For years, scholars have thought the perfect surgery consult was impossible. Comedic ophthalmologist Will Flanary, a.k.a. Dr. Glaucomflecken, characterizes the golden consult as one in which the surgeon is not consulted too soon — because the patient is not sick enough to require his or her services — and one in which the surgeon is not consulted too late, or else …
The “golden consult” revisited
Last year, I witnessed the extreme consequences of untreated childhood trauma as a medical trainee rotating through multiple safety-net hospitals in Los Angeles County.
I helped care for children who arrived in our emergency departments after multiple suicide attempts due to trouble in the home. Some children confided in me about their parents’ struggle with untreated substance use or mental illness and how witnessing these conditions deeply affected them.
Other children were …
It’s time to invest in trauma-informed ACEs interventions
The federal 988 hotline represents a promising new approach to alleviating the nation’s growing mental health crisis, but several key challenges loom that could derail this well-intentioned initiative.
One significant information technology challenge the hotline will face involves how to uniformly store and interpret mental health data (more on that later) but the most immediate roadblock is a lack of awareness.
Though the hotline is scheduled to debut in July, the program, …
The new 988 hotline has the potential to transform mental health care, but challenges loom
Early in my addiction medicine fellowship, I met a patient for the second time while shadowing another physician in their practice. The patient was a former nurse with opioid use disorder on maintenance therapy with buprenorphine (commonly called Suboxone, the original brand name of a formulation combined with naloxone), a partial opioid agonist that is FDA-approved for the treatment of opioid use disorder and can be conveniently prescribed in the …
Protect the rights of licensed health care workers to take buprenorphine
We spend so much of our lives chasing a sense of doing “enough” and being “enough.”
Though I anticipate it’s been years in the making, I feel like I woke up one day and just had enough. This time, it wasn’t in a hopeless way. It was more of an awakening and permission to stop running on the treadmill to nowhere.
At first, I felt a wave of grief as I let …
When is enough … “enough” in your career?
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“Change is overdue. Physicians who need help for mental health issues or substance use disorders need to get it in a manner that is free of financial and other conflicts of interest. They need to be able to go to …
What doctors need to know about physician health programs [PODCAST]
Mental health disorders are by far the largest cause of disability in the world. More money is spent on mental health than either diabetes or cardiovascular disease. About 45 million people in the U.S. have a mental illness. Almost every American will, at some point or another, face a mental health challenge. It may be related to depression, anxiety, suicidal thoughts, substance abuse or maybe something more circumstantial like grief …
How to fix the psychiatrist shortage in the U.S.
Every primary care doctor knows what we are up against. The obstacles are many: payers, licensing boards, MOC, CME requirements, coding for billing, access issues, and the changing clinical field.
Sometimes these cause real harm.
Fifty miles north of where I-95 ends in Maine, winters there are long. My friend Dr. J did locums and spent a winter there. He tries new things wherever he goes, like spearfishing on Maui. So he …
Boards should protect the public, not destroy doctors
There are many topics on which I cannot claim to be an expert. I cannot solve the issue of gun violence, I don’t know what will “fix” the current societal crises, and I have no idea what will happen in the future regarding climate change.
There is one topic that seems to be coming up with more frequency and regularity, and I am qualified to speak on that. The shortage of …
Why is there a shortage of mental health professionals?
He was a tall, healthy psychiatric technician, experienced in his line of work. He was a CNA but wanted more. He wanted to help heal the troubled, forgotten, and neglected — behavioral health was his niche.
He would lead the way with therapy sessions in this group every day. This was Intensive management: the intermittent home for the paranoid schizophrenics, bipolar, and MDD.
They came in all shapes and sizes — wealthy, …
Game over for behavioral health
It’s been five days since I’ve been able to sleep. My two-month-old daughter coos softly in her bassinet. My husband sleeps soundly next to me. But I lay awake, hijacked by thoughts that I am a bad mother, wife, and doctor. This unwanted torment consumed me. All I wanted was to remain still and make this stop.
I lay awake; time stands still.
I am swept by flash currents beyond my control.
I …
A physician’s struggle with postpartum depression
On June 4, 2022, CNN.com published an Opinion piece written by Carolyn Chen: “Why ‘do what you love’ is the worst graduation advice.” As a mother of a recent college graduate, with two others close behind, I read it to garner insights into which encouraging words to use with my own babies entering the adult workforce. The target audience is college graduates, narrowing the relevance to those privileged to …
Who do we become when we love work more than we love ourselves?
An excerpt from The Paper Tiger Syndrome: How to Liberate Yourself from the Illusion of Fear.
Your Original Blueprint is the part of you that knows abundance is your natural state. It’s the inner voice, which says, I am full. I am satiated. I am content. I am peaceful. …
The body is the gateway to the Original Blueprint
I always got my contacts from Costco, and it constantly felt like a chore. Like any child made to go on errands with their parents, Costco was my eye-rolling-moan-inducing trip.
I realized my eyes were inadequate in third grade while reciting the Hail Mary. I was a little distracted as my blue and green plaid skirt was all twisted and the scratchy green sweater vest a little too tight. Despite years …
Fresh prescriptions: Looking for the twinkling lights
“When people think of eating disorders, the image is often of an emaciated, white teenage girl in the hospital hooked up to feeding tubes. In fact, eating disorders are varied in how they present in a person, and they certainly do not ‘look’ a certain way.
Eating disorders occur in all cultures, …
Eating disorder myths debunked [PODCAST]
The landscape of medicine and health care is constantly changing. With the integration of electronic medical records (EMR) and other technological advances, physicians and health care providers must be much more adaptable than ever before and possess unprecedented levels of technical literacy in the field.
The modernization of health care has been a driver of burnout, defined as “the constellation of symptoms that occur when your energy account …
I used to spend most of my day listening.
As a high school counselor, I encouraged teenagers to talk. Feeling stressed, they said, is their automatic response to demanding teachers, parents’ high expectations, and the drama of shifting friendship alliances.
Daily dilemmas and problems affect everyone: the terrified boy who just heard rumors he was going to be jumped after school, the teary-eyed girl whose teacher embarrassed her in front of the …
10 suggestions for a smoother high school experience
I walk onto the inpatient unit on a Monday morning. The feeling of discomfort begins to overwhelm me. Perhaps this was due to being forced back to inpatient, but I felt it had to do with changes in the process.
I started my training at a time when therapy was a central part of education. Understanding even the most psychotic patients was a key element of our field. I do not …
Re-wounding the wounded healer
When Japanese billionaire Yusaku Maezawa acquired the company that makes Lovot, a pet-sized robot for emotional support, it spoke about more than a financial investment in robotics. The news was tied to love, companionship, and healing. It also revealed the global loneliness and social isolation pandemic. The use of assistive robots is gaining popularity in Japan and China to deal with the caregiver shortage because social isolation is …
Simple solutions for social connections
“Many families still prefer their providers to wear a mask. I have no way to know who carries what political or health views around their mask-wearing. Their masks were off, and mine was on. When I asked them for their preference of whether they feel comfortable with me wearing a mask …
A psychiatrist presenting emotion [PODCAST]
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