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Physician voices
I am on rounds with the medical team on the floor that has patients with medical problems and psychiatric comorbidities. My presence is not actually needed; however, the social worker who attends regularly usually feels the need for support from…
I am on rounds with the medical team on the floor that has patients with medical problems and psychiatric comorbidities. My presence is not actually needed; however, the social worker who attends regularly usually feels the need for support from her attendings, who do not have the “time” to attend these meetings, so I have attended at least weekly. As I sit in the nursing station where the team meeting …
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Why doctors don’t know their patients, only their initials
Physician voices
I have spent years watching the development of quality programs. What began as a way to ensure patient safety has gradually given way to an independent group of individuals whose job it is to interpret regulations and monitor those interpretations.…
I have spent years watching the development of quality programs. What began as a way to ensure patient safety has gradually given way to an independent group of individuals whose job it is to interpret regulations and monitor those interpretations. In the process, the clinical richness of medicine has been lost. Judgment, narrative, and context matter less than forms and metrics. The work has shifted away from the bedside and …
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The 9 laws of health care quality: Why metrics miss the point
Conditions and diseases
I was at a meeting discussing issues concerning upcoming audits by various regulatory agencies and noticed a change that made me aware of the fact that many years have come and gone since I started this journey in administrative and…
I was at a meeting discussing issues concerning upcoming audits by various regulatory agencies and noticed a change that made me aware of the fact that many years have come and gone since I started this journey in administrative and public psychiatry. I was the only man in leadership at this table. I was the second oldest person at this table. Surrounded by a group of younger, intelligent, and energetic …
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A physician’s reflection: Is it time to pass the torch?
Physician voices
Reflecting on a recent meeting about upcoming audits by regulatory agencies, I couldn't help but notice a significant shift. As the lone male leader and the second eldest person present, surrounded by a dynamic group of younger women, I couldn't…
Reflecting on a recent meeting about upcoming audits by regulatory agencies, I couldn’t help but notice a significant shift. As the lone male leader and the second eldest person present, surrounded by a dynamic group of younger women, I couldn’t deny the passage of time since I embarked on my journey in administrative and public psychiatry. Far from lamenting, I welcomed this change, recognizing its necessity and long-overdue arrival. Witnessing …
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Bridging the gap: When experience meets innovation in health care
Physician voices
It is a typical day on the inpatient unit. A patient is refusing medication, and I want to take her to court to compel her to take medication while her lawyer is arguing for her right to refuse. Me: "She's…
It is a typical day on the inpatient unit. A patient is refusing medication, and I want to take her to court to compel her to take medication while her lawyer is arguing for her right to refuse.
Me: “She’s clearly psychotic. She has lost her family, and she has no place to live… all because of these delusions.”
Lawyer: “But is she behaving in a dangerous way?”
Me: “Being unable to survive …
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Does the legal system harm psychiatric patients?
Physician voices
I walk onto the inpatient unit on a Monday morning. The feeling of discomfort begins to overwhelm me. Perhaps this was due to being forced back to inpatient, but I felt it had to do with changes in the process.…
I walk onto the inpatient unit on a Monday morning. The feeling of discomfort begins to overwhelm me. Perhaps this was due to being forced back to inpatient, but I felt it had to do with changes in the process.
I started my training at a time when therapy was a central part of education. Understanding even the most psychotic patients was a key element of our field. I do not …
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Re-wounding the wounded healer
Health policy
During my psychiatric residency, I had the good fortune to train with a number of public and administrative psychiatrists. These individuals focused their attention on the care of the severely ill and the underserved and understood the systems of care…
During my psychiatric residency, I had the good fortune to train with a number of public and administrative psychiatrists. These individuals focused their attention on the care of the severely ill and the underserved and understood the systems of care that exist to provide this care. They also taught me the problems within the system and how it often creates more problems for the patients than it solves.
My story begins …
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The legend of the “oatmeal law”
Conditions and diseases
For many years, I have treated individuals with substance use disorders. I have found this work to be both gratifying and frustrating. Part of the frustration stems from interactions with governmental agencies and families. The families are, of course, fearful…
For many years, I have treated individuals with substance use disorders. I have found this work to be both gratifying and frustrating. Part of the frustration stems from interactions with governmental agencies and families.
The families are, of course, fearful and frustrated. They are watching their loved ones “die” before their eyes and want someone to fix it. It is difficult to understand that their loved one’s brain has changed, that …
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Don’t yell at me. I’m trying to help.
Conditions and diseases
I began my career in psychiatry with the desire to work with dying patients. This is an odd way to begin, but I had begun my career with interest in oncology and eventually discovered the field of psycho-oncology. After graduating,…
I began my career in psychiatry with the desire to work with dying patients. This is an odd way to begin, but I had begun my career with interest in oncology and eventually discovered the field of psycho-oncology. After graduating, the first population I worked with was HIV infected individuals when an HIV diagnosis was a certain death sentence. The work centered on helping the individual accept their impending death …
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Alone and frightened is the way COVID patients die
Physician voices
I have been working with psychiatric patients for the better part of 30 years. During this time, I have worked in psychiatric emergency rooms, prison wards, substance abuse treatment centers and inpatient psychiatric units. I have been proud of the…
I have been working with psychiatric patients for the better part of 30 years. During this time, I have worked in psychiatric emergency rooms, prison wards, substance abuse treatment centers and inpatient psychiatric units. I have been proud of the fact that, despite working in some dangerous areas, I have never been harmed by a patient. I have been threatened, swung at — but never injured. Once a patient decided …
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I was attacked by a patient and want my fear to help others
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