A recent report stating that one in 50 school children carries an autism diagnosis appears to confirm anecdotal evidence that we are experiencing an increase in the autism rate.
But there are a number of things that should be considered in a discussion of these findings — and leading that discussion should be methodology.
These new data from the CDC’s National Center for Health Statistics (NCHS) are culled from a …
Explaining the rise in the autism rate
Politicians, financial experts, pundits and main street America would love to predict what’s going to happen to America in the next five years. But we don’t have to dust off the Dow Jones or the S&P, or even wonder what the Feds are going to do about Medicare, taxes, the debt ceiling or Afghanistan.
All we have to is understand the five stages of grief first developed by Dr. Elizabeth Kubler-Ross.
Elizabeth …
America is experiencing a crisis of grief
While I am currently a second year medical student, my story is one of a sister.
When I was six years old, my mother asked me a question that would forever change my childhood: “Honey, would you be alright with having a foster child join our family? It would mean a little boy coming to live with us for a while.”
My response did not take much thought; how could I refuse …
The heroic task of finding a physician who takes Medicaid
My office consultation for the 50 year-old woman was her complaint of chest pain. I could not help but glance at her insurance and it was for Medicare. I have always been fascinated with what types of disability people have which qualifies them for Medicare and SSD, (Social Security Disability), before the usual age of 65. To say that I have observed bizarre and inequitable awards would be a gross …
Why I’m skeptical of the growing number of disability beneficiaries
God helps those who help themselves.
-Something that sounds like truth but fortunately isn’t mentioned in any religious text
“I’m gonna beat this thing again, Doc! I just know it!”
Over the course of several years, I helped care for a man with a very rare cancer that recurred over-and-over. With each new tumor, he became more focused on beating the disease and despite the repeated setbacks, he remained eternally positive. He spent …
Cancer patients who are positive in the face of terrible adversity
Having to confront an indeterminate outcome that might be bad seems to cause more anxiety than having to confront an outcome known to be bad.
In one study, patients requiring colostomies (a rerouting of the passage of stool from the rectum to an opening in the abdomen) that were potentially reversible were actually found to be less happy six months after their operation …
When you’re feeling sad or depressed, try to find anticipatory joy
Recently one of our readers posted this comment:
“If any Shrink Rapper ever has the time and inclination it would be interesting to read about what you would do to fix the mental health system, particularly the issue of involuntary hospitalization, if you had unlimited funds and political resources. You’ve been in the trenches, it would be great to hear your thoughts.”
Over on Peter Earley’s blog I see that …
Violence and severe mental illness: 6 questions to ask
Multi-tasking has never been my forte and so I like to keep my schedule organized. Mondays, I see all of my on-treatment patients. Tuesdays and Thursdays I see new patients in consultation. Wednesdays are reserved for treatment planning and research projects. But Fridays—well, Fridays are usually the best day of the week. Not only is the weekend approaching, with time to spend on my menagerie and the ever present home …
Caring for the emotional needs of a cancer patient
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman is evaluated during a routine examination. She is very concerned by her lack of interest in sexual intercourse. The patient feels like she “just doesn’t want to be touched.” She used to enjoy intercourse and does not know why she feels this way now, but she acknowledges that it is causing …
MKSAP: 54-year-old woman is evaluated during a routine examination
A sample agenda as the consulting psychiatrist with a homeless outreach team:
8:17am. Arrive at the office, which is in a tall building that is a short walk from the New York Stock Exchange. Speak with the case managers and social workers about who should be seen that day.
8:55am. Walk with a case manager to the ferry terminal meet Paul (note: all patients described here are composites of people I have …
One day of a psychiatrist with a homeless outreach team
In 1804, Frederich Serturner experimented with opium and created something new—morphine—named after the Greek god of sleep and dreams, Morpheus. More than 200 years later, at least 8 million Americans fall asleep at night under the influence of an opioid. Every morning, 40 of them don’t wake up.
As described in a previous article on this subject, the United States is in the grip of a prescription opioid disaster: with 2 …
Why long term use of opioids is not the answer
Sam burst into the office, a two-year-old wild bundle of energy. Squealing with delight — or was it distress; it was hard to tell — he ran from toy to toy not looking at me or his mother, Jane. He was unable to engage with anything. Jane had brought him to see me in my pediatric practice because, “he hits me, has explosive tantrums, and I can’t take him anywhere.” …
Raising a child alone in a culture of quick fixes
Let’s talk a little about health accountability. Two news items have provoked the following rant: why is it always someone else’s responsibility?
The first item was on NPR. The FDA, reacting to the epidemic of prescription drug abuse in this country, is offering incentives to the pharmaceutical company that can come up with a less addictive painkiller. Such a drug would be a gold-mine for that pharma company because it could …
Make patients more accountable for their own health
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Sometimes the health care system just does not work.
I had seen him one week earlier on a Friday afternoon, accompanied by his estranged wife. They were there because of concern about increased depression. He told me that he had stopped taking his lithium and paroxetine (Paxil) several months earlier because he felt they weren’t working. He also readily admitted to having returned to the habit of drinking one or two …
An epic fail when it comes to mental health
It’s almost unthinkable that in an era preoccupied with “evidence-based” medicine and “best practice” advice, one of the worst drug problems in the United States flows right out of our health care system. Unlike other major epidemics such as those connected to methamphetamine, crack cocaine or other illegal drugs, our prescription opioid problem is full of irony and agony, because it has been fueled, to a certain extent, by the …
The irony and the agony of our prescription opioid problem
“Sometimes, how you feel at the end of an interview can be clinically revealing,” my preceptor says. “How does this patient make you feel?”
***
“Mr. M?” I ask gently, knocking on the hospital room door. “May I come in?”
“Hello? Hello?”
I enter at what I think is an invitation to me, but see that 79-year-old Mr. M is speaking into the phone instead.
“I’m sorry, I can come back…” I start to say. …
Countertransference is a reality that must be grappled with
A sample agenda as the consulting psychiatrist at a geriatric adult home:
8:20am. Arrive at the concrete building. Wave through the locked glass door at the woman sitting behind the desk. She pushes a button and the door buzzes. Pull the door open. Say good morning. She never sounds cheerful when she replies, “Good morning.”
Because there is no open stair access, take the elevator up one floor. It travels slowly. The …
One day of a psychiatrist at a geriatric adult home
Like most Americans, when I learned that twenty children and six adults had been massacred in Newtown, Connecticut, I recoiled. Like most parents, my next thought was for my own son, the image I retain of his happy, smiling self for one moment replaced by an image of his tiny body lying twisted on the ground. Even as I write these words, an emotion I rarely feel—one I often can’t …
Why should I try to find compassion for Adam Lanza?
I wrote in a previous post about what life was like growing up in Newtown, Connecticut. It truly is a picturesque New England town. But what might be surprising is that within that town sat a gem. A hundred acres of wooded rolling hills within which sat an inner campus of professionally landscaped and meticulously manicured grounds crowned with stately and handsome brick buildings in a colonial architectural style. These …
The closing of a mental health facility in Newtown
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
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