July 20th, 2007 by Dr. Val Jones in Health Policy
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Dinah at Shrink Rap had all her Medicare billing sheets returned to her this week. She had neglected to use the new forms with “red dropout ink.” These forms are not provided by Medicare, but must be purchased by the psychiatrist from a government or commercial printer. Good luck figuring out which parts of the form you’ll need, Dinah – seems as if there are many different versions (snapouts, continuation sheets, single sheets, part 1 and part 2) and they’ll cost you more than a few psychotherapy sessions will be reimbursed (not to mention the time you spend re-filling them out).
I suppose that if you do the math, it might be easier to just pay your patients to go elsewhere? The red tape (in this case “red ink”) never ceases to amaze me. Anyone else struggling with this problem?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 6th, 2007 by Dr. Val Jones in Expert Interviews
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An important new study related to Americans’ use (and abuse) of alcohol was recently published in the Archives of General Psychiatry. I caught up with Revolution Health’s addictions specialist, Bruce Phariss, MD to get his perspective on this very common, yet often disabling addiction.
Dr. Val: Is there anything surprising or new
presented in this study? If so, what is it?
Dr. Phariss: It
isn’t necessarily surprising, but it is striking that 30% of Ameicans have an
alcohol problem at some point in their lives. Alcohol problems often develop
slowly and no one “notices” that it has become a problem until well after the
fact. That’s why it takes 10 years on average for those that get treatment to
actually get the treatment. The study also highlights the fact that a huge gap
exists between those needing treatment and those receiving treatment. We’re
still not doing a very good job in the treatment community of getting the word
out there that treatment is available and that treatment
works.
Dr. Val: Why do you think that only 25% of
people with alcohol abuse problems get treatment?
Dr. Phariss: Three things: First, denial and stigma keep many “unaware” that they have a
problem. The first step in the stages of how people change behaviors is
awareness. If you don’t know you have a problem, you can’t change it. Along
this same line, if alcoholism is viewed as a moral failing instead of as a
medical condition, then good, moral people don’t think they can be alcoholics.
That’s good logic, but unfortunately, alcohol is non-discriminatory and even
good, moral people develop alcohol problems. Fighting through that
generalization of stigma is too tough for many people and they never seek
treatment or attempt to change their behavior.
Second, our cultural still
galmorizes drinking and drugging. Although the hype surrounding the many young
starlets currently in rehab centers appears to say how tough these addictions
are to kick, the overall slant is to add cache to the celebrity. It’s cool to
need rehab, it’s cool to be that out of control with alcohol and substances,
it’s almost synonymous with celebrity of a certain type. Sadly, this message
influences the behavior of many Americans, especially the under 25 crowd, who
are the most venerable to developing addictive behaviors.
Third, many people stop on their
own without treatment. Almost anyone who does find their way into treatment of
any kind (AA, treatment programs, etc.) has tried to stop on their own at least
once, maybe a hundred times. Just think of the many times you’ve heard someone
say “New Year’s Eve is my last day of drinking” or “I’m going to give up booze
for Lent and not pick it up again” or, my favorite, “I can give it up any time I
want….” In fact, some of the 75% of the people who need to deal with their
drinking do deal with it on their own. But many others need help of some kind.
Breaking down barriers to treatment — access and psychological and financial
barriers — remains the goal of the treatment community.
Dr. Val: What sorts of interventions might be
most useful (on a personal and on a national scale) to reduce alcohol abuse and
dependence?
The debate on a national level as to how to intervene to reduce alcohol
abuse and dependence is ongoing and heated at times. However, many intervention
and prevention programs focus on underage, college age and the under 25-year-old
drinkers. If you don’t a drink until age 21 you are four or five times less
likely to develop an alcohol problem than someone who drinks before the age of
21. But underage and college age drinkers are becoming more numerous, not less,
so we must be doing something wrong. A few colleges have taken an approach I
like: in addition to providing counseling, supporting AA meetings by providing
space, a few colleges have taken to trying to change the “perceived norm” about
drinking on campus. Although in fact most kids on campus do not binge drink on
a regular basis, the perception by incoming freshman is that everyone drinks
more than they do. This holds true for the guy who drinks two six packs a day
(clearly way too much)….he actually thinks that the majority of students drink
more than he does. What is a motivating emotional factor for college students:
they want to be accepted, to be a regular, normal guy or girl. If the
perception is that normal is to drink a bucket, then as a group they will be
more likely to drink heavily. A few colleges have taken the simple step of
making the student body aware that, in fact, most students do not drink to
excess. That simple step has helped to curb the trend of more and more alcohol
on campus.
Dr. Val: What’s the take-home message to be
gleaned from this study?
Dr. Phariss: The take-home message is that the medical profession has a long way to go in
de-stimatizing treatment for alcohol use disorders and that the substance abuse
treatment community remains too distant, too inaccessible and too timid in
announcing that treatment works. As the AA slogan says: “It works if you work
it, so work it, you’re worth it.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 9th, 2007 by Dr. Val Jones in True Stories
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My grandmother was a kindly woman. She grew up in a frontier town in Alaska, the daughter of
a photographer. She lived simply, and
spent the majority of her waking hours figuring out how to stay warm. Much to her delight, her mother eventually
moved to San Francisco,
where she was able to thaw out and bloom.
She went on to marry a charismatic business man (one of the
early founders of Technicolor Films) and had 6 children, the first of whom was
autistic. It was a great challenge
taking care of all those kids, with her husband away on business much of the
time. And there were no special services
for children with autism then. So it
came as no surprise when my grandmother seemed a little forgetful and frazzled. But that forgetfulness was not so innocent as
it turns out.
Memory lapses grew into more advanced confusion, as her
children noticed that she was becoming unreliable. She would forget to pick them up from school,
couldn’t remember where they were going next, and didn’t recall what they had
told her only moments prior. My
grandmother had early onset Alzheimer’s disease – and it would take her on a
path of no return.
By the time I was old enough to know my grandmother she was
being cared for by home health aids. She
was still extremely sweet and gentle, and could have short conversations that
were interesting and engaging, but she had no idea who I was, or why we were
speaking. Still, her Victorian
upbringing caused her to be extremely well mannered – never letting on that she
secretly wondered why this “nice young girl” (a perfect stranger) was spending
time with her in her house.
But the strangest part of grandma’s journey with Alzheimer’s
was that it took her on a reverse tour of her former life. She seemed to be reliving each day that had
had the most emotional impact on her – in descending chronological order. So that some weeks she believed that each day
was her 60th birthday… and then she’d move on to each day being her
58th birthday, and so on… But the most heart-wrenching span of weeks
were when she thought it was the day of her husband’s death. She wept all day long, reliving the
experience. We would ask her why she was
crying, and she’d look at us incredulously, “Well, don’t you know that Kay died
today?” Our lack of appreciating that
obvious fact added to her extreme loneliness… as if she had lost her husband
and no one else cared or noticed. We
would try to dissuade her of that notion, reminding her of the actual date and
who each of us was. But alas, the
neurons that housed her emotions seemed to outnumber those that ordered her
memories, and so only time could change her of her perception of reality.
We all watched grandma deteriorate over the years, being
dragged backwards through time by some invisible force, verbalizing her
experiences as she relived them. It was
a kind of bizarre way to learn about her life – through the eyes of a woman who
told old stories as if they were currently occurring.
But eventually the stories ceased, and she regressed to a
non-verbal state. Her mind had finished
its story telling long before her body was ready to let go.
Grandma lived until the age of 96, and passed away
peacefully in her sleep. I can only hope
that she was dreaming of pleasant events in her early childhood when she
slipped into the ether – a baby in a shadow of memory.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 8th, 2007 by Dr. Val Jones in Announcements
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This has been a really interesting week for me. My “Top 10 Tips for a Healthy Wedding” really struck a nerve – and in an unparalleled flurry of interest, I have been speaking to groups of people on the radio and in podcasts about weddings, marriage, and the medical angle on this wonderful celebration of human connectedness.
I was speaking with Gordon Deal from the Wall Street Journal Radio Show (Gordon is a truly affable interviewer) and I got a question that I had not anticipated but in retrospect makes a lot of sense. I was telling him about my decision to buy a wedding dress on the fly, picking one off the shelf in the first store I went to. He transitioned nicely to: would you say that your financial decisions follow your style for purchasing dresses? How have you and your husband worked through financial planning together?
Wow. I had to think on my feet on that one – leave it to a Wall Street journalist to get a financial angle on a story. My answer was truthful and brief – yes, my husband is more conservative than I am, but we have worked hard to get on the same page, thanks to a great financial advisor. (Squirm)
Kristi King at WTOP (partnered with the Washington Post) was up next – and we had a nice chat about the do’s and don’ts of wedding diets.
Then I got to speak to a Randy & Ken in Oklahoma City on KOKC. The weather report preceded my interview, and I couldn’t help but worry about the severe wind conditions down there. When asked about some good tips for a healthy wedding I mentioned that having a plan B is critical – especially if you’ve planned an outdoor wedding with a tent in Oklahoma!
On the eve of my second wedding anniversary I participated in a blogger call with Dr. Charles Foster (who is an amazingly insightful psychologist and relationship counselor – you should definitely listen to this podcast because it is very well worth it if you have any problems whatsoever with in-laws or your own family). We spoke with Rhonda from “Our Wedding Plus” blog and fielded questions from others remotely.
On I moved to a live show in Chicago with Theo & Gerrard at WVON (host to the Al Sharpton show) where we had a warm conversation about the meaning of marriage and the importance of a strong family nucleus for the fabric of American society.
There is at least one more interview awaiting (a contemporary music radio station in Hawaii) and I have to say that this has been one wild ride. As a physician I feel totally privileged to have been given the chance to speak with such a wide variety of Americans about a joyful, complicated subject that unites us all – the wedding.
Now if my taxi hijacking post sparks this sort of interest, I suppose I might need to hang up the stethoscope and focus on social commentary and relationships.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 28th, 2007 by Dr. Val Jones in Opinion, True Stories
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A psychiatric nurse once relayed an observation to me that I
have been pondering for the last decade.
We were working together in an inner city “dementia unit,” populated
with patients with end stage Alzheimer’s, vascular dementias, and brain
disorders of unclear etiology.
Individuals were parked in geri-chairs in institutional hallways, others
were in bed in 4 point restraints for their own protection, still others were
muttering to themselves in wheelchairs.
We were discussing the case of a particularly unpleasant
patient – he would swing at people as they got near him, trying to hurt them –
scratching, punching, even biting if you got close enough. His favorite thing was to grab nurses’, or
other female staff’s, breasts or crotches. He rarely succeeded at this, since most staff
were aware of his tactics, though he sat in his chair nearly motionless, like a
Moray eel in a reef cave, small eyes and snaggle teeth, mouth open slightly at
all times, taking slow deliberate breaths as he waited for an unsuspecting ocean
dweller to wander inadvertently into his reach.
I asked the nurse how she thought he had gotten to be so
rotten. She replied simply, “When people
get older they become more like themselves.”
That one sentence has fascinated me ever since. Could it be that as we age (and our minds
lose their ability to maintain the social graces we were taught), we slip into saying
things in an uncensored manner, and behaving the way we truly want to? Or is the difference between “sweet little
old ladies” and “mean old biddies” a matter of how much damage there has been
to their frontal lobes?
The scientist in me would like to explain away all agitation
as an organic brain disorder. But I just
don’t think we can reduce human behavior to neuroanatomy. The complexity of a lifetime of circumstances
and individual choices – and their interaction with personality – are soul-defining.
Perhaps age brings wisdom and life experience… or maybe it
unveils the truth about who we’ve been all along. Either way I have a feeling that when the time
draws near for our bodies to give up our souls, we can catch a glimpse of what people
are “made of” in their final words and deeds.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
