Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Medicare Cuts: How Will It Affect The Patients?

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*

Psychiatrist Considers The Difficulties That Would Arise When Treating Children

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*

Patients Need Encouragement To Talk About Depression

More than two in five patients hesitate to discuss depression in the primary care setting, leading researchers to offer practical tips on how to encourage people to broach the subject.

The big reasons for not talking to doctors included fears about patient confidentiality and fear of losing emotional control in front of the doctor, among those with a history of depression. Among those with no prior history, a fear of antidepressants/psychiatry and the perception that primary care isn’t the right setting are two big reasons.

To learn why patients choose not to talk about their depression, researchers Read more »

*This blog post was originally published at ACP Internist*

Psychiatrist Weighs In On Clinic’s Decision To Halt Xanax Supply

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*

Building On The Strengths Of Your Perfectionism

I often think of the well-known expression “perfect is the enemy of good” when I am endlessly rewriting an article to make it better (when it is already good enough) and in the process just make or even miss a deadline. But this old saying also reflects the dark view many people have of perfectionism. As a personality trait, it is seen as obsessive and at times pathological. People who are perfectionists may become so focused on setting a high standard for themselves that they live their lives as if graded constantly on a report card.

But perfectionism has a bright side, too. Desirable aspects of this personality trait include conscientiousness, endurance, satisfaction with life, and the ability to cope with adversity. This helps explain why some perfectionists become corporate leaders, skilled surgeons, or Olympic champions.

Dr. Jeff Szymanski, a clinical instructor of psychology at Harvard Medical School and executive director of the International OCD Foundation, believes it is possible to become a better perfectionist—by building on the strengths of this quality and learning to minimize its drawbacks. In his new book, The Perfectionist’s Handbook, he discusses this theory in greater detail and provides exercises people can try at home. Read more »

*This blog post was originally published at Harvard Health Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »