Medical Specialty >> Psychiatry

Doctors Lounge - Psychiatry Answers

Back to Psychiatry Answers List

If you think you may have a medical emergency, call your doctor or 911 immediately. Doctors Lounge ( does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site.

DISCLAIMER: The information provided on is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Please read our 'Terms and Conditions of Use' carefully before using this site.

Date of last update: 8/24/2017.

Forum Name: Psychiatric Topics

Question: Confidentiality and Psych visits

 goex2f - Tue Mar 31, 2009 1:03 pm

I would like to know if it is possible to see a psychiarist and maintain strict confidentiality; I am willing to pay cash and not use my insurance. I work in a hospital in a sensative clinical setting and I have seen firsthand how any history of psychiatric care has a negative impact on one's employment status; especially in these stressful economic times. I know that such discrimination is perhaps illegal, but it exists...Anyway, is there any reason that I can't make an appointment as a John Smith and pay cash, as long as I don't defraud anyone? Thanks.
 simonne westort LPN - Tue Apr 07, 2009 11:10 pm

Your visit should be strictly confidential when talking to a psychologist.
The only reason something would be reported to certain individuals, would be if
you had discussed concerns of harming yourself or others.
The part about it being legal. I think that if you were using a credit card number or someone elses identity illegally, that would encouter a problem.
I hope that you will feel comfortalbe enough to get help with your situation.
Good luck with whatever you decide you need to do.
 goex2f - Wed Apr 08, 2009 6:17 am

Thanks Simonne-I was actually concerned about seeing a psychiatrist (a medical doctor) confidentially as opposed to a psychologist (counselor)...The irony is that I work in a large hospital as a clinician (nothing to do with mental health) and I have seen several employees (one RN and one pharmacist) have their careers negatively impacted by a record of psychiatic treatment. I guess that we are expected to ignore a problem if we want to keep our careers. I was hoping that if I paid cash that I could be seen as an anonomous patient.
 Faye Lang, RN, MSW - Fri Apr 10, 2009 1:43 pm

Hello goex2f,

As Simonne stated, strict confidentiality is the gold standard of treatment. However, I have also seen treatment "leaks" within a hospital environment. It takes a strong individual to ignore the leaks and demand confidentiality with no effect on one's career, via legal means if necessary. Just as a person should not be penalized for having a broken bone, he or she should not be penalized for having a "broken" emotion. While it is not unethical for you to seek treatment and pay cash to lessen the possibility of exposure and leave no paper trail, it may not be necessary. If you are able to obtain services within a nearby community or a local private provider, set up a contract from the first session identifying your concerns and expectations about strict confidentiality. Using a false name is not unethical in itself unless intended for fraud, but it could cause difficulty if you have family issues that need to be addressed. Perhaps using just your first or middle name would work for you.

Good luck to you.

Faye, RN, MSW
 goex2f - Fri Apr 10, 2009 6:16 pm

Thanks Faye-It's hard to work in a hospital (I'm a clinical pharmacist) and not be able to access a needed outpatient service. Initially, I thought that I might be exaggerating the need for confidentiality until I saw firsthand several employees lose their jobs or miss promotions just because they had a history of mental health treatment. I guess that it is possible to seek legal redress for violations of confidentiality, but that is not practical. My current problem is depression-related and my first thought is to just treat it myself, which I know is a bad idea. But witnessing flagrant violations of patient confidentiality has caused me to lose almost all of my faith in medical practitioners. As an aside, I just turned 50 with a bad family history of colon cancer and I was supposed to have a colonoscopy, a procedure that I have witnessed with my students many times. When scheduled the procedure, I specified no conscious sedation (I don't trust that, especially now); they reluctantly agreed. When I reported for the test, the GI doc wanted to start an IV "just in case they wanted to give me something" and I went somewhat ballisic. I asked why would they do something that I specifically told them I did not want and the doc told me "let us do our job, we know what we are doing". I mentioned that I didn't apperciate being lied to, removed the IV and left. Now, every time I see the GI lab people at work, they give me a hard time about not trusting them and that I need to have this test done asap due to symptoms. I guess that I have lost all objectivity, but my trust in the medical system (that I am a part of) is now zero.
 Faye Lang, RN, MSW - Mon Apr 20, 2009 3:16 pm

Hi Goex2f,

It's true that while health care confidentiality is the law, people remain people and sometimes forget the importance of confidentiality. I am very concerned about your need for a colonoscopy. It is common to start an IV line so that it's available should you require pain medication. You need to decide which is worse - leaving colon cancer unidentified and untreated or having something for pain if it becomes unendurable. Your experiences seem to have caused you to feel out of control, and are now doing all that you can to control your environment. That is a common occurence with many psychiatric issues, including depression. I urge you to take the risk and have the colonoscopy, and to seek out a therapist outside your medical community.

Faye, RN, MSW
 goex2f - Fri Apr 24, 2009 3:01 pm


| Check a doctor's response to similar questions

Are you a Doctor, Pharmacist, PA or a Nurse?

Join the Doctors Lounge online medical community

  • Editorial activities: Publish, peer review, edit online articles.

  • Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.

Doctors Lounge Membership Application

Tools & Services: Follow DoctorsLounge on Twitter Follow us on Twitter | RSS News | Newsletter | Contact us