Surprisingly, they discovered that these policies use physician time and delay treatment. It’s funny, because preauthorization policies were designed to save money. And I imagine they do, for the insurer, but they cost money for everyone else. Read more »
*This blog post was originally published at Shrink Rap*
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Hi. I am a practicing psychiatrist based in New York City. I find your blog interesting, informative, and, at times, funny. Now, can you guess which entry I’d like to comment on?
Mel Brooks once said (paraphrased) that if you slip on a banana peel and land on your butt, it’s comedy. If I fall down a flight of stairs, it’s tragedy. I’ve had a long-term interest in humor, and a brief career as an unpaid stand-up comic in L.A. (Brief because my bombing to “killing” ratio was about 15 to one.) With respect to my experience as a therapist, I now occasionally utilize humor in my treatment, but only extremely judiciously once I have gotten to know my client. I learned my lesson early.
At the beginning of my residency training, during my second session with a client, I commented that perhaps he felt like Groucho Marx when Groucho said that he “wouldn’t want to be a member of any club with standards low enough to accept [him].” I sat back, feeling as if I had made the interpretation of the century, and waited for a reaction. I got one. Read more »
*This blog post was originally published at Shrink Rap*
I’ll cut to the chase: I loved this book. Five stars. Two thumbs up.
When I read books, especially psychiatry books that I write about on Shrink Rap, I often read more carefully and sometimes more critically. I was so immersed in reading “Just Like Someone Without Mental Illness Only More So” that I didn’t stop to think, I just went on the journey.
Mark Vonnegut is a pediatrician and the son of my favorite author when I was in junior high school. His memoir is a poignant and candid account of his struggles with, well, life in general, and life with a psychotic illness in particular. Schizophrenia, bipolar disorder — who knows? (I’ll vote for bipolar disorder.) Some illness where he had three episodes in his twenties, then another episode 14 years later.
Thorazine and lithium and megavitamins and psych wards. Xanax and alcohol and how humiliating it is to be psychotic on a stretcher in the ER hallway of the hospital where he works. Divorce and remarriage. First and second families. Childhood as the son of a financially struggling, not-yet-famous eccentric writer, and adulthood as the son of an icon. Vonnegut is a hippy, a mainstream doctor, a middle-aged softball player, then finally a guy who accidentally poisons himself with wild mushrooms. Read more »
*This blog post was originally published at Shrink Rap*
I just finished reading Dr. Gary Small’s book, The Naked Lady Who Stood On Her Head.
In the final chapter of the book, Dr. Small talks about his mentor, friend, and father figure who’s mentioned throughout the book. The mentor approaches him on the golf course, where they meet to talk, and says he needs psychotherapy and Small is the man to do it. The author is surprised, hesitant, and a bit uncomfortable with the demand (it comes as more than a request.) His wife likens it to the need for a plumber or a dentist, and Dr. Small takes on the task. The mentor calls all the shots: Where the meetings will be, what pastry they will eat, the form of his payment. The author initially misses the diagnosis and uses this as an example of how one can be blinded.
So is it okay for a friend to treat a friend? Read more »
*This blog post was originally published at Shrink Rap*
The Relative Unimportance of Diagnosis In Psychiatry
As we will soon be witness to the emergence of DSM-V, the new rule book for psychiatric diagnosis, I am reminded of all the pitfalls of diagnosis in psychiatry. In other fields of medicine, diagnosis is based primarily on etiology, with objective findings, rather than on symptoms alone, as it is in psychiatry. When you go to your internist with stomach pain, there’s an endoscopy to look for ulcers, a sonogram to look for gall stones, a blood test to look for hepatitis. But in psychiatry, there is no CT scan to check for bipolar disorder, no blood test to assess if the patient has schizophrenia, no spinal tap to check for major depression.
For the psychiatric community at large, diagnosis is important for many reasons. It helps doctors sort out patients so that clinical trials can be conducted on similar groups of patients. It enhances communication among psychiatrists when behavioral, affective and cognitive symptoms can be categorized. But for the individual patient, it is less useful. Some patients fit nicely into DSM categories, and others don’t. There are many patients who have unique combinations of symptoms across several diagnostic criteria. This leads to assigning multiple diagnoses, and confusing the treatment picture. Read more »
*This blog post was originally published at Shrink Rap*
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