Sunday, March 27, 2016

The Final Report on the Germanwings Tragedy

Over on Clinical Psychiatry News, I have an article up on the final report about the Germanwings pilot who crashed the plane into the French Alps.  A sad topic, but do read it.

Thursday, March 24, 2016

Guest Blogger Dr. Thomas Franklin Writes About His Own Experiences With Major Depression and Why He's Doing A Triathlon

Becoming an Ironman for Myself and My Patients

The sliver of light coming under the door of the windowless office seemed unbearably bright and offensive. I turned away from it and closed my eyes. There is a flat spot on the back of my head that, if angled just right, would lie on the textbook I was using as a pillow. In a few moments, I would be asleep again. I was supposed to be out seeing patients, but it was all I could do to show up at work and hide in my office. My supervisor was a gentle woman who would come check on me a couple of times a day. She would crack the door and ask, “Dr. Franklin, why don’t you come out and see one of the new patients?” 
“I can’t. I just can’t... I’m no good to anyone.”
Drifting in and out of consciousness in that dark room seemed far superior to being up and about, feeling the pain that seemed to emanate from my chest and flow throughout my body. It was as if my blood had been replaced by some impossibly dense material that could barely flow, making every step I took an effort. If I didn’t lie on that floor and feel my body supported all the way from that flat part of my skull to the small of my back, to the backs of my ankles, it felt like I might fall through to the center of the earth, through the dirt, rock, and then to the molten core where I would be incinerated. I wondered if that might be better than living like this.

Fearing Stigma but Seeking Help

I was a psychiatric intern at the time, and I was depressed. But I couldn’t bring myself to seek treatment. I suffered like that for months until I saw a colleague in consultation, where I described suffering the symptoms of attention deficit disorder, but suggested that a third-line medication for that diagnosis, also used for depression, might help me. I needed so much more than that medication, but my depression, my own inhibitions, and stigma kept me from getting the help I needed. Difficulty concentrating seemed a safer problem to admit to than depression. I was worried that I wouldn’t be taken seriously as a psychiatrist if it became known that I, too, was a patient. 
I continued to suffer off and on for years, finally getting into real treatment for the first time after my training was over. A combination of psychotherapy and medications led to the relief of stabilization. Ultimately, psychoanalysis, a more intensive therapy experience, helped me to fundamentally change how I thought about myself and the world, which led to not just relief, but a transformation of how my mind worked. Eventually, I was able to stop taking medicines. The way I had felt only years before seemed so far away. I felt a part of the human race. 
Until now, I have kept quiet about my experience. A continued fear of stigma has kept me quiet. I felt that if I was known as a psychiatric patient, even a so-called “cured” one, I would be labeled or disgraced or stereotyped. I thought it might hold back my career.
But the only way to combat stigma is to speak out. This is not easy, but I am inspired by those that have travelled before me on this road and by my current patients. I can’t go on urging them to be courageous, to face down the stigma they were feeling, without doing all I can to fight stigma myself. Only by shining the light of truth on people’s lived experience of mental illness will stigma finally become a thing of the past. 

Why a Triathlon?

After my psychoanalysis was over, I took up triathlons. Exercise has not only helped my mood, but I found that endurance sports are a powerful metaphor for what living with a mental illness can be like. In some ways, training for and finishing races makes me feel that I have mastery over that part of me that suffered so much.
In triathlons, like in depression, you have to go on putting one foot in front of another for as long as it takes. It will be painful. Your best-laid plans will go awry. Small mistakes early in the race can turn into big problems before the end of the day. The finish line will seem an impossibly long way away. There are moments of despair, but also moments of triumph. There is beauty around the next corner that can give you hope, if you only look up long enough to take it in. But preparing for and finishing the race is much more about your mind than your body. 
On July 24th, I will be racing the 140.6 miles of the Ironman Lake Placid triathlon to fight stigma, to show people that are suffering that treatment works, and to raise money for the Sheppard Pratt Patient Care Fund so that no one has to go without the treatment they need. 100 percent of the monies donated to this fund are spent on patient care. Maybe someone we help get treated will become the next courageous voice in the fight against stigma. Please give generously, whatever that means for you in your life. Thank you for your support.

Dr. Thomas Franklin is the medical director of The Retreat at Sheppard Pratt. He is a clinical assistant professor of psychiatry at the University of Maryland School of Medicine and a candidate at the Washington Center for Psychoanalysis. He is Board Certified in Addiction Medicine and Psychiatry, and has extensive experience in psychotherapy, psychopharmacology, and addictions and co-occurring disorders. Dr. Franklin previously served as medical director of Ruxton House, The Retreat’s transitional living program, before assuming the role of medical director of The Retreat in 2014.

Friday, March 18, 2016

Finding Help

Yesterday, I was a speaker at the University of Maryland's Cultural Diversity Day.
The theme was Urban Trauma: Understanding Its Impact and Navigating Access to Mental Health Care. I thought I would share some of my slides with our readers.  And now I know how to put a PowerPoint Presentation into a blog.

Monday, March 14, 2016

Listen to ClinkShrink Discuss Physician Assisted Suicide on the Radio

In case you haven't heard, our ClinkShrink has strong feelings about legislation to allow Physician Assisted Suicide.  She has written about it Here and Here.

A few weeks ago, ClinkShrink was on the radio talking about proposed legislation in Maryland.  She did a great job. 
Here's the link, you can listen to the whole show hosted by Sheila Kast.

Sunday, March 13, 2016

To Aetna: I am NOT in your network

Dear Aetna,
I would contact you directly, but believe me, I've tried. 

Perhaps you could help me.  I am a psychiatrist is Baltimore and somehow my name is on Aetna's provider panel.  I never filled out an application or request with Aetna and I have no desire to be on their panel.  Over the last couple of years, I had gotten a few calls from prospective patients, clarified that I am not an Aetna provider, at least not willingly, and left it at that. Recently, the calls have escalated to as many as 5 a week.

I have called Aetna repeatedly, and I can't seem to find a voicemail option that allows me to speak with a human.  I received a call (left as voicemail) from Aetna the other day saying I must refund a patient because I charged more than the allowable rates for an Aetna-cover patient, and the  patient told them I was not in network, and a number was left for me to call. When I dialed that number, the automated answer machine knew who I was (I suppose by my phone number?) but then none of the prompts led to an option to discuss network participation or to speak with a human.  I have also gone to their website, where there is a place to report network issues, and I reported there that I am not in network and never heard anything.  I googled the Chief Medical Officer and tried to call him, without success.  This is a lot of time and effort to dis-enroll from a company I had never enrolled with!  Even your contact page is a fiasco.
  Network inadequacy is an enormous problem for patients and Aetna makes it extremely difficult to address.

Wednesday, March 09, 2016

What Do The Kids Need to Know?

That's a great title for a post, isn't it?
Unfortunately, this isn't going to be about anything all that juicy.  I'm giving a talk on Access to Care next week to 60 or so psychiatry residents in training.  I thought I would ask our readers: What should young psychiatrists know about finding a psychiatrist?  Are there things that make it harder or easier to find someone?  What should they know about health insurance participation?
Write something I hadn't thought of  and I'll read it at my presentation!
Thank you for your help.