This article is making the rounds among physicians on Twitter. Much of the information in the article, unfortunately, is accurate.
For some of the reasons stated there, I left the “traditional” health care system and pursued work at the “fringe.”
Part of this is due to my clinical interests: I like working at the intersections of different fields. For example, I like the intersection of psychiatry and hospital medicine, which is called Read more…
Sluggish cognitive tempo may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered.
And I have seen some beauts during my forty years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by “experts” brim full with diagnostic exuberance — sometimes well meaning, sometimes influenced by extensive drug company affiliations — and always ungoverned by simple common sense, a respect for …
Sluggish cognitive tempo is a dangerous diagnostic idea
In my 30 years as a practicing psychologist, I’ve seen a lot of patients with many diagnoses. In that time, I’ve seen treatment approaches evolve. Periodically, when news of a mass shooting makes the headlines, the dialogue about mental health will rise to the top of the national agenda, but — in general — we still have a long way to go in our attitudes toward mental illness.
I think it’s …
It’s about mental health, not mental illness
Traditional psychodynamic therapy is often caricatured as endless, with a complacent therapist silently growing cobwebs, listening to a patient who never plans to leave. This isn’t completely unfounded: There are therapeutic advantages to losing track of time, “swimming in the material,” and letting one’s therapeutic focus be broad. The patient’s chief complaint, i.e., the ostensible reason for coming, often gives way to more troubling underlying conflicts and concerns that might never appear in …
Good psychotherapy eventually ends
Recently, I gave a lecture entitled, “Treating Depression in Primary Care,” at an annual conference for physician assistants. I spent a good portion of the talk on the fundamentals that have been essential to me during my 15 years of practice. When things go awry in mental health care, the majority of the time it is because one or more of these fundamental principles was neglected.
My fear is …
The Ten Commandments of good psychiatry
For more than a decade I’ve taught a seminar in dynamic psychotherapy to psychiatry residents. One tricky issue that arises every year is the apparent choice between conducting a “supportive” psychotherapy, versus an “analytic” or “insight-oriented” one. I developed a sailing analogy to clarify this issue, and to teach an important point about it.
Most patients appreciate emotionally comforting support. Many seek a therapist who will provide a listening ear, who …
The choice between supportive and insight psychotherapy
One good thing about doing anything for three decades or longer is that you get to see cycles and repeated events, things that fail and things that work. I hope that over the last thirty years of learning about psychiatry and mental health (and yes, I am still learning and hope to acquire that one last little piece of knowledge on my deathbed) that I have paid attention to the …
My best teachers are my patients
Medical student Joyce Ho recently wrote an article in which she admitted to discomfort raising the topic of religion with patients. As a “polarizing” issue that could make the doctor-patient relationship “more unprofessional,” Ms. Ho imagined that patients would fear playing into their doctors’ prejudices, particularly if the doctor were atheist, and that this fear would push some patients away from the inquiring doctor. Despite her instructor’s recommendation to ask …
Self-censoring of patient information may be a public health hazard
A patient I see for psychotherapy, without medications except for an occasional lorazepam (tranquilizer of the benzodiazepine class), told me his prior psychiatrist declared him grossly undermedicated in one of their early sessions, and had quickly prescribed two or three daily drugs for depression and anxiety. He shared this story with a smile, as we’ve never discussed adding medication to his productive weekly sessions that focus on anxiety and interpersonal conflicts. Indeed, …
What does it mean for a patient to be undermedicated?
As a psychiatrist, I was trained to begin the mental status examination and overall assessment of my patient as soon as I greeted them in the waiting room. Even now, three decades after finishing medical school, I follow almost the same sequence of actions in my day-to-day interactions with my patients that I did as a resident in training. Granted, there are now electronic medical records and I rarely come …
Weighing a patient offers a treasure trove of information
The page comes from the psychiatry intern on call. “There’s a situation with patient RB on the unit. Please advise.”
We gather in the hall outside the patient’s room. There are already three — no, four — security guards standing several feet away with their arms folded. Backup. Ready. Ready for what? We whisper in hushed tones as the intern explains what happened.
He was “acting out.” He was running through the …
There’s movie psychiatry, and then there’s real psychiatry
Adults are the ones who are supposed to be stressed, not kids. Childhood is supposed to be the stress-free part of life, right?
Well, maybe not. At least not for teens.
According to a recently released survey from the American Psychological Association, teens are actually more stressed than their parents.
Researchers surveyed 1950 adults and 1,018 teens last summer and asked them a whole bunch of questions about the stress in their lives, and how …
Let’s do something about teen stress
Over the course of medical school, you are expected to get comfortable with a whole host of expensive-sounding equipment (see: popsicle stick becomes tongue depressor).
You sling a stethoscope around your neck, maybe tuck a reflex hammer in your white coat pocket, and begin that privileged journey of looking for things that don’t sound or sit quite right.
You learn rather quickly that it won’t be you on stage, and somehow, you landed …
Why we need to break the silence on eating disorders
ADVERTISEMENT
I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide.
I’ve lost only colleagues, friends, lovers — all male physicians — to suicide.
Why?
Here’s what I know:
A physician’s greatest joy is the patient relationship.
Assembly-line medicine undermines the patient-physician relationship.
Most doctors are burned out, overworked, or exhausted.
Many doctors spend little time with their families.
Workaholics are admired in medicine.
Medicine values …
There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine. Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.
A 2006 survey of emergency nurses showed that 25% …
When patients abuse emergency department workers
When I was a resident one of my attendings said, “You know why patients are called ‘patients’? It’s because they have a lot of patience. For us.”
Patients in hospitals do a lot of waiting. They wait for physicians. They wait for nurses. They wait to use the bathroom. They wait to undergo procedures. They wait for their IVs to stop beeping. They wait for the person next door to stop …
Don’t take patients’ patience for granted
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
The four pedestrians never saw it coming.
Around 11:45 p.m on June 15, 2013 on a road in Burleson, Texas (a suburb of Fort Worth), the driver of a stranded SUV and three people who had stopped to help her change a flat tire were killed when 16-year-old Ethan Couch smashed into them with his red pickup truck. Seven other teens were in the truck with him. Drunk, and driving 70 …
Affluenza: How to be sick without being sick
A frequent response to those contemplating suicide is to remember friends and loved ones, how much one is needed and how much one would be missed. Some people have a sense this statement is true and that the depressive emotions are inaccurate, so seeking therapy, medication, or riding out the episode will result in returning to whatever emotional mode is typical. Others don’t believe this sentiment, and they potentially live …
Existing for others is not enough
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 …
Why psychiatrists don’t take insurance
Get free updates delivered free to your inbox.
