We’re all waiting for something.
As kids, we waited for the time that we could do it ourselves, go it alone, tie our own shoelaces, order our own food off the menu, take our baths by ourselves, and walk up and down the street or around the mall without parental supervision. We were kids. We didn’t yet have enough life experience or enough insight to realize that the time we occupied, …
We will be waiting for something until the day we die
I had had a long day yesterday, starting with a trip up the interstate to Columbia to meet with other medical chiefs from around the state of South Carolina to discuss the issues that affect the practice of psychiatry in the mental health system today.
We had struggled with the electronic medical record, Medicare paybacks, e-prescribing, CPT coding, content of notes, billing time, and motivating our medical staffs to accept the …
They’ll soon be talking about my generation, but I’m not there yet
I was a junior medical student, wearing a short white coat, pockets stuffed with reflex hammer and spiral bound Washington Manual of Therapeutics, rubber tourniquet and pens and pads. I was on a rotation out at the Dwight David Eisenhower Army Medical Center in Augusta, Georgia. DDEAMC was not too far from my home away from home, the Medical College of …
How to sign your name: A decades-old lesson that still resonates
It happened out of the blue, as such experiences often do.
I had parked my car and was walking a short distance from the public parking deck on a covered concrete sidewalk, past the open expanse of lawn and twinkling Christmas lights in front of the hospital. I was going to visit a friend who had just had surgery, and it had been quite some time since I had been in …
The memories we have during the holidays
“I don’t get no respect!”
-Rodney Dangerfield
He was a little guy, munching on the taco lunch that his mother had brought into my office for him, his younger sister and herself. I was a little miffed, I won’t lie, that the family knew they had an appointment with me right after lunch, but they decided to make the appointment itself lunch. I tried to concentrate on my interview questions and assessment, shredded lettuce …
How can our society regain respect?
I have been visiting different sites and having staff meetings with different groups of clinicians since I came back to my psychiatric services chief job recently. I have noticed something that is very important to the smooth operation of a mental health center, and most likely any health care facility you might look at.
In order to do the best job possible and help the most people who need us, we …
Medicine then and now: The importance of team
Once upon a time I saw a patient for followup, a woman I had seen for several visits in the past. She had voiced the usual oft-heard complaints about insomnia, changes in appetite, lack of energy, diminished interest in pleasurable activities, and other associated symptoms of chronic depression. Most of these had been addressed and had gotten at least partially better, to the point that her overall quality of life …
The hallucinations that psychiatric patients experience
I love football.
There is one thing that I absolutely believe to be true about the sport I love.
Any given team can beat any other team on any given day.
Sometimes my love of sports and the little metaphors that sprout from it spill over into my workspace as well.
At the end of each shift I work in telepsychiatry, one of the last things I do is complete an electronic log of …
The vast majority of folks I see want to kill themselves
I received a very intriguing question the other day.
“What happens when someone despicable, someone who has committed some horrible act or made some terrible decision, comes in for evaluation or treatment and you have to see them?”
I have been asked to see child molesters of the worst kind, men (usually) who have done things so vile to children that it would make your stomach turn to hear about them. Having …
Why the despicable deserve the best care possible
So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species?
Is it the severity of psychotic illness? The rampant drug and alcohol use that starts now when kids are pre-adolescent? Is it the broken families that are producing another generation of children who …
Going all the way should mean more than completing high school
“Yeah, Doc, I drink. I drink a lot. Some nights I drink a case of beer and a half pint. Can’t sleep if I don’t drink. Relaxes me. Pure and simple. Numbs me up like novocaine.”
A toothless grin.
“It’s the feeling of floating away. I don’t know, I just keep coming back to it. Stuff goes in, feel a little flushed, a little rush, then I go somewhere else, you know? …
What keeps some people from feeling that they really matter?
I have been asked one question about my work in telepsychiatry more that any other, hands down.
“Can you really help a mental health patient like that, through a television screen?”
The quick and dirty answer? Yes, absolutely.
The extended answer? Read on.
Psychiatry is an intensely personal specialty. It requires knowing yourself as a doctor, as a therapist, as a consultant, and as a person more than any other kind of medical practice I …
Can telepsychiatry really work?
It is tempting to use our sense of sight to make snap judgments about people, places and things.
Think about it. When you walk into a restaurant, if you see a sparkling clean dining room, you probably assume that the kitchen looks the same and that the food will be prepared in a clean, safe environment. When you see a well-dressed pilot and crew walking onto an airplane that has been …
When evaluating mental health patients, go beyond snap decisions
A commenter recently asked the other day about staging patients, especially mental health patients, in the hallways. This is sometimes done, along with triage and initial assessments, because of the very real lack of appropriate space in a busy, full emergency room. What do I mean by this?
Well, as any of you know who have ever been to the ED for anything at all, once you get through the front …
Hallways are no places for psychiatric evaluations
“Most EDs do not have separate secure areas in which psychiatric patients can be held. They typically don’t have a psychiatrist immediately available to evaluate the patient and provide guidance on management, and they do not have extra nursing staff to monitor often unpredictable patients.”
This was a comment on one of my blog posts.
Well, we have been talking about the way psychiatric patients get to the ED …
Treating the psychiatric patient in the ED: 3 changes I’d like to see
Recently, Dr. Mike Sevilla decided to hang up his podcasting mic, his blogging tools, his Twitter creds, and his Facebook presence, all in one fell swoop. Find out more about Mike the man, and why he decided to take this drastic action, at his website.
Now, I have known Mike for some time on Twitter primarily, where we will sometimes comment back and forth about issues of the day …
Why this doctor writes and puts himself out there
“Well then, if you won’t prescribe the Xanax for me, I guess I’ll just have to get it off the street.”
“If you send me home, I promise you’ll be reading about me in the obituaries tomorrow.”
“I’m in terrible pain. You have to treat me. You have to give me narcotics. If you don’t, I’ll call the state medical board and report you.”
I hate to be manipulated.
Hate. It.
There is a certain …
True pain and suffering: There is no place for manipulation
There was the time I was hugging a trashcan in the lobby of the community hospital ED just a few blocks from my house. Not because I have a molded plastic fetish or because I like the smell of trash, mind you. I had an itinerant renal calculus, otherwise known as a kidney stone that was moving through my urinary system.
It. Hurt. Like. Hell.
I. Wanted. To. Die.
I was throwing up …
For psychiatric patients in the ED, waiting is the hardest part
Okay, so this morning I want you to think about something with me. I want you to be honest, as honest as you can, as I will be with you too. Deal? We can’t move forward until you agree.
Right.
What do you feel when you’re driving along, you come to the next busy intersection, stop for the red light, and see that homeless guy? You know the very one I’m talking …
Being indigent is not a crime, but being an uncaring doctor should be
The ED is a hectic place.
Sore throats. Heart attacks. Dog bites. Broken bones. Strokes. Major trauma. If you work in an ED, you see it all. And then some.
Is it any wonder then, with the potential for literally thousands of medical and surgical problems to stumble through the doors of an ED, that hospitals and the bodies that accredit them demand strict, regimented, standard, reproducible emergency assessments …
Psychiatric patients don’t fit the usual medical mold in the ED
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