“You’re not sorry.”
Within two days two different patients said this to me, each with hatred in his voice. Each time I was alone, each time I had known the patient for only a few minutes, and each time the rage was directed at me and only me.
For seven months, I had avoided being the bad guy. When a patient got upset, he accused my superiors, and I hid behind their …
Be the bad guy with good intentions
Are you or your patients sleeping well? Mine are not, and I wasn’t either. Do you ask them how they sleep? I never used to ask, and no one asked me. When I was in medical school, we had rigorous instruction in taking detailed medical histories. Sleep quantity and quality were not included.
What changed? Is it the digital age we live …
2 ways to help your patients get better sleep
Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …
Physicians can be better doctors by being patients
Have you been tearful and sad after the death of a loved one? Did you notice changes in appetite, difficulty sleeping, troubles concentrating, and decreased energy for at least two weeks after the loss? Did you think that was a normal, healthy, and adaptive response to a major loss? Well, if you believe the new DSM-5 criteria approved by the …
Grief is not a disorder and should be considered normal
For the families who lost children, their world as they knew it has effectively ended. Yet somehow the sun rises again and the next day is here. For the rest of us grieving along with these families, the only way to move forward is to take what President Obama called “meaningful action.” I interpret this to be action that is radical and significant enough that it will somehow give meaning …
How can we as a society honor the dead children?
I would like to start out by thanking all the fantastic health care workers. As a recovering person with diagnosed concurrent disorders – having both addictions and mental health issues – I have seen the challenges and abuse often faced by doctors, nurses, counselors and support staff working within the healthcare system. This article is in no way meant to hurt, …
Stop the stigma and give patients a chance
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
I’ve been thinking lately about all the great advances in medicine over the years. There have been lots of them. And despite everything you’ve heard about looming cuts in healthcare, I have no doubt that the hits will keep on coming. Since I seem to be on this Top 5 thing lately, I figured I would continue this ride and rank my top 10 medical advances over the years. There …
10 advances that have changed medicine forever
For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management. It all gets mushed together, a patient may talk about an upsetting event in their lives (psychotherapy) and then mention they are having trouble sleeping or a side effect to a medication (medication management), then go on …
How Medicare will devalue the work of psychiatrists
I live in Eugene — a sweet little community with snow-capped mountains, farmers’ markets and the friendliest people around.
But a few weeks ago, one of our beloved pediatricians shot himself in the head in a public park. Earlier this year, one of our surgeons was found dead in his car from carbon monoxide poisoning.
And just before him, a urologist shot himself in the head in his backyard. Before him, a …
Why aren’t more people talking about physician suicide?
When Rodney Peterson, a high school headmaster in Boston, assaulted his wife five weeks after she gave birth, it seemed a textbook example of the way abusive partners exploit new mothers’ vulnerability. Women are more likely to be assaulted or killed by partners while pregnant or after recently giving birth, research shows.
Traditionally, children were regarded as accidental bystanders to violence involving their parents – a view that is now being …
How children are affected by violence involving their parents
According to Nichiren Buddhism, the reason we’re all here is to enjoy ourselves, to be “happy and at ease.” Though this may sound like a license for lasciviousness and hedonism, in reality it’s far from it: enjoying ourselves, as most of us know from experience, is far harder than it sounds. To develop lives in which we can freely enjoy each moment requires far more work—far more self-development—than many would …
Enjoying ourselves is far harder than it sounds
“By the way,” my chief resident told me on the first day of my inpatient psychiatry rotation, “don’t lick your lips in front of him.”
“Wait, what happens if–”
I fell silent as the patient walked into the interview room. The resident wanted to discuss his paranoid delusions; the patient wanted to discuss his discharge.
The patient wasn’t ready to leave because the medications that made the demons stay away were also making his …
On the inpatient psychiatry ward, a new code governs
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These days, the world is a very scary place.
You go to school. You go to school some more if you can afford it and you feel so inclined. Then, if you’re one of the really crazy ones like me, you go to school some more. Somewhere in that late night caffeine and chili cheese fries induced sophomoronic (no, do not adjust your set) craziness, something starts to click. At least …
Why psychiatry is the right choice for me
When I write from my clinical experience as a behavioral pediatrician, I am careful to change identifying information to protect the privacy of my patients. It is rather freeing, therefore, to write about characters in a novel. Left Neglected by Lisa Genova, who is also a neuroscientist (perhaps she took the story from some real cases) offers some important insights into this complex subject.
The story revolves around Sarah, a 37-year-old mother of three …
Heal relationships without needing a devastating life event
I vividly remember the first day my medical school classmates and I met our cadavers in the anatomy lab. Large body bags lay on metal tables that had been bolted to the floor. I remember the sheer size of the bags best. No doubt existed in my mind that dead human bodies indeed lay within them. And yet part of me couldn’t quite grasp that I was actually going to …
Strive to maintain our compassion for others
Charlotte Scott had an eye for madness—for just the right amount of madness. As a booker for The Springer Show, her job was to find—and forgive me if I’m getting too technical here—minor nut jobs, the kind of people who were just unbalanced enough to make for entertaining T.V. but not so wacky that they would pull an Uzi out on the audience.
I learned about Scott while reading Jon Ronson’s …
Help your doctor understand where you’re coming from
“All psychiatrists do is push drugs!”
I have heard this repeatedly, from students, wary patients, even family members who don’t pick up on a carefully worded hint that they just might benefit from getting help. For some reason, no one makes the same complaint about infectious disease specialists, or oncologists, though I wager that the success rates of our drug treatments are roughly equivalent.
As a psychiatrist, I try to treat people …
Why clinical decision making in psychiatry is difficult
Could “mommy porn” have value in the doctor’s office? Unless you live in a cave (and we physicians sometimes do), you have heard of British author E.L. James’ modern erotic 50 Shades of Grey trilogy, 30-plus million copies sold, overwhelmingly to women. The trilogy is an erotic love story about a naïve college graduate who rescues an abused billionaire – a …
Viagra for women: Prescribe 50 Shades of Grey to your female patients
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
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