as "uncooperative" or "flight risk," or to remark that the provider was too easily frustrated by--or just downright hostile to--my attempts to explore my medication options. Too often providers read questions about options as medication resistance, rather than an attempt to make an informed decision.

My medical records are missing an important component--patient assessment of a provider's mood and behavior! This is something that should not be summarily dismissed, because psychiatrist who does not treat patients as he or she would like to be treated leaves the door open to medical error and missed diagnoses.

I am a veteran and have received, both medically and mental health-wise, some of the best care in my life (65 years old).  I think the Vets Administration often has a negative image, but I have found it to be high quality and caring.  They are also making an increased emphasis on mental health services, especially to accommodate our returning soldiers from the Irag-Afghanistan conflict. I hope you give them credit.  Alice Holstein, Ed.D.