It was the first time I had every flunked a test. My fragile ego was shattered. It was my first year at University of California, San Diego School of Medicine, one of the most difficult to enter. I failed my pharmacology test, not because I was stupid, not because it was difficult, but because I was clinically depressed.
A dark cloud covered my head and I could not see. Much of my …
We should not succumb to spiritual darkness
I recently read an article in the New York Times titled “When Doctors ‘Google’ Their Patients,” which details one physician’s thoughts on whether or not doctors should look up their patients on the Internet.
What struck me was the fact that despite growing up with the Internet and being able to find information about practically anyone using Facebook, LinkedIn, Google, or Instagram, I have never once been tempted to find out …
Should doctors ever Google their patients?
Every once in a while a brilliant investigative journalist can get us back on track when we have been led badly astray. I hope that a recent New York Times front page story, “The Selling of Attention Deficit Disorder,” by Alan Schwarz will have that kind of special societal impact.
Schwartz has previously written a series of accurate and hard-hitting articles exposing the over-diagnosis of ADHD and the consequent careless and excessive …
It is time to re-evaluate ADHD and return to safe practice habits
I’m coming out, but it isn’t what you’re thinking. I’m writing this to finish answering a question that I was asked 25 years ago by an attending physician. He was a Scotsman with a ruddy complexion and it was early in my third year of medical school. I had been up since 4am rounding on patients and then assisting on a general surgery case.
Answering the esoteric questions the Scotsman posed had …
The stigma of becoming a psychiatrist
While on my inpatient psychiatry rotation, I had the opportunity to work with an adolescent female with a troubled past and a significant history of psychiatric illness. It was through coloring that her barriers broke down and we were able to establish a safe space for difficult conversations. She was safely discharged two weeks after her suicide attempt. As she left, she gave me a hug and handed me this:
Through our patients we find ourselves
I’ve been skeptical of the trend of “holding back” children with late birthdays. These are kids, usually born in the summer, who are just a few months short of the next grade cut-off. Some parents wonder whether it would be wise to hold them back a few months, so they end up one of the oldest (rather than youngest) kids in their class. This might seem to confer an advantage …
Holding children back a grade and ADHD: A problem or solution?
A colleague of mine recently pointed out a study by the Center for Health Care Strategies (CHCS) about mental health care for children. Among their findings was this: Almost 50 percent of children enrolled in Medicaid who are prescribed psychotropic medications receive no identifiable behavioral health treatment.
This is a disturbing, though not surprising, statistic given that these medications are commonly prescribed by primary care clinicians. Children living in poverty often experience greater environmental stress and may …
Mental, not behavioral, health care: Why it matters
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Here are the most popular posts of 2013.
The 10 most popular KevinMD posts of 2013
A standard part of any psychiatric evaluation involves inquiring about a patient’s sleep. Hidden in the answers that follow the basic question of, “How are you sleeping?” are the clues that are needed to diagnose what is ailing the patient seeking help from me.
For those with depression, they typically report early morning awakening (i.e. they wake 3-4 hours earlier than needed) and are not able to return to sleep. Those …
Treating the nightmares associated with PTSD
Before medical school I worked in a research lab investigating the relationship between stress and memory. As a research assistant, I dutifully administered memory test and collected saliva samples to test for cortisol levels.
My boss sent the data to her statistician for analysis, and was thrilled to find that despite the lack of connection between most of the variables of stress and memory studied, there was one positive finding — a …
Evidence-based medicine and the limitations of research
When the American Academy of Pediatrics changed the guidelines for ADHD to expand age of diagnosis to include children from age 4-18 (from 6-12), that number of cases would rise was, by definition, inevitable. The recent survey by the CDC, published in the current issue of the Journal of the American Academy of Child and Adolescent Psychiatry, indicating that one in 11 children in the US carry a diagnosis of ADHD, …
We need a movement to deconstruct the ADHD diagnosis
“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?
As a psychiatrist who is passionate about integrative mental health treatments, I was excited to spend five days recently in St. Petersburg, Florida for the annual conference of the American Board of Integrative and Holistic Medicine.
At the conference, I learned that even more than I previously realized, our ecosystem and environment have a profound effect on our happiness and wellness, and can either give us easy access to good food …
Should we consider an integrative psychiatry model?
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This wasn’t just plain terrible,
this was fancy terrible.
This was terrible with raisins in it.
-Dorothy Parker
More and more of my clinic time is devoted to evaluation and treatment of depression and anxiety rather than sore throats, coughs, UTIs and sprains/strains. An outbreak of overwhelming misery is climbing to epidemic proportions in our society.
A majority of the patients who are coming in for …
We have lost all perspective about what is truly terrible
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
It seems to be trendy these days to say we’re all overmedicated. People say we swallow a pill to try to escape any fleeting negative feeling, or that we throw them at our kids for any bad behavior. To be honest, there are times I agree.
However, sometimes people take the anti-medication thing way, way too far. They say antidepressants are a conspiracy of the drug companies to make us all …
How to know whether antidepressants will help
Sometimes I’m surprised I wasn’t born with gills.
It’s like I was meant to spend more time in water than on land. I didn’t discover this until I was thirteen or so, when I started high school and had to join a sports team because of a school requirement. I arbitrarily chose water polo, because it was a fall sport. I sucked at …
7 life lessons I learned from surfing
Pinel, the father of modern psychiatry, is famous for liberating his patients from their chains. But he did a whole lot more. Pinel spent long hours listening attentively to each patient’s life story so that he could correlate their life experiences with the onset and course of symptoms.
Pinel got to know his patients well enough to like them as people. When given the choice of joining Napoleon as personal physician …
Why psychiatry is handicapped today
In Pierce County, Washington, where I work, it is difficult to find a psychiatrist to care for psychiatric cases that are outside the scope of practice of a primary care physician. Our community is not unusual in this situation. There is a nationwide shortage of physicians specializing in psychiatry.
According to Tom Insel, MD, the director of the Institute of Mental Health in 2011 both the number of psychiatry residency programs and the …
When it comes to psychiatry, primary care could use the help
When I was in middle school, I went to Lake Tahoe with my best friend on a ski trip. I had only been skiing a few times before, and even though my friend was only twelve, she was already a talented and experienced skier.
She was patient with me, but I became increasingly frustrated as I had trouble going down even the most basic runs without falling. At one point, after falling …
Antidepressants and the placebo effect
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