August 22nd, 2011 by Dinah Miller, M.D. in Opinion
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I’ve been at it a long time, and one thing (of many things) that I still have not gotten down is scheduling. I seem to have a method to my own madness, but somehow I imagine it’s not how other people do this. I’ve heard other shrinks say, “I’m booked for the next 4 weeks” or say they aren’t taking any new patients. Some people put a “no new patients” message on their answering machine. Wait, so no appointments for 4 weeks? What if a patient calls and needs to be seen very soon? Like this week? If you can’t wait, go to the ER? I thought the point of having a private doc was that you didn’t have to go to the ER unless something couldn’t be handled safely as an outpatient. And if you tell the world that you don’t take new patients, then don’t people stop referring to you? It seems to me that patients will come in and announce, “I’m doing better and want to come less often,” “I’m moving,” “I’m done,” or they will cancel an appointment, not call back, and not be heard from again for weeks or months. Sometimes it all happens on very short notice and life can be very unpredictable.
In my pre-shrink days, I thought that psychiatry worked such that patients came every week (or twice a week, or whatever) and had their own slots. Tuesday at 1, that’s me! So a psychiatrist had every slot full with patients this way, and could be “full,” until a patient finished and stopped coming, and then another soul was let in to the Tuesday at 1 slot. Gosh that would be nice, but it doesn’t seem to work that way. Read more »
*This blog post was originally published at Shrink Rap*
August 14th, 2011 by Dinah Miller, M.D. in Opinion, True Stories
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Benedict Carey is a New York Times mental health reporter. In last Sunday’s Times, he wrote about Joe Holt, a man with a diagnosis of schizophrenia. Mr. Holt was dealt a particularly tough deck of cards: in addition to a diagnosis of schizophrenia, he had a horrible and traumatic childhood with much loss, placement in a facility where he was physically abused, and periods of homelessness as a teenager. He now has a stable marriage, has adopted children and keeps numerous foster children, and holds two jobs, one as a computer consultant and another as a therapist (if I read that correctly). He struggles with his emotional life, but my take on this was that this is one extremely resilient man who has waged a successful battle against many demons and his story is inspirational.
So Benedict Carey often writes stories that are skeptical, if not outright critical, of the mental health field. This story did not have that tone. I found it interesting, though, that he chose a person with a diagnosis of schizophrenia who’s life was not “typical.” What did I find not typical? Read more »
*This blog post was originally published at Shrink Rap*
August 2nd, 2011 by Dinah Miller, M.D. in Opinion
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In the Clinical Encounters case featured here two days ago, I presented the story of a psychiatrist who goes for a urological procedure and discovers that one of his former patients is the nurse assisting. People wrote in to suggest ways he should handle this awkward situation and I was struck by the idea that some suggested he tell the urologist that he knows the nurse in a social setting (because he can’t tell the other doc that the nurse was his psychiatric patient) and the assumption that the urologist would be understanding, and that perhaps the urologist should have policies in place in case of such events.
Do surgeons think this way? Read more »
*This blog post was originally published at Shrink Rap*
July 23rd, 2011 by Dinah Miller, M.D. in Book Reviews, Opinion
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Rob Dobrenski, PhD. is a psychologist who blogs over on ShrinkTalk.net. He’s written a book about what it’s like to be a psychology graduate student, a psychotherapy patient, and a psychologist. Oh, we like the folks who go from Shrink blog to Shrink book — it somehow feels familiar — and so I agreed to read his book: Crazy: Tales on and Off the Couch.
So bear with me while I tell you that the book rubbed me wrong at the outset. Dr. Dobrenski begins by saying something to the effect that he describes things that all shrinks feel, and if they say they don’t, they aren’t being honest. I really hate it when people tell me what I feel. It’s like saying that Prozac made your depression better and if it didn’t, then you just didn’t recognize it. And then the book gets off on a provocative start — Rob discovers that many people in his life, from a patient, to a colleague, to himself — are “f***ing crazy.” The asterisks are mine. Dr. Dobrenski had no trouble using the word — I counted 19 times in the 39 pages, including in direct quotes of discussions he has with both a patient and one of his supervisors. Not in a million years. I wasn’t sure what the point was. To let people know he knows obscene words? To be Read more »
*This blog post was originally published at Shrink Rap*
July 16th, 2011 by Dinah Miller, M.D. in Opinion
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Dr. Maureen Goldman talks about self-disclosure for psychiatrists and brings the topic up in the context of Marsha Linehan’s recent announcement that she was treated for a psychiatric disorder as a teenager.
In Clinical Psychiatry News, Dr. Goldman notes:
Psychiatric care and psychotherapy are different from the Alcoholics Anonymous fellowship, where the mutual sharing of personal experience is an integral part of helping people maintain sobriety. I believe that there is middle ground between disclosing personal information and presenting myself as a blank slate. In my practice, I show myself to be a real person. I make mistakes and admit them. I joke about my poor bookkeeping skills and inferior technological skills. I look things up during sessions if necessary, and I tell patients when I need to do research or consult with a colleague. I treat them as real people, too, not just as patients.
I do not, however, share my own story. Mostly, I think that I can help people feel heard, understood, and known, and create a therapeutic plan without personal disclosure. I communicate that “I get it” without being clear that “I really get it.”
I cannot speculate about the motivation behind Dr. Linehan’s decision to allow her mental health history to be chronicled in the New York Times. The story was a very public disclosure, and in that way quite different from a disclosure made in the context of a one-on-one, doctor-patient therapeutic relationship.
We’ve talked in detail about self-disclosure before, and specifically about whether psychiatrists should tell their patients if they’ve suffered from a psychiatric disorder. See Read more »
*This blog post was originally published at Shrink Rap*
I’ve been at it a long time, and one thing (of many things) that I still have not gotten down is scheduling. I seem to have a method to my own madness, but somehow I imagine it’s not how other people do this. I’ve heard other shrinks say, “I’m booked for the next 4 weeks” or say they aren’t taking any new patients. Some people put a “no new patients” message on their answering machine. Wait, so no appointments for 4 weeks? What if a patient calls and needs to be seen very soon? Like this week? If you can’t wait, go to the ER? I thought the point of having a private doc was that you didn’t have to go to the ER unless something couldn’t be handled safely as an outpatient. And if you tell the world that you don’t take new patients, then don’t people stop referring to you? It seems to me that patients will come in and announce, “I’m doing better and want to come less often,” “I’m moving,” “I’m done,” or they will cancel an appointment, not call back, and not be heard from again for weeks or months. Sometimes it all happens on very short notice and life can be very unpredictable.
