October 2nd, 2011 by Dinah Miller, M.D. in Health Policy
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Over on Shrink Rap News, Roy wrote a post about proposed Medicare cuts. He continued the conversation here on Shrink Rap.
I want to expand on the discussion in what I hope will be easy-to-understand terms. Why would anyone who is not a doctor even care what Medicare reimburses their docs? Let me tell you why you might care.
Doctors all have one of four designated categories within the Medicare system:
1) The doc participates and accepts Medicare assignment. The fee for the service is set by Medicare, the patient makes a co-pay and the doctor bills Medicare and gets the rest of the fee from Medicare.
2) The doctor is “non-participating” –which is a deceptive term, because non-participating docs are within the Medicare system. The fee for the service is set by Medicare and is typically 5% less then the fee for participating docs, but the patient pays the Medicare fee in full to the doctor, the doctor files a claim with Medicare, and Medicare reimburses the patient for a portion of the fee.
3) The doctor has formally opted-out. In this case, Read more »
*This blog post was originally published at Shrink Rap*
September 26th, 2011 by Dinah Miller, M.D. in Opinion
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My hat goes off to kiddy shrinks. It’s a tough field, full of issues we don’t see in adult psychiatry.
Our comment section often buzzes with talk about the over-diagnosis of bipolar disorder in children and the ethics of giving psychotropic medications to children. The Shrink Rappers never comment on these things. Why? Because we don’t treat children. I have no idea if the children being treated are mis-diagnosed, over-diagnosed, wrongly-diagnosed, or if the increase in treatment represents a good thing—- perhaps children who would have suffered terribly now are feeling better due to the option of medications. I’ve certainly had adult patients tell me their children were treated with medications, the children have often eventually stopped the medications and emerged as productive adults. Would they have outgrown their issues anyway. Or did the treatment they received switch them from a bad place to a good place and enable them to carry on in a more adaptive way? Ugh, my crystal ball is on back-order at Amazon!
Why I’m Happy I’m Not A Child Psychiatrist: Read more »
*This blog post was originally published at Shrink Rap*
September 22nd, 2011 by Dinah Miller, M.D. in Opinion
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I’m posting this because Roy fell asleep at the wheel and missed the Xanax article on the front page of yesterday’s New York Times. In “Abuse of Xanax Leads a Clinic to Halt Supply,” Abby Goodnough writes about a clinic where they’ve stopped prescribing Xanax because to many people are abusing it. Goodnough writes:
“It is such a drain on resources,” said Ms. Mink, whose employer, Seven Counties Services, serves some 30,000 patients in Louisville and the surrounding region. “You’re funneling a great deal of your energy into pacifying, educating, bumping heads with people over Xanax.”
Because of the clamor for the drug, and concern over the striking number of overdoses involving Xanax here and across the country, Seven Counties took an unusual step Read more »
*This blog post was originally published at Shrink Rap*
September 15th, 2011 by Dinah Miller, M.D. in Opinion
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Please see my post on Clinical Psychiatry News and yesterday’s post What’s in a Note? along with the reader comments.
One reader asked why it’s weird to want to see your shrink’s notes and why shrinks refuse to show them on the grounds that they may distress the patients. Another reader asked why doctors write “patient denies” as though they don’t believe the patient. These are both great questions worthy of their own post.
Why don’t psychiatrists like to show patients their notes? Are they really going to “harm” the patient? There are a few reasons why a psychiatrist may not want to show a patient her notes. Here is my list of thoughts as bullet points. Please feel free to add to it. Read more »
*This blog post was originally published at Shrink Rap*
August 30th, 2011 by Dinah Miller, M.D. in Humor, Opinion
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If you haven’t seen Anderson Cooper catch a case of the giggles on live TV, you can still watch it on YouTube. I missed the first showing, but saw Mr. Cooper replayed it on his own Ridiculist List. But what’s this doing on Shrink Rap?
I watched the re-run, and I found myself laughing out loud. Only, it wasn’t a good, happy, hearty laugh, it was an embarrassed and uncomfortable laugh, and I realized I’d taken on the feelings of the newsman. If I were a psychiatrist (oops, I am, even in August), I might say that Anderson Cooper Read more »
*This blog post was originally published at Shrink Rap*
