Dinah Miller, MD
Dinah Miller is a psychiatrist and physician coach.
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Physicians
When was the last time someone sat down with you to talk about what you want from your career? Let me ask this differently: When was the last time someone sat down with you and listened while you talked about…
When was the last time someone sat down with you to talk about what you want from your career? Let me ask this differently: When was the last time someone sat down with you and listened while you talked about what you want from your career? If your answer is yesterday, or last week, or last month, or anytime in the last year, and you love what you do without …
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What do physician coaches do, and what can they do for you?
Meds
The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.” The letter went…
The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.”
The letter went on to explain that there was no further recourse, and that the medication would not be approved because it was not Food and Drug Administration–approved for the condition my patient had: …
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There is no oversight for prior authorizations. There should be.
Physicians
In 2007, I wrote a post called "Why Shrinks Don't Take Insurance." The post is a bit dated, the CPT codes have changed since then, and the reasons to not take insurance have increased. Many other doctors don't take insurance…
In 2007, I wrote a post called “Why Shrinks Don’t Take Insurance.” The post is a bit dated, the CPT codes have changed since then, and the reasons to not take insurance have increased. Many other doctors don’t take insurance now, though psychiatry remains the number one specialty where doctors don’t participate in health insurance plans. This is an updated version of that same post.
Many psychiatrists in private practice don’t …
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Why psychiatrists don’t take insurance
Conditions
First a disclaimer: I’m a psychiatrist, not a cardiologist, but I’ve followed with personal interest the discussions about calculating cardiac risk and indications for statin treatment. Risk is an interesting word, because risk is about populations; it loses the individual.…
First a disclaimer: I’m a psychiatrist, not a cardiologist, but I’ve followed with personal interest the discussions about calculating cardiac risk and indications for statin treatment. Risk is an interesting word, because risk is about populations; it loses the individual.
And it seems that statin treatment has taken on a bit of stigma — something we’re used to in psychiatry — now you can eat your cake and have low cholesterol, …
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Another take on the statin issue: Can lifestyle changes kill?
Physicians
I’m lucky, I work for one of the best hospitals in the country and I have access to the best medical care that our society has to offer. With one glitch, that is -- when I access that care, my…
I’m lucky, I work for one of the best hospitals in the country and I have access to the best medical care that our society has to offer. With one glitch, that is — when I access that care, my medical records are put into a system that can be viewed by thousands of people, some of whom include my bosses, co-workers, supervisees, neighbors, and even some of my patients.
I …
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Why the days of medical privacy are over
Physicians
For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management. It all gets mushed together, a patient…
For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management. It all gets mushed together, a patient may talk about an upsetting event in their lives (psychotherapy) and then mention they are having trouble sleeping or a side effect to a medication (medication management), then go on …
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How Medicare will devalue the work of psychiatrists
Physicians
Going to the doctor can be confusing. Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors. While I think it's wonderful that patients trust their doctors, there are times when patients want more…
Going to the doctor can be confusing. Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors. While I think it’s wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask. There is nothing specific …
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Ask your doctor smart health questions
Patients
Sam is young man is applying for a summer program, a real resume builder. Among other things, the application asks if he has been treated for a psychiatric disorder. In fact, he's seen a therapist and he's felt anxious at…
Sam is young man is applying for a summer program, a real resume builder. Among other things, the application asks if he has been treated for a psychiatric disorder. In fact, he’s seen a therapist and he’s felt anxious at times. His internist gave him some Lexapro samples and he feels better. The symptoms of his problems have been limited to his own subjective distress. His anxiety is not something …
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When applications ask about your psychiatric history
Tech
Joe Frisch is a staff scientist at the SLAC National Accelerator Laboratory at Stanford University. Dr. Frisch writes: "I wonder when we will start seeing really addictive games banned? I don't know what makes games addictive though. Angry birds is…
Joe Frisch is a staff scientist at the SLAC National Accelerator Laboratory at Stanford University. Dr. Frisch writes: “I wonder when we will start seeing really addictive games banned? I don’t know what makes games addictive though. Angry birds is a mystery to me – there is no ongoing story line, you don’t really gain any abilities as the game …
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Angry Birds: A psychiatrist explains the addiction
Education
For years, I supervised residents. They would come in each week and tell me about a patient in crisis. If no one was in crisis, they’d say all their patients were fine and they didn’t know what to talk about,…
For years, I supervised residents. They would come in each week and tell me about a patient in crisis. If no one was in crisis, they’d say all their patients were fine and they didn’t know what to talk about, even though I had told them to pick a patient they saw weekly and either audio-record the sessions or take detailed process notes. Psychotherapy, I would say, is a …
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Psychiatry residents need to learn psychotherapy
Physicians
We really don't even have a precise definition of what "psychotherapy" is, and CPT coding has defined it in terms of time spent in a session and reimbursements. A 50-minute session gets coded as 90807 which stands for "45-50 minute…
We really don’t even have a precise definition of what “psychotherapy” is, and CPT coding has defined it in terms of time spent in a session and reimbursements.
A 50-minute session gets coded as 90807 which stands for “45-50 minute psychotherapy session with medication management on an outpatient basis in a physician’s office.” The frequency doesn’t matter, nor does the content of what transpires– at least not for the CPT …
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Psychotherapy from the psychiatrist’s point of view
Patients
Why is it that some people have a psychiatric disorder and they bounce back and it's not a big deal, while others struggle terribly? For the unlucky ones, mental illness defines them. Here are some factors that affect how much…
Why is it that some people have a psychiatric disorder and they bounce back and it’s not a big deal, while others struggle terribly? For the unlucky ones, mental illness defines them.
Here are some factors that affect how much impact psychiatric illness has in a person’s life.
- The severity of the symptoms. Any way you dice it, mild-to-moderate anxiety can often be hidden
…
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Predicting how much impact mental illness has in a person’s life
Physicians
"I have bipolar disorder. Can I be a doctor?" It's one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may…
“I have bipolar disorder. Can I be a doctor?”
It’s one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick …
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Can I be a doctor with bipolar disorder?
Physicians
Seems like a simple enough question: How do you find a psychiatrist? It's not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or…
Seems like a simple enough question: How do you find a psychiatrist?
It’s not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there’s the overriding insurance question. Not to mention location, location, location.
We’ve talked before about insurance, and if you haven’t read Why Shrinks Don’t Take Your …
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Tips to find a good psychiatrist
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