你的心理治疗师是怎么描述你的

BOSTON — David Baldwin wasn’t sure how he had come across the other day in group therapy at the hospital, near the co-op apartment where he lives with his rescue cat, Zoey. He struggles with bipolar disorder, severe anxiety and depression. Like so many patients, he secretly wondered what his therapist thought of him.
波士顿——大卫·鲍德温(David Baldwin)和他救助的猫咪佐伊(Zoey)共同居住的合作公寓附近有家医院，不久前的一天，他在那里参加了一次团体治疗，但并不确定自己当时给人留下了怎样的印象。鲍德温一直在与会让人陷入极度焦虑和沮丧之中的躁郁症做斗争。和很多患者一样，他会暗自揣测治疗师对他的看法

But unlike those patients, Mr. Baldwin, 64, was able to find out, swiftly and privately. Pulling his black leather swivel chair to his desk, he logged onto a hospital website and eagerly perused his therapist’s session notes.
但与其他患者不同， 64岁的鲍德温能迅速地、悄悄地找到答案。他把黑色皮转椅拖到自己的书桌前，随后登录到医院的网站，急切地看起了他的治疗师对那次会谈的记录。

The clinical social worker, Stephen O’Neill, wrote that Mr. Baldwin’s self-consciousness about his disorder kept him isolated. Because he longed to connect with others, this was particularly self-defeating, Mr. O’Neill observed. But during the session, he had also discussed how he had helped out neighbors in his co-op.
临床社工斯蒂芬·奥尼尔(Stephen O’Neill)写道，鲍德温对他的疾病感到尴尬，这让他处于孤立的状态。奥尼尔注意到，该状态给他带来了强烈的挫败感，因为他渴望与人交往。但在治疗期间，他也曾谈论过自己是如何给合作公寓里的邻居们帮忙的。

“This seems greatly appreciated, and he noted his clear enjoyment in helping others,” Mr. O’Neill wrote. “This greatly assists his self-esteem.”
“人们似乎非常感谢他，他则明显感到帮助别人时他自己也乐在其中，”奥尼尔写道，“这可以非常有效地帮他建立自尊心。”

A smile animated Mr. Baldwin’s broad, amiable features. “I have a tough time recognizing that I’ve made progress,” he said. “So it’s nice to read this as a reminder.”
鲍德温宽和的脸庞上掠过了一丝微笑。“我很难确认自己已经有所进步，”他说，“阅读这些内容让我得到了提示，真不错。”

Mental health patients do not have the ready access to office visit notes that, increasingly, other patients enjoy. But Mr. Baldwin is among about 700 patients at Beth Israel Deaconess Medical Center who are participating in a novel experiment.
心理疾病患者是无法便捷地查询门诊病历的，尽管罹患其他疾病的患者已经逐渐可以这样做了。但包括鲍德温在内，以色列堂-女执事医疗中心(Beth Israel Deaconess Medical Center)的大约700名患者正在参与一场新奇的实验。

Within days of a session, they can read their therapists’ notes on their computers or smartphones. The hope is that this transparency will improve therapeutic trust and communication.
参加完会谈数日后，他们就可以在自己的电脑或者智能手机上阅读治疗师做的记录了。提高信息透明度的目的，是希望加深医患之间的信任和沟通。

“We’re creating a revolution,” said Dr. Tom Delbanco, a professor of medicine at Harvard and a proponent of giving patients access to notes by therapists as well as by physicians. “Some people are aghast.”
“我们正掀起一场革命，”主张允许患者查看治疗师及医生所做记录的哈佛大学(Harvard)医学教授汤姆·德尔班科(Tom Delbanco)表示，“有些人被惊呆了。”

The pilot project has raised questions in the mental health community. Which patients will benefit and which might be harmed? How will the notes alter a therapeutic relationship built on face-to-face exchanges? What will be the impact on confidentiality and privacy?
这一试点项目已经在心理健康群体内引发了争议。哪些患者会从中受益，哪些又会受到伤害？病历将如何改变基于当面交流的医患关系？对保密性和隐私权又会有什么样的影响？

And the project presents difficult choices for those who argue for parity between medical and mental health patients. Should patients with schizophrenia, for example, who may stop taking their medication after reading that they are doing well, have the same access to treatment notes as those with irritable bowel syndrome?
该项目也让主张同等对待内科和心理疾病患者的人面临艰难的抉择。举例来说，精神分裂症患者如果读到关于自己的病情正在好转的内容，或许会停止用药，他们也该和肠易激综合征患者享有同等的查阅诊疗记录的机会吗？

But the lingering underlying question is, do patients really want to know what their therapists think? Dr. Kenneth Duckworth, who is the medical director of the National Alliance on Mental Illness, an advocacy group, said: “I’ve offered to share my notes with patients and they’ll say, ‘No, I’m good.’ But it’s a good concept that should be researched.”
在人们脑海中徘徊的根本问题则是，患者真的想知道他们的治疗师是怎么想的吗？倡导组织“全国心理疾病联盟”(National Alliance on Mental Illness)的医务主任肯尼思·达克沃斯(Kenneth Duckworth)博士表示：“我已经表示愿意和病人分享我做的记录，而他们会说‘不用了’。但它是一个值得研究的好想法。”

The practice is so new that it is too early for a comprehensive evaluation. The Department of Veterans Affairs, which began making medical and mental health records available online last year, is only just beginning to study the effect on mental health patients.
这种做法非常新颖，对其加以综合性评估还为时尚早。去年着手把内科和心理疾病病历放在网上以便查阅的退伍军人事务部(Department of Veterans Affairs)，也不过刚刚开始研究该做法对心理疾病患者的影响。

Older studies from psychiatric wards where patients read charts with doctors found that the patients were confused or offended by the content. But as doctors helped interpret their notes, patients began participating more in their care and trusting their team.
此前有人研究过心理病房的患者与医生共同阅读病历的情形，其结果表明：一些内容会让患者感到困惑和受了冒犯，但在医生帮忙加以解释后，患者开始更多地参与治疗，也更信任他们的治疗团队。

Although Beth Israel therapists report that some patients have no interest in reading their notes, responses from a few have been positive and powerful.
尽管以色列堂-女执事医疗中心的治疗师表示，某些患者没兴趣阅读病历，但还是有患者做出了积极的、强烈的响应。

Stacey Whiteman, 52, a former executive secretary in Needham with multiple sclerosis, faces growing cognitive as well as physical difficulties. The disease has shaken her self-image and relationships; her psychological health affects her willingness to manage the disease. She finds that her medical and mental health notes complement each other.
尼德汉姆(Needham)公司前行政秘书斯泰西·怀特曼(Stacey Whiteman)患有多发性动脉硬化症，面临着身体和认知上的双重问题。这种疾病损害了她的自我形象和人际关系；糟糕的心理健康状况影响了她控制病情的意愿。她发现，内科和心理疾病病历是互为补充的。

“Yes, the therapy notes can be hard to read, and sometimes I wonder, ‘Really, I said all of that?’ ” she said. “But there’s no question that reading this stuff just charges you back up to moving forward.”
“不错，诊疗记录可能很难读，有时候我会怀疑，‘我真的说过这些话吗？’”她说，“但毫无疑问，阅读这些东西可以督促你继续接受治疗。”

While such a program may be feasible in larger systems like Beth Israel, a Harvard hospital, some solo practitioners fear it may require too much time and technological sophistication.
以色列堂-女执事医疗中心是哈佛大学的一所附属医院。在此类规模较大的机构里，这样一个项目或许是可行的。但有些个体从业者担心它太耗费时间，在技术上太过复杂。

But Peggy Kriss, a psychologist in Newton, is an early adopter. For over a year she has maintained a website with private pages for patients on which she posts session notes, as well as articles, videos and meditations.
不过，牛顿市的心理学家佩吉·克里斯(Peggy Kriss)是一位先行者。一年多来，她一直在维护一个由服务于患者的私人网页构成的网站。除了会谈记录，她还会在上边发布文章、视频以及自己的一些思考。

Toward the end of each session, she and the patient begin the note together defining the key points that have been raised.
每次治疗结束前，她会和病人一起着手整理会谈记录的内容，厘清此前提到的重点问题。

Dr. Kriss said that for most of her patients, online notes have become the new normal. One described them to her as a security blanket between appointments.
克里斯医生称，对她的大多数患者而言，线上记录已经成了一种新的常态。一位病人将其形容为两次会谈间隙的慰藉。

Some write replies. “An O.C.D. patient told me I was spelling things wrong,” Dr. Kriss said. “So I said, ‘I’m just modeling anti-perfectionism for you.’ ”
有些患者会回帖。“一位强迫症患者告诉我，我犯了些拼写错误，”克里斯医生说，“于是我回应道，‘我只是在为你示范什么叫反完美主义。’”

The Beth Israel project grew out of OpenNotes, a program by Dr. Delbanco and his colleagues that made physicians’ notes accessible to 22,000 patients at three institutions. A 2011 study showed that patients responded positively and became more involved in their care.
以色列堂-女执事医疗中心的项目脱胎于由德尔班科博士及其同事发起的“公开病历”(OpenNotes)计划。该计划让三家医疗机构的2.2万名患者得以查阅医生做的记录。2011年的一份调查报告显示，患者们做出了积极的响应，开始对治疗更为投入。

More systems are adopting the model. At least three million patients now have swift access to office visit notes, including observations and recommendations.
更多的医疗机构正在采用这种模式。眼下，至少有300万名患者可以便捷地查阅包括医生意见和建议在内的门诊病历。