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{October 18, 2012}   Dr. Michael Paré in need of psychiatric help as he continues to publish confidential patient information.
 
 
 
 
 
 
 
 
 
                                                                                                            Mike Paré blowing his own trumpet !
 
 
 
 
 
 
 
The following article by GP Michael Paré describes an encounter between himself and a female patient as he publicly quotes her responses and his diagnosis of her “personality disorder”. Though he did not inform the patient, the public now knows at least that in Dr. Paré’s cocky opinion as a GP, she had “potentially two or three additional personality disorders” as well.   Wow !!!    So Not Ethical !!!
 
 
 
Fascinating to see Doc Paré pompously discussing Boundary Lines as he arrogantly violates Patient-Doctor Privacy and Confidentiality by putting his article in the public arena where his patient may easily recognize herself or be identified by others from published quotes, clues and far too much detail.
 
 
Anybody still believe in “Privacy” and “Confidentiality” when it comes to OHIP Medicine”?  Dream on…..  !  Best to stay clear of this GP should you ever be unfortunate enough to have “Issues”. If you don’t want your dirty linen washed in public, call yourself Ms or Mr. “Smith” and pay cash to an Analyst.  Shame on this GP who should learn to shut up! 
 
 
 
 
 
 
 
 
 
 
 
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BOUNDARY LINES   –   by Dr. Michael Paré

Most people don’t like to be labelled in a negative way. A natural reaction to being labeled is to take offence and to retaliate, or both. Some people fight back with a relatively inoffensive slur: “Oh yeah? Well, you are a stupid head!” or with a more aggressive comeback: “Bleep you, you bleeper!”

However, the purpose of labelling is rarely to harm. In the medical profession, the process of identifying what is wrong with a person (diagnosis) is meant to facilitate treatment, and this is one step closer to improved health.

Thus, labelling is often essential in medicine. And because the needs of the patient are paramount and the physician is charged with taking care of these needs, there must be a distinct difference in roles of the patient and the physician. The physician’s authority to label, diagnose and treat is what distinguishes the physician from the patient. To officially label a patient is the physician’s duty and prerogative.

Of course, not everyone is inclined to agree. A patient of mine insisted I was not, under any circumstances, to psychiatrically label her. She demanded I not diagnose her as having a mental disorder. She said she had already been diagnosed with too many psychiatric labels.

I tried to empathize with her by saying something like, “I can certainly see how upset you are. Have you had a large number of psychiatric diagnoses that you do not agree with?”

To which she responded: “Well you certainly got that right, buddy.”

Her response seemed devoid of sarcasm, which indicated that my empathetic statement had made her feel understood. Nevertheless, she was less pleased with me when, a few minutes later, I interrupted her ongoing vocal and aggressive diatribe against any and all psychiatric diagnosing to inform her that I had already “labelled” her. This left her seemingly somewhat shocked; she stopped and listened.

I went on to explain that, as a physician, I am required to sometimes label a patient with a diagnosis, and that it is my duty to do so. I also clarified that I did not know the exact diagnosis, yet I felt reasonably certain she was likely suffering from some sort of personality disorder and potentially two or three other personality disorders. (I did not mention this, as it seemed unlikely the information would be well-received.)

She calmed down a little bit and said, with a tone of dejected resignation: “Well, you are certainly not the first to say so, that’s for sure.”

She then became significantly more calm and open to my need to set boundaries. Even though she had originally entirely rejected the process of assessment and diagnosis, she did agree to potentially return later to our medical clinic for further assessment.

Although I labelled the patient’s behaviour as “extremely aggressive” (albeit in the private confines of my head, and now, in the not-so-private confines of this blog), her potential commitment to continued therapy (or any patient’s commitment, for that matter) can only be labelled as “positive.”

Dr. Michael Paré is co-ordinator of the Medical Clinic for Person-Centred Psychotherapy in Toronto and chairman of the OMA section on GP-psychotherapy.

________________

  

In his most recent article, Michael spills the beans again. Though he uses fictitious names, again he quotes the patient and again the subject and content of the conversation are clear. A patient clever enough to find Michael’s “article” would recognize himself/herself immediately. Why the urge to share private conversations with patients with the world and the web?

 

Michael is a GP but puts on a ridiculous act of being a “psychiatrist”, Clearly he feels if he writes enough psycho-babble people might believe him. Below another installment on “Boundary Lines” by    “Fake- it -’till -you- make- it -Mike”.

Written by Dr. Michael Paré on October 31, 2012 for CanadianHealthcareNetwork.ca

Boundary lines need to be drawn between the physician and the patient—not only so there is appropriate contact between them when they speak face-to-face, but also so they interact appropriately in other spheres of communication, such as over the telephone or Internet.

I man who was not my patient but rather my colleague’s patient (I will refer to my colleague as Dr. Smith), violated my boundaries during a telephone conversation I had with him. I only agreed to talk with this patient (I’ll call him Steve) because my secretary told me he had said: “Something bad might happen to me if I do not talk to Dr. Paré and get his advice.”

I found this somewhat manipulative, and also eerie. I was also a little uncomfortable because I try to avoid giving simplistic advice. As most psychotherapists know, advice is not usually helpful.

I was also concerned and curious. What bad “thing” could happen to Steve? I felt a professional responsibility to take the call.

When I talked to Steve he sounded quite calm and not particularly anxious. Rather than sounding depressed or angry, Steve sounded frustrated. I was careful to check for any suicidal or homicidal ideation, but he did not indicate any. To be extra cautious I suggested he discuss his emotional problems with his own physician-therapist. Steve explained that he had attempted that, but his own psychotherapist was not telling him exactly what to do.

Of course I was not surprised. Most competent therapists would avoid giving advice. Steve claimed his therapist was not taking his complaints seriously. Immediately I felt considerable empathy—not for the patient, but for his unfortunate psychotherapist. It seemed to me that what he wanted was direct and simplistic advice on how to deal with his (in his actual words) “mean and scary wife.”

“She is not doing what I want her to do,” the patient told me. “I want you to call her and tell her to do what I say.”

I almost laughed out loud because this radical request was so absurd. I considered briefly how I should explain this was not possible. I uttered some pseudo-empathetic words and told him that, unfortunately, I could not help to resolve his domestic conflict.

Then Steve told me (and I quote): “My wife has threatened to kill me.”

I was understandably very alarmed by this shocking statement. My sense of impending danger rose. I was still unsure, however, whether this was a true case of severe interpersonal conflict or just Steve trying to manipulate me. I told him that if this was what he believed, he should get out of the house and find a safe place to stay. I also advised him to call the police and/or to obtain legal help.

Steve reassured me he did not feel like he was in any danger whatsoever. This proved that he was trying to manipulate me. Apparently Steve’s motive was to get me on the phone and keep me on the phone.

He continued to insist that his safety was not at risk. He thought my fearing otherwise was unwarranted. He insisted that his remark about his wife being homicidal was simply a “figure of speech.” He also denied having any verbal communication problems.

I felt totally manipulated by this misleading information. Amazingly, Steve refused to take any responsibility for the loaded statements he was making. He insisted my worries were entirely unwarranted and that there was no danger. It was as though he had taken me hostage on his emotional roller-coaster ride.

I finally suggested he talk to his personal psychotherapist about his concerns and that he seek a social worker. He continued to be verbally demanding and unrealistic. His thinking was erratic and he showed a complex mix of both passive and passive-aggressive aspects of his personality.

If this meeting had been face to face, would our conversation have been different? The medium is the message, as Marshall McLuhan once said. Does this mean that different types of boundary lines need to be drawn according to the medium?

You cannot hang up on a live conversation, but hanging up would not usually be ethically correct on the phone either. Of course, in this scenario, it was rather tempting. Perhaps it is primarily a question of more carefully fielding my phone calls.

Dr. Michael Paré is co-ordinator of the Medical Clinic for Person-Centred Psychotherapy in Toronto and chairman of the OMA section on GP-psychotherapy.

_____________________________

And “Mike”  –  with boundless arrogance, profound unprofessionalism and lacking any compassion   –   happily continues to publish private and confidential information about his patients all over the internet.  “Peggy” should have no trouble recognizing the following exchange between herself and this medical con man:

The balancing act: compassion and professionalism vs. the aggressive patient

 
Written by Dr. Michael Paré on December 14, 2012 for CanadianHealthcareNetwork.ca
 
Clearly the bottom line for the effective physician is the health and wellbeing of his or her patients. Nevertheless, there is a definite balancing act between caring for the patient and the cost of delivering such care. I refer not to the financial cost but to the emotional and psychological cost to the physician, which can be very high when a patient is difficult, unco-operative or overly aggressive.For example the following patient’s outburst was not particularly pleasant for me to hear. To paraphrase, Peggy (not her real name) said something like:“Why don’t you f—ing get back to me Dr. Paré! I left a voice message yesterday for you to call me. As I said it is not urgent and I’m OK, but I want to ask you something. What I feel like doing is carving into my forehead with a knife a message that reads, ‘Dr. Paré just does not f—ing care about his patients’ so that when I bleed to death people will know it was your fault, and that you are a lousy doctor.”I immediately—with considerable trepidation—called Peggy. She pleasantly responded, with supreme minimization, “Oh, did I say all that? I guess I was sort of upset when I left that message. Sorry.”In addition to helping his or her patients, a physician must also practise self-care. This may even mean me entirely avoiding a patient such as Peggy, who was causing me a very high level of stress.

On the other hand, it is also the responsibility of the physician to face their fears and at times deal with the intense countertransference reactions brought about by engaging with such challenging individuals. Obviously avoidance of all difficult patients is neither suitable nor ethically responsible for a practising physician. It could be perceived as an abandonment of our ethical commitment to needy individuals.

Yet as helpers we need to balance our compassion, empathy and professionalism, while still taking good care of our own health. Self-care is not selfish, but rather a necessary component of being a good physician. As the old adage goes: You cannot truly take care of others if you have not first taken proper care of yourself.

Over the course of my career I have often been forced to weigh my needs with the needs of my patients. As in the rest of life, some people are more difficult than others. In cases where the patient’s behaviour is overly aggressive and extremely unco-operative, the doctor-patient relationship may simply not be healthy enough.

Sometimes re-establishing a boundary line means issuing a warning to the patient. In worst-case scenarios, I have had to terminate care and refer the patient to another physician (this is only rarely the case).

“Peggy” is an example of a patient who I had considered referring to another physician because of the intense stress I had felt when dealing with her sometimes extreme behavioural outbursts. The angry, screaming message she left on my voicemail was deeply shocking. Her bitter resentment was coupled with a clever wit and an impressive spewing of searing sarcasm that was both disturbing and yet strangely fascinating to me. When I listened to her appalling message it sent cold chills down my spine. I had a visceral counter-reaction, causing me profound distress. There was this strange combination of personal fear, fascination, and paradoxical allure. Was this a healthy thing for the physician to be experiencing? My own psychotherapy supervisor and even my own personal psychotherapist didn’t know!

Perhaps I should have stopped seeing Peggy as a patient after she committed such an awful verbal attack via the telephone. Nevertheless, after having a frank discussion with her about why another such outburst might result in her being terminated as my patient, I decided to give her a second chance. This time, it was her that got the strong message from me.

The physician practises self-care to be healthy enough to do the work of psychotherapy. Being a martyr to the patient or to the system is never the best strategy. It does not help the patient or the system, and clearly (of course) does not help the physician.

If a patient simply disturbs my own wellbeing, well, that is just part of the job. Yet, if my sanity is at risk, then it is clearly time to refer the patient on.

Dr. Michael Paré is co-ordinator of the Medical Clinic for Person-Centred Psychotherapy in Toronto and chairman of the OMA section on GP-psychotherapy.

 

And Mike rambles on …………………….

 

The delicate art of acting professionally

 
Written by Michael Paré on April 4, 2013
 

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Boundary Lines

by Michael Paré

 
 

Professionals need to be careful about being professional. Although it is important to continue to be professional at all times—with the possible exception of when you are sleeping (yet even when sleeping you could be acting unprofessionally if you are also part of an “on-call” schedule and are avoiding waking up and getting to work).

 
An aside: who you sleep with might very well be a key professional issue!
 
 
 
Clearly it is not easy to precisely define “being professional”. If the reality of “beauty” is in the eye of the beholder, then also—to some extent—this is also the essence of professionalism. And yet not to the same ultimate extent, since beauty may correctly be defined almost entirely subjectively. And yet this is not the case with professional behaviors. Professional activity is not entirely subjective since we need to follow objective codes of ethics, regulatory colleges rules of conduct, etc.
 
 
For the individual practitioner to ensure that he/she is acting in a professional way, deep ongoing self-reflection is exceedingly beneficial. Sincerely contemplating their feelings, their behaviors and motives, and their thoughts is crucial. Also more formal supervision with a mentor—which is a kind of assisted self-reflection—is also very helpful.
Professionalism is exceedingly complex and very subtle. As frequently discussed in this space any definition of professional behavior and boundaries is often also very contextual. Many times the correct answer to specific questions concerning professional behavior is that: “It-all-depends” (i.e. it all depends on the specific and detailed context).
 
 
And so we see that words are very slippery things (to say the least). Therefore even the expression “a professional” may refer, at least in a perverse, or instead in an ironic way to a hired killer, (i.e. a “professional” killer rather this an “amateur”) murderer!
Nevertheless when discussing ethical behaviors there are some definite limits and certainly not everything is arguably acceptable.
 
 
 
‘”It might be acceptable to rip off the patient’s clothes (in an emergency medical setting in response to the clinical management of a victim of physical trauma). And yet usually ripping off the young nubile patient’s clothes is a serious boundary violation. Sometimes it might be acceptable (and even life saving) to cut deeply into a person’s abdomen with a sharp knife (in surgery), and yet this is never acceptable in psychotherapy.”
 
 
It is often said that in real estate the mantra is: “location, location, location”, while in defining professional behavior it might be said that the corresponding motto is: context, context, context.
Share some ways you have had to pause or reflect on being and acting ‘professionally.
 
                                                                                                    _________________
 
 
 
 
 Rather unfortunate when Mike uses an example of  “ripping”  the clothes off a “nubile” young thing. Freudian slip? A lifelong dream…..?  Mike certainly seems to expose his deepest desires. This GP-Psychotherapist is in need of a Psychiatrist to analyze his innermost fantasies. .
 
 
I would like to say to  Mike: “You either are a professional or you’re not .”   Of course Mike  finds it difficult to define “being professional”.  In Mike’s case, having no qualifications as a psychiatrist, his whole career is an act.  Mike truly is  the Emperor without Clothes.
 
 

 

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