April 18th, 2011 by Dinah Miller, M.D. in Opinion
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From time to time, our readers comment that they are distressed with a diagnosis a psychiatrist has given. They’ve met with a doctor, talked for a while (half an hour, an hour, maybe two hours) and based on whatever information the psychiatrist has, a diagnosis is made. Maybe it’s right, maybe it’s not, and maybe the diagnosis will change over time. Some readers have commented that they object to the idea that psychiatrists must assign a diagnosis to be paid, when in fact there is no diagnosis, and they think that’s wrong. The psychiatrist should work for free?
Since I don’t accept insurance, I’m not obligated to make a diagnosis, but if I don’t put one on the statement, the patients won’t get reimbursed. Some tell me that they aren’t submitting psychiatric claims to an insurance company, others don’t have insurance, and many do submit claims. I’m left to wonder why someone with no psychiatric diagnosis would consult a psychiatrist to begin with, especially since some diagnoses (Adjustment Disorder, for example, or Anxiety Not Otherwise Specified) are not particularly stigmatizing. Read more »
*This blog post was originally published at Shrink Rap*
April 13th, 2011 by Dinah Miller, M.D. in Health Tips, Opinion
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This is for Dr. D.
We were having lunch when Dr. D mentioned she wanted to write a book aimed at teaching residents how to
do psychotherapy. It would start with a section on What Makes a Good Therapist? What does she thinks makes a good therapist? Real life experiences which impart an ability to empathize. Do we grow from our own difficulties? More specifically, do we grow in to better therapists? I asked another shrink this, and he said that people like to believe there is some meaning to their suffering, and perhaps it’s nice to believe that if you’ve been stuck suffering, then it makes you a better therapist, but he wasn’t so convinced it was true. Me? I don’t know, maybe. Or maybe not. Personally, I’m fine with the idea of not suffering, at all, ever again, so long as I live.
In residency, I was taught that warmth and empathy are important to being a good therapist. Read more »
*This blog post was originally published at Shrink Rap*
April 9th, 2011 by Edwin Leap, M.D. in Opinion
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I sometimes see men and women who come to the emergency department and tell me about their PTSD, caused by service in Iraq or Afghanistan. I believe some of them; others I doubt, since their PTSD seems directly connected to a desire for Percocet, Lortab, MS-Contin or other prescriptions for back pain. Sadly, the VA system does not lend itself to inquiry by outside physicians, so in many instances I am treating them in an information vacuum.
However, as I contemplate their allegations of PTSD, I wonder how many physicians and nurses from emergency departments have the disorder. I’m no psychiatrist, but it just seems probable that the years of cummulative stress, the years of sleeplessness and snap decisions, the untold shifts filled with unpredictable chaos, pain, threats, death and anxiety would add up to significant emotional turmoil for providers who work in that environment.
It is appropriate that we are attentive to the needs of those who serve in combat zones. And yet, they may spend only spend one or two years there. Granted, that can be terrible enough. Read more »
*This blog post was originally published at edwinleap.com*
April 8th, 2011 by RyanDuBosar in Research
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College-aged women in the UK say they would trade longevity for an ideal body weight.
320 women studying at 20 British universities (ages 18-65; average, 24.49) completed a survey in March.
The research, conducted for new eating disorder charity The Succeed Foundation, in partnership with the University of the West of England (UWE), found that nearly 30% of women would trade at least one year of their life to achieve their ideal body weight and shape:
–16% would trade 1 year of their life
–10% would trade 2-5 years
–2% would trade 6-10 years
–1% would trade 21 years or more Read more »
*This blog post was originally published at ACP Internist*
April 4th, 2011 by AnnMacDonald in Health Tips, True Stories
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One of my closest friends is a two-time breast cancer survivor. Terry (as I’ll call her) has been cancer free for eight years—long enough to be considered cured (generally defined as being in remission at least five years). But in no way is she “free” of cancer. Every abnormal blood test, every callback for another mammogram terrifies her so badly she can’t sleep until doctors rule out a recurrence. In some ways, the ongoing psychological and emotional challenges she faces have been worse than the physical treatments she endured.
I thought about Terry when I read the latest government statistics on the number of cancer survivors in this country. Nearly 12 million Americans—4% of the population—are still alive after a cancer diagnosis.
In many respects this is terrific news, and a testament to improved diagnosis and treatment options. But survivorship comes at a psychological price. We discussed these challenges at length in the Harvard Mental Health Letter, but here’s a quick look at some of the major issues. Read more »
*This blog post was originally published at Harvard Health Blog*
