What We Do, What We Say, What We Don't Say: Confidentiality In The Publication Of Clinical Writing

Questions concerning analysts' publication of material from the analyses of their patients have troubled the field of psychoanalysis since its inception. Disguise inevitably distorts the clinical material and is often insufficient to protect the patient from recognition. Asking the patient's consent for publication intrudes upon and alters the analytic process. While analysts have largely reached a consensus about the need for anonymity in published material, there is still considerable debate about the necessity for obtaining patients' consent when using their material for publication. In this paper, I will trace the evolving meanings of disguise, and particularly of consent, in the analytic literature. I will place a particular emphasis upon the differing theoretical belief systems that underlie the analyst's decision to ask consent from her patient or not to do so, and I will argue that, although decisions on asking consent remain a complex matter, such coherent belief systems should play an important part in analysts' decisions regarding consent. I will illustrate my thought processes and some clinical situations with brief examples, and I will conclude with some practical recommendations, with the hope that these will stimulate further discussion in the analytic community.

Addressing Nursing Scholarship: A Framework for Currency and Number of References

BACKGROUND

Timeliness and number of references in written work is often a topic of controversy. Decisions about choice of references become complex when there is little recent published information or a great deal of important historical work on a topic.

PURPOSE

The study aim was to develop a framework to guide authors to determine the number and currency of references to support their writing.

METHODS

This study used a descriptive design with three steps: review of journal author information for guidance about reference currency (n = 247); correspondence with journal editors (n = 27); and a survey of nurse educators (n = 44) regarding currency and number of references in written assignments.

RESULTS

Findings affirmed that recent literature is vital for nursing scholarship. Numerical guidelines offered were not based on identifiable consensus or rationale. Historical perspectives published over 5 or 10 years earlier are valued, even sometimes required. For a clinical paper, citation of the most current literature is viewed by editors and educators as essential, and may suffice.

CONCLUSION

Based on the findings of this study and our search of the literature, we developed three decision making algorithms for searching the literature and selecting references by currency and number.

(How) Can We Write about Our Patients?

The ethical underpinnings of writing about patients are explored, the question of how best to undertake the writing of case reports being subordinated to a more general question about the ethics of choosing how or whether to write. An unsolvable paradox is encountered here: that we need to write or speak about our clinical work in order to conceptualize and understand the work we are doing, but that in the very gesture of doing so, we are breaking a fundamental bond with the patient. This conundrum is viewed from a number of vantage points. The controversy about how best to go about writing clinical accounts is first addressed, after which the literature is reviewed to draw out the ethical conflicts that writing about patients engenders in the patient. Next attention is given to undercurrents in the analyst's motivation to write, again drawing on current literature. Finally, a consideration is provided of how, based on what we might learn from this review, these problems can be addressed.