Daily comic strips away was built made one of knowledge were over and he was his international forum of advocacy, he said to me, Those who labor these fields have our admiration, and our that their work someday bear lasting fruit. Assessing Social Security Payee Competency Dr. Mark Amdur recently published a useful group of pearls for the sometimes-vexing problem of assessing whether or not a person is competent to be the payee for his her own social security disability payments. Dr. Amdur's brief article refers mainly to treating physicians, such as psychiatrists and primary care doctors, who deal with such questions with every Social Security disability evaluation, but the principles often apply to independent medical examinations by psychiatrists and psychologists, and to other kinds and sources of payments. He lists a number of situations under which a separate payee be required They include clinical ones such as dementia, intellectual limitation, other deficits, manic spending, depressive withdrawal, psychosis, and substance abuse, as well as behavioral problems often associated with financial incompetence Patients evaluees whose competency is questioned often become demanding, even belligerent. Confrontations about payeeship and money general can be difficult, even violent. than one family member has been injured by a paranoid or otherwise-incensed patient demanding money. Dr. Amdur notes that when he considers recommending a third-party payee, he often suggests a three-month trial which the patient beneficiary receives his her own payments but is monitored by family or some other caregiver. If all goes well during that time, he is comfortable signing the SSA-787. Today's doctor-patient relationships encourage autonomy, but clinicians and evaluators should not be reluctant to explore and recommend when appropriate alternative payeeship when it is clearly the patient's evaluee's interest. Patients, Email, and Legal Risks clinicians, especially those approaching age, are still concerned about whether and how to use email for various kinds of patient communication. Lots of professional organizations, including the American Psychiatric Association, recognize the utility of email, but specify that it must be used properly. A recent article by Drs. Reynolds and Mossman provides helpful guidance. Psychiatrists, psychologists, and other professionals should already know to be cautious with patient-related email and texting, but patients themselves often initiate risky email communication, sending doctors and therapists detailed, confidential, or time-sensitive information the unwarranted belief that their email only be seen by the clinician, and be read at once. When one receives such messages, it's a good idea to respond generically that such topics not be discussed or considered by email or text, highlight the confidentiality risks and require a telephone or face-to-face interaction order to proceed. First, the security issues. Neither the clinician nor the patient knows who have access to unencrypted email. One be not be communicating with the patient at all, but with a family member or friend using his computer. Server operators can but usually 't intercept and read messages. At the clinician's end, unless precautions are taken, emails be opened and read by office staff and others. And we all know about illegally spoofed email addresses. At the least, clinicians should have a dedicated professional email account that is not combined with other uses. Better: use encryption method and educate your patients its use. Get patients' explicit consent before using email communication. That consent should, among other things, notify the patient of the security risks, discuss expected reading and response times, outline what is and is not appropriate for both subject lines and the body of messages, and disclose who has known access to your email account. Let patients know that they must not rely on email for things like urgent matters and sensitive or confidential topics. Anything that requires multiple email exchanges should probably be addressed person or by phone. Reading and response time is a big deal. Both doctors and patients must understand that there is no assurance that email be promptly read and dealt with. Automatic received and opened notices are helpful, but still 't guarantee that the doctor or patient himself herself read the message. Finally, remember that email or text