Please don’t call me a “prescriber.” Yes, I know it’s easier to say “prescriber” than “psychiatric nurse practitioner or psychiatrist.” The word “prescriber,” however, puts severe limits on what I can do and how I can help.
You may believe that, because I have a license to prescribe medications, that’s all I choose to do. In fact, you may believe that’s all I know how to do.
Psychiatrists can do a lot more than that.
As a …
A study published in the journal Pediatrics showed that young fathers, those who became dads at an average age of 25 years, have a 68% increase in depression symptoms within the first five years of becoming dads. This applied to young dads who lived with their children and their wives or girlfriends. Dads who lived away from their children and older fathers did not show that same increase in rates of …
Young fathers can also get postpartum depression
This evening, I read a post written by a woman who finds herself feeling alone, depressed, desperate, and afraid of losing herself as she goes through medical school.
This post is my response to that woman.
Dear colleague and friend,
You are not alone.
You are far from home. You are far from your family. You are far from the desert, the open …
Responding to a medical student in pain
“Am I a hypochondriac?”
It’s a question I hear with quite some regularity, almost never from people who suffer from bona fide anxiety disorders related to their health.
No, the fact that all you have is a simple upper respiratory infection — the common cold — instead of a potentially lethal strain of H1N1 avian flu does not qualify. Not when your response to my reassurance is relief. That’s completely appropriate, and …
Health anxiety: What hypochondriasis really should be called
It was 4:30 a.m., and I was on the side of the road, drenched in sweat and tears. I had finally slowed my breathing to normal. I was going to be late for rounds. No time to obsess over possible questions. No time to memorize lab values, or practice regurgitating them.
I thought of home. My family and friend, who I hadn’t …
I never understood the loss of empathy during medical training. Until now.
In his piece on Robin Williams, Andrew Solomon of the New Yorker states that every 40 seconds, someone commits suicide. Actually, it’s every second of every day, as people choose the action, or inaction, that will end their lives sooner. When the patient with metastatic melanoma, who is quite capable of getting to the refrigerator, refuses to take food or liquids, she is taking her life. Her body will …
Was the death of Robin Williams preventable?
In every life we have some trouble
When you worry you make it double
Don’t worry. Be happy.
It will soon pass, whatever it is.
Don’t worry. Be happy.
– Bobby McFerrin
Much has already been written in reaction to Robin Williams’ untimely death, about his incandescent talent, his prolific career, his decency and kindness, his addiction and his mental illness. His death robbed his fans of many more years of his genius …
Broadcasting suicide in social media: A failure of responsibility
When I hear debate over the association between SSRIs (selective serotonin re-uptake inhibitors, a class of antidepressant medication) and suicidal behavior in children and adolescents, I am immediately brought back to a night in the early 2000s. As the covering pediatrician I was called to the emergency room to see a young man, a patient of a pediatrician in a neighboring town, who had attempted suicide by taking a nearly …
When medications devalue the opportunity to listen
Today, I saved a life.
And I wish I could tell you a story about fancy heroics — about an exploratory laparotomy, a chest thoracostomy, or a patient that coded and I was the last person to perform the chest compressions that brought them back to life. But I can’t. But I can tell you that I saved a life.
She was 16-years-old, and moved here four years ago from a different …
Today, I may have saved a life
I was shocked and deeply saddened when my daughter announced at the dinner table that Robin Williams had died of an apparent suicide. My wife and I and the three of our children home at the time all pretty much gasped audibly in unison, and then for a moment after, you could have heard a pin drop.
For a bit after that, we talked about our shock and sorrow. And then after that, …
A physician reflects on Robin Williams
We are civilized people in the United States. We don’t set up leper colonies or concentration camps or psychiatric snake pits to banish people with severe mental illness. Instead we send them to jail or prison — almost 400,000 of them, more than 10 times the number receiving care in hospitals. And we also blithely ignore the fact that additional hundreds of thousands live homeless on the streets or in …
Society’s mismanagement of the mentally ill is a disgrace
A wise friend who had completed residency told me prior to my starting training that the key to having fun was “never sit down when you get home from work.”
Three years out of fellowship and practicing as a psychiatrist in Brooklyn, the words still resonate today. The residents and medical students that rotate with me marvel at the stories of my full time acting career as a resident performing in …
Work-life balance begins in residency
As doctors we prescribe a lot for our patients — pain relievers, medications for specific ailments, exercise, or vitamins. However, too often we forget the power of vitamin C: human connection. As a therapist and medical doctor for children and adults with ADHD, I don’t underestimate the power of employing a variety of treatments that treat the patient as a whole; this may include medication, recommendations about diet, exercise and lifestyle …
The other vitamin C: Are you prescribing it?
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OpenNotes is “a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.” According to their website, three million patients now have such access, generally online. Participating institutions include the MD Anderson Cancer Center in Texas, Beth Israel Deaconess in Boston, Penn State Hershey Medical Group, Kaiser Permanente Northwest, and several others.
Patients with a premium account in the My HealtheVet program at the VA have access to outpatient primary …
Progress notes are a poor tool for doctor-patient collaboration
Somewhere late morning, after rounding on my first day of internship, I received a call from my sister.
“She wants to kill herself. What do I do?”
We had been through this before with our mother, fifteen years ago, the week I moved out of her house. She ended up in the psychiatric unit as we packed our bags to move in with our grandmother. This time, fifteen years later, things were …
Medicine has allowed me to intellectualize my mother’s illness
At the recent gubernatorial candidates forum on mental health, Martha Coakley repeated the oft-heard phrase that depression is like diabetes. Her motivation was good, the idea being to reduce the stigma of mental illness, and to offer “parity” or equal insurance coverage, for mental and physical illness. However, I am concerned that this phrase, and its companion, “ADHD is like diabetes,” will, in fact, have the exact opposite effect.
A recent New …
Stop comparing depression to diabetes
I am a great supporter of mental health research but worry that it has lost its sense of proportion and is chasing the wrong priorities.
The really glamorous stuff consumes almost all of the enormous NIMH budget and now has behind it the huge addition of a $650-million private donation aimed at solving the genetics of mental illness.
Neuroscience is an extremely easy sell to Congress and rich philanthropists because it promises …
A cruel paradox when it comes to mental disorders
It was with much distress that I read a New York Times front page article by Benedict Carey about the heart wrenching plight of the Serpico family in their journey to get proper psychiatric treatment for their two sons. As a child and adolescent psychiatrist who has served children and families for more than 30 years, trained many child psychiatrists, and served as president of the American Academy of …
It’s time we stood up for the orphan of organs: the brain
Today, I celebrated mental health care. And this was after a morning of battling with insurance companies, patching together community care plans, trying to create an inpatient bed for a suicidal patient where none exist, and arguing with agencies for better patient support.
I work on a busy inpatient psychiatric unit that provides a daily reminder of the beauty, heartache, and pain that define living with mental illness. The diverse stories of …
Why this is an exciting time to work in psychiatry
I recently read an interesting article in Glamour about why Zosia Mamet, an actress on HBO’s Girls, refuses to “lean in.” While the column focuses on the influence of modern-day feminism on notions of professional success, her words resonated with me as a medical student and an aspiring psychiatrist.
“I have been incredibly blessed with success in my chosen career. I’ve worked my a** off and had the support and encouragement …
Can medical students lean in to psychiatry?
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