August 2nd, 2011 by Dinah Miller, M.D. in Opinion
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In the Clinical Encounters case featured here two days ago, I presented the story of a psychiatrist who goes for a urological procedure and discovers that one of his former patients is the nurse assisting. People wrote in to suggest ways he should handle this awkward situation and I was struck by the idea that some suggested he tell the urologist that he knows the nurse in a social setting (because he can’t tell the other doc that the nurse was his psychiatric patient) and the assumption that the urologist would be understanding, and that perhaps the urologist should have policies in place in case of such events.
Do surgeons think this way? Read more »
*This blog post was originally published at Shrink Rap*
July 23rd, 2011 by Dinah Miller, M.D. in Book Reviews, Opinion
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Rob Dobrenski, PhD. is a psychologist who blogs over on ShrinkTalk.net. He’s written a book about what it’s like to be a psychology graduate student, a psychotherapy patient, and a psychologist. Oh, we like the folks who go from Shrink blog to Shrink book — it somehow feels familiar — and so I agreed to read his book: Crazy: Tales on and Off the Couch.
So bear with me while I tell you that the book rubbed me wrong at the outset. Dr. Dobrenski begins by saying something to the effect that he describes things that all shrinks feel, and if they say they don’t, they aren’t being honest. I really hate it when people tell me what I feel. It’s like saying that Prozac made your depression better and if it didn’t, then you just didn’t recognize it. And then the book gets off on a provocative start — Rob discovers that many people in his life, from a patient, to a colleague, to himself — are “f***ing crazy.” The asterisks are mine. Dr. Dobrenski had no trouble using the word — I counted 19 times in the 39 pages, including in direct quotes of discussions he has with both a patient and one of his supervisors. Not in a million years. I wasn’t sure what the point was. To let people know he knows obscene words? To be Read more »
*This blog post was originally published at Shrink Rap*
May 18th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network
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I’ve previously written about what face-to-face smoking cessation services typically do, largely based on my own experience. However, while at the SRNT annual conference I met two Smoking Cessation Advisors working in Lancashire, England who appeared to have a successful service, so thought it worth sharing some of their information.
Jan Holding and Eileen Ward manage a UK National Health Service (NHS) Stop Smoking Service in Lancashire in the north of England. Both are nurses by training and many of the 14 staff providing the treatment have primarily a nursing background. Their service sees around 450 new clients per month (i.e. over 5000 new clients per year). Services are provided at “community sessions” at various locations all over their catchment area, and clients are given their own hand-held record which they keep, and take with them to sessions, enabling them to attend whichever community location suits them at the time. While clients can make scheduled appointments, the service is also flexible, allowing clients to “drop-in” to community sessions without an appointment. Although some initial assessment sessions take place in a group format, most of the sessions are delivered in a one-to-one format via a relatively brief discussion with a smoking cessation advisor. These community sessions often take place in a large community room from 4pm to 8 pm in the evening, with multiple types of services being provided in the same room at the same time at different corners (e.g. initial assessments in one corner, prescribing of varenicline in another, and nicotine replacement therapy in another). It is not uncommon for around 200 clients to attend a single community session.
Clients are frequently encouraged to use NRT prior to quitting smoking (about half do this) and usually use more than one smoking cessation medicine (more than half do). Nicotine replacement therapy is provided via a voucher system requiring either no cost to the client, or just a co-pay (around $10 USD).
The service runs 6 days per week and includes evening sessions, and aims to reduce most of the usual barriers to entering treatment. Their “3 As” approach emphasizes “Accessibility, Availability and Adaptability”. They also specifically try to develop smoking cessation advisors who are passionate about their role, have a positive attitude to the importance of quitting smoking, and are therefore very committed to that work, as well as being knowledgeable about it.
My understanding is that the quit rates at this service are pretty good. But perhaps the best testimony to its success is the fantastic volume of clients who attend…..largely influenced by positive word-of-mouth via other clients. The success of this service reminds us that there isn’t just one way to do it, that all smoking cessation counselors and systems may need to be flexible and adaptable in order to help as many smokers to quit as possible.
For further information on what a smokers’ clinic does, see: What does a tobacco treatment clinic do?
This post, Smoking Cessation Programs: Lessons From The UK, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
