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 12th, 2011 by RyanDuBosar in Research
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Prescriptions for antidepressants given by nonpsychiatrists to patients without a specific psychiatric disorder increased more than 12% in 12 years, leading to the drug class becoming the third most commonly prescribed, a study found.
A study in the August issue of Health Affairs reported that antidepressant prescriptions by doctors who didn’t record a specific psychiatric disorder increased from 59.5% of all prescriptions by nonpsychiatrists in 1996 to 72.7% in 2007.
Researchers reviewed data on patients age eighteen or older from the 1996-2007 Centers for Disease Control and Prevention’s National Ambulatory Medical Care Surveys, a national sample of more than 233,000 office-based visits. The proportion of antidepressants prescribed for patients without a psychiatric diagnosis increased from 2.5% of all visits to nonpsychiatrist providers to 6.4% between 1996 and 2007. For visits to primary care providers, antidepressant prescribing grew from 3.1% to 7.1%. For other nonpsychiatric providers, visits without a psychiatric diagnosis grew from 1.9% to 5.8%. In contrast, antidepressants prescribed with a psychiatric diagnosis increased from 1.7% to 2.4%.
Patients who received antidepressants without a psychiatric diagnosis by nonpsychiatrist providers were more likely to be Read more »
*This blog post was originally published at ACP Internist*
August 10th, 2011 by AnneHansonMD in Opinion
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I’ve always been struck by the similarity between solitary confinement inmates and monks. Historically, monks were kept under the vow of silence. They could only leave their cells to attend religious services. The only visitors they were allowed tohave were their religious advisors. (If any of you have seen the movie Into Great Silence you’ll know what I’m talking about.) The idea of the modern penitentiary came from this ‘penitence’ process: put someone in a room by himself, give him religious guidance while he’s there and he’ll reflect, repent and reform. This was how prisons were run in the Nineteenth Century too: prisoners were kept under the rule of silence and they could only come out of their cells for religious services or for work. No one ever alleged that monks became psychotic because of this though.
Then there’s the psychiatric seclusion room. Again, a bare cell with a bed or a mattress, no visitors, no clothes except a hospital gown. There is no ‘vow of silence’ or ‘rule of silence’ though.
So what makes the difference between the prison segregation cell, the monk’s cell and the psychiatric seclusion room? Read more »
*This blog post was originally published at Shrink Rap*
August 5th, 2011 by AnnMacDonald in Opinion, Video
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When I leave for work in the morning, I go through my precommute checklist. Train pass, check. Wallet, check. Coffee mug, check. Smart phone, check. Keys to the house, check. Only when I’m sure that I have everything I need do I open the door and head outside.
Sometimes I worry that this morning routine is becoming too much of a ritual. Is it possible that I have obsessive-compulsive disorder (OCD for short)?
Probably not. The fact that I am able to get out the door every morning means that my daily ritual isn’t interfering with my ability to function, says Dr. Jeff Szymanski, a clinical instructor in psychology at Harvard Medical School.
You have OCD when obsessions and compulsive behavior Read more »
*This blog post was originally published at Harvard Health Blog*
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.
