Good thoughts. I'll try not to rant. Not because I don't love to rant, but because I don't have time. Stigma is regrettable. Sometimes it is reasonable, sometimes unreasonably exaggerated, and sometimes just bigotry. I do think that the clinical record should be very honest (though not necessarily contain very personal details unless they are relevant to care or safety). Future clinicians need to know what they are dealing with; the treatment record should be defensible to authorized reviewers, etc. The key is not in downcoding the diagnosis or other information, but in keeping the clinical record accessible only to those who are entitled to see the information. When it comes to the patient's knowledge about his/her own illness, I like honesty but understand the occasional need to temper it if complete information would be dangerous or unduly upsetting. This is a slippery slope, of course; accurate diagnosis and frank exploration of symptoms and behaviors are important keys to good care and the best possible prognosis. Competent patient participation is a laudable goal, even for psychotic patients. Accurate diagnosis and honest recording of behaviors and symptoms is often important to third parties as well, assuming the third parties are entitled to the information. People in critical or dangerous vocations come to mind, as well as ordinary folks who cannot safely drive, pilot planes, parent children, etc. It is important not to downcode or otherwise hide things that significantly affect the safety of others. THe above are quick thoughts. Others can probably add a lot, and also think of exceptions or criticisms.
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