Psychiatrist won’t give up a patient’s list of medications

DEAR DR. ROACH: My sister has asked her psychiatrist for a list of the medications she has been on during the past few years. She would like to try a new one, as she is crying constantly and seems disoriented. He won’t explore changing meds and also won’t give her the list, claiming he hasn’t got the time. Isn’t it illegal not to give her this information? Who should she contact in the state of New York? I am very worried. This does not seem professional. -- Anon.

ANSWER: I am not an expert on the law, but in New York, a patient has the right to see their medical record, with some exemptions, which might possibly apply in your sister’s case. The first is that “personal notes and observations maintained by the practitioner [ i. e., the psychiatrist]” may be denied by the practitioner. The second is that “information that the practitioner determines may reasonably be expected to substantially harm the patient or others” may also be denied.

It’s not clear to me how a list of medications would qualify as an exception, and I think it likely that the medication list might not have been kept separately by the psychiatrist, requiring a review of all your sister’s notes to recreate a list, which is indeed time-consuming and might be considered part of the “personal notes and observations” exemption.

I have two suggestions. The first is to go through your pharmacy, who probably does have a list of all the medications she has been on ( but I don’t know how long her pharmacy may keep the list). That’s likely to be the easiest way to get the information.

The second is to have your sister see a second psychiatrist. Her current psychiatrist is more likely to give the kind of detailed information, which another psychiatrist would need to formulate a new treatment plan, directly to a colleague.

DEAR DR. ROACH: What is dysautonomia? Can you explain it and its symptoms? -- V. A.

ANSWER: The autonomic nervous system is comprised of all the things that the nervous system does without our awareness. While you reach out for a cup of tea, you are aware of your arm moving, as well as your hand feeling the teacup and bringing it over to drink: These are all part of the somatic nervous system. But while you are doing that, the autonomic nervous system is regulating your heart rate, body temperature, movement of your stomach and intestines, and a thousand other body functions that a person is normally unaware of.

Dysautonomia is a general term for an issue occuring within the autonomic nervous system. This can affect one system ( blood pressure is a common one, with too low blood pressure causing dizziness or fainting upon standing) or many systems. A condition called familial dysautonomia affects many systems. In addition to the low blood pressure upon standing, those affected by this condition may have nausea and vomiting, swallowing problems, poorly regulated stomach movement, defective temperature regulation and poorly regulated breathing.

There are unfortunately many diseases that can affect the autonomic nervous system, sometimes as its primary manifestation ( like familial dysautonomia and others), or sometimes along with other issues ( Parkinson’s disease is an example of a condition that often affects the autonomic nervous system in addition to the somatic).

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.