I am in favor of asking patients for permission to publish clinical material about them, but am against disguising clinical material. Altering facts to disguise a patient's identity is like publishing false scientific data. Instead, details should be omitted unless they are crucial. While there are quite a few reports of patients who were offended by publications with their clinical material, some patients may be offended if the clinician does not use their material. Whatever the procedure for requesting consent, the tone and mindset of the therapist are critical. There must be clarity, in the clinician's mind and communications, that the patient can refuse consent with no adverse consequences.