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Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen. All patient vignettes are confabulated; the psychiatrists, however, are mostly real. --Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)
The first pig, a female, was captured last week with nets, animal control officials said. Both pigs were taken into custody in the 600 block of Hammonds Ferry Road.
Karen Gower, manager at the Red Wing Shoes store near where the pigs were apprehended, said her employees are going to miss the animals, which they used to watch regularly. One of her employees, she said, was feeding them.
"We understand they had to take them, but we're kind of sad to see them go," she said. "They would lay there stretched out like a dog under a tree for hours."
Animal Control Officer Glenn Johnson and Jim Bennett of the Department of Natural Resources were praised by officials Wednesday for pulling off the capture of the second pig, which involved the use of tranquilizers. Officers were concerned about the pig's safety, they said.
"As the scientists will also tell you, neurotransmitters respond to everything: hugs, kisses, conversation, books, pictures, gardening, hunger, worry, rows, war – all raise or lower chemical levels."Ah yes, clinical depression and suicide must be the result of not getting enough hugs or the fact that you haven't taken up gardening. Cringe-worthy health reporting, at its best. The reporter concludes:
"...supposedly scientific comments of this sort serve little purpose except to coax women into a state the doctors can then medicate."Amazing. A simple study about caffeine and depression has somehow been morphed into another nefarous plot by evil Dr. Pillshrink.
social media use by physicians. According to a survey by QuantiaMD, nearly 90% of physicians use social media, much more than the general public. Most social media use---about 67%---is for personal reasons. A third of physicians reported getting at least one Facebook friend request from a patient, but most of these requests are turned down. For me the most interesting thing was that only 8% of physicians reported using a blog for professional reasons. That seemed low to me.
Good studies for psychiatric treatments are desperately needed. In the meantime, we have patients, in our case children and adolescents, who desperately need help. These children may be out of control, overwhelmed by anxiety, dangerously aggressive, disorganized in their communication, floundering in school. We need to help them. Medications, often along with behavioral therapy, can have a transformative effect. If they don't help, we are not forced to continue using them. We would like to see objective research catch up with the clinical realities but can't wait until that happens. Furthermore, falling back on pure non-pharmacological treatment is not the better alternative, since these treatments have rarely undergone objective evaluation.
As to the issue of psychoactive drugs actually harming patients by altering their brain chemistry over the long term, which Angell posits, here too data is lacking. It makes no sense to forego present benefit because of undemonstrated future harms. We try to weigh the risks of psychoactive drug treatment against the risks of forgoing treatment. That risk often includes academic failure, dropping out of school, substance abuse and even suicide. Unfortunately, the risks of avoiding demonstrated useful treatments are not something critics, like Angell, consider.
I think Medicare needs to reinvent its game by moving away from per-visit payments -- which reward volumes -- toward payments based on severity-adjusted episodes of care combined with quality and outcomes multipliers -- which rewards quality and efficiency.
By re-inventing the way Medicare pays all providers, not by quantity but by quality and efficiency, it has a chance to bend the cost curve without making it harder for beneficiaries to find a doctor who will accept Medicare. Medicare enrollees deserve to be treated better. If Congress messes this up, there will be hell to pay at the ballot box.
Sent to us from TigerMom and Jay at Two Women Blogging-- which is oddly enough a blog by three women (all that education and they can't count???-- and shamelessly stolen off BoingBoing
Need something to do on Sunday before the Ravens game? Need a good book to read? Want to meet your favorite blogging Shrinks? Come visit the Shrink Rappers on Sunday, September 25th at 1PM in the Peabody Library. For more details see The Baltimore Book Festival Website.
Over on KevinMD, an anonymous doctor has post up called the Absence of Joy about his own problems with depression. He writes:
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 — its doctors stopped writing new prescriptions for Xanax and its generic version, alprazolam, in April and plan to wean patients off it completely by year’s end.
My hat goes off to kiddy shrinks. It's a tough field, full of issues we don't see in adult psychiatry.
Like Dinah, I also was thinking of writing something. I went to Twitter, and saw that many people were saying what they were doing at the time of hearing about the attacks. It made me think -- for the umpteenth time -- where I was and what I was doing at that time.
If any of you readers would like to describe what you were doing on 9/11/2001, the day of the terrorist attacks, please feel free to do so in the comments.
I was in my private practice office at GBMC seeing my first patient of the day. A very healthy, but very anxious older man with frequent physical complaints. Very nice guy. We were just finishing a therapy session (~8:50am) and I sent him out and was writing my note. My office was in a hospital office building in a suite run by a primary care physician, so there were also several exam rooms, a large front office with a receptionist and two office staff, and a waiting room with maybe a dozen chairs.
The first plane hit at 8:46 am ET (detailed timeline here on Wikipedia).
My 9am patient, a middle-aged woman with even more anxiety problems whom I had helped with a severe benzo addiction, came back early to tell me that a plane had crashed into one of the twin towers in NY and that another one was heading to DC. My initial reaction was disbelief. She must have gotten that wrong. I go out to the front office where everyone is crowded around a TV, listening to the news. My 8am patient is still there.
She was my last patient of the day. Everyone else cancelled. If they hadn't, I would have. The day was filled with fear, uncertainty, and doubt. But there was a camaraderie. We all grew closer with this common experience. The images, burned into our collective brains.
The one peaceful image that equally burned into my brain: for four days I gazed for long periods at the sky in amazed wonder. Not a single plane. Not a single jet entrail drifting across the sky. "This must be what the sky looks like in Wyoming," I recall thinking. Beautiful! I'm tearing up just thinking about it now. I've still never made it to Wyoming. But I will never forget.
One option was to let the day pass without a blog post. The other was to say something about the fact that it's September 11th, a day that left so many people so distressed. It was never an option to post on an unrelated topic.
I find myself pushing thoughts of that day out of my head, and then, periodically, I'm drawn to watching a YouTube video of the towers falling. Mostly, though, I've had nothing to say because what is there left to say? It was horrible.
My patients have not been talking about 9/11. They all want to tell me where they were during the earthquake that shook us a few weeks ago, and whether they lost power during Hurricane Irene. I'd asked a former guest blogger who lives in NYC if he wanted to write about 9/11, and he said he'd think about it and I haven't heard back. Another friend was standing under the towers when they collapsed. I asked if he'd like to write for a psychiatry blog and he said he'd been unable to write about it, perhaps in his memoir, and last year he left the country on the day. This was a tragedy that evades words and pulls us to places that are difficult to go. I want to thank David Hellerstein, again, for writing a guest post for us on Resilience in honor of the anniversary. When I first read his post, I liked it, but I thought it was about resiliency, and not the aftermath of the terrorist attacks. Perhaps that is truly the best place to go as we all carry on with hope in our hearts.
And finally, I'd like to link to a memorial note for for my friend, Carlos DaCosta.
Peace to all.
|@ 2011 AVAM Kinetic Sculpture Race|
There's lots of talk about Electronic Health Records and where the information goes and who has access to it, with the assumption that easy communication is mostly a good thing. EHR's, cloud storage, and all there is to argue about aside, let's put a question out there: What's in a psychiatrist's note, anyway? For the sake of our hypothetical discussion here, let's skip the evaluation note, and just talk about progress notes. Oh, if you'd like to know what's in a psychiatric evaluation, buy our book, we go on and on (and on) about what happens and what gets written.