I have a confession to make. I don’t think what I do each day makes any sense.
Perhaps I should explain myself. Six months ago, I started my own private psychiatry practice. I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions. I figured that an independent practice would permit me …
Why I’m not sure that psychiatric medications work
Consider the following two clinical scenarios:
1. William, a 62 year-old accountant, has been feeling “depressed” since his divorce 5 years ago. His practice, he says, is “falling apart,” as he has lost several high-profile clients and he believes it’s “too late” for his business to recover. His adult son and daughter admire him greatly, but his ex-wife denigrates him and does everything she can to keep their children from seeing …
Delivering mental health care in a more rational fashion
Whatever your opinion of the Affordable Care Act, you must admit that it’s good to see the American public talk about reducing health care costs, offering more efficient delivery systems, and expanding health care services to more of our nation’s people. There’s no easy (or cheap) way to provide health care to all Americans, particularly with the inefficiencies and absurdities that characterize our current health care …
Reform needs more than expanding health care coverage
I have a confession to make. I don’t know what “bipolar disorder” is. And as a psychiatrist, I’ll admit that’s sort of embarrassing.
Okay, maybe I’m exaggerating when I say that I don’t know what bipolar disorder is. Actually, if you asked me to define it, I’d give you an answer that would probably sound pretty accurate. I’ve read the DSM-IV, had years of training, took my Boards, treated people in …
Why the diagnosis of bipolar disorder isn’t clear
The practice of medicine has changed enormously in just the last few years. While the upcoming implementation of the Affordable Care Act promises even further—and more dramatic—change, one topic which has received little popular attention is the question of exactly who provides medical services. Throughout medicine, physicians (i.e., those with MD or DO degrees) are being replaced by others, whenever possible, in an attempt to cut costs and improve access …
What could bring psychiatry to its knees, or save it
An article in the New York Times recently described the increasing use of stimulant medications such as Adderall and Ritalin among high-school students. Titled “The Risky Rise of the Good-Grade Pill,” the article discussed how 15 to 40 percent of students, competing for straight-As and spots in elite colleges, use stimulants for an extra “edge,” regardless of whether they actually have ADHD. I’ve written about ADHD. It’s a real …
Applying ADHD lessons to medical marijuana
When asked what makes for good patient care in medicine, a typical answer is that it should be “patient-centered.” Sure, “evidence-based medicine” and expert clinical guidelines are helpful, but they only serve as the scientific foundation upon which we base our individualized treatment decisions. What’s more important is how a disorder manifests in the patient and the treatments he or she is most likely to respond to (based on genetics, …
What does patient centered care say about psychiatry as a science?
I’m reluctant to write a post about ADHD. It just seems like treacherous ground. Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another. But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.
If …
Why we should eliminate the diagnosis of ADHD
One of my most vivid memories of medical school was during my internal medicine rotation, when it had become apparent to me that, despite spending my pre-clinical years studying complex pathophysiology and pharmacology, and the fine art of history-taking and the physical exam, the actual clinical work seemed to be more like a numbers game. I felt like I was always responding to a data point: a blood pressure reading, …
The erosion of psychiatric training has consequences
A doctor’s primary responsibility is to heal, and all of our efforts and resources should be devoted to that goal. At times, it is impossible to restore a patient to perfect health and he or she must unfortunately deal with some degree of chronic disability. Still other times, though, the line between “perfect health” and “disability” is blurred, and nowhere is this more problematic than in psychiatry.
To illustrate, consider …
Psychiatry should not be a tool for social justice
A cover story by Gardiner Harris in the New York Times spotlights the changes in modern psychiatry, from extensive, psychotherapy-based interaction to brief, medication-oriented “psychopharm” practice.
The article shares nothing new, particularly to anyone who has paid any attention to the rapid evolution of the psychiatric profession over the last ten years (or who has been a patient over the same period). While the article does a nice …
Do patients accept hurried, fragmented, disconnected care?
The scientific journal Nature ran an editorial recently with a rather ominous headline: “Psychopharmacology in Crisis.” What exactly is this “crisis” they speak of? Is it the fact that our current psychiatric drugs are only marginally effective for many patients? Is it the fact that they can often cause side effects that some patients complain are worse than the original disease? No, the “crisis” is that the …
Current psychiatric drugs are only marginally effective
Do we treat diseases or symptoms in psychiatry? While this question might sound philosophical in nature, it’s actually a very practical one in terms of treatment strategies we espouse, medications and other interventions we employ, and, of course, how we pay for mental health care.
It’s also a question that lies at the heart of what psychiatry is all about.
Anyone who has been …
Does psychiatry treat symptoms or diseases?
Treatment-resistant depression is one of those clinical terms that has always been a bit unsettling to me.
Maybe I’m a pessimist, but when I hear this phrase, it reminds me that despite all the time, energy, and expense we have invested in understanding this all-too-common disease, we still have a long way to go. Perhaps more troubling, the phrase also suggests an air of resignation or abandonment: “We’ve tried everything, but …
Treatment-resistant depression is a myth
Get free updates delivered free to your inbox.
