Saturday, December 30, 2017

Oh For A Self-Correcting World

Good bye, 2017.  Personally, it was a good year.  Politically, not so much.  Our country has become so alarmingly polarized, and it seems we have so many problems!  

Here in Baltimore, things are difficult for so many people: firearm deaths have surged, with 345 deaths this year -- a far higher number than New York City where there are under 300 deaths, even though New York has many times the population that Baltimore has.  Overdose death have surged as well. Crime, poverty, homelessness,--they are all big problems.  The latest tax cuts promise to help corporations, and perhaps they will be good for the overall economy, but I worry about the effect these legislative changes will have on access to health care, and on our country's most vulnerable people.  And even among the "haves," depression and anxiety is rampant, suicide rates are high, substance abuse disables and kills, and we talk about doctor burnout and suicide in a country with physician shortages.  It's all disheartening.

I wish innovation were easier.  Our war on drugs has been a failure, and in moments of desperation, all sorts of things get tried.  Then sometimes, the 'solutions' become part of the problem.  For example, Physician Health Programs were an innovation to help struggling docs, and they have been very helpful for many, but there have been reports of abuses, and over on Clinical Psychiatry News, I wrote an article asking if PHPs were diagnosing for dollars.  Rehabs have popped up everywhere, but many of them are not using evidence-based treatments, and so much of treatment for opioid abuse still focuses around blaming the patient, moral failures, and an emphasis on abstinence-based treatments which are wonderful if they work for you and terrible if they leave you dead when a medication-based treatment might have given you some chance to live.  Given all the failures in our war on drugs, I might like to see how things transpire if we decriminalized all drugs of abuse, but somehow these things happen in sweeping moves, and if that doesn't work, it's hard to undo.  

Medicine has adopted Electronic Medical Records as a standard.  They add hours to a doctors day, contribute to physician burnout, and don't clearly improve the quality of patient medical records or clinical care: in fact many patients don't like talking to doctors who are clicking away and not getting to know them as people.  Maybe it's still growing pains, and surely the databases they generate are helpful in research to learn about factors that effect disease and the efficacy of treatments.  Maybe we will grow into these records, but they were rolled out with incentives, or in hospitals where they cost hundreds of millions of dollars, so at this point, there is no going back.

So I long for a world where we could try innovative changes -- in how we tax people, in how we address epidemics, in how we solve a multitude of problems, not by using the methods of the person who speaks (or tweets) the loudest, but by trial and error, with test runs on small segments of the population, with the ability to go back or try something new (easily) if what we try doesn't work.  Gun control, physician burnout, drug treatments, interventions for those who are name your problem.  Oh for a self-correcting world.  

Monday, December 04, 2017

Recent Reads: Black Man in a White Coat and Vengeance

I just wanted to put up a quick note about two books I've read recently.

Black Man in a White Coat is a memoir written by Duke psychiatrist Damon Tweedy.    So what's it like to be a black med student and doctor, and not just anywhere, but at Duke.  Tweedy notes that he was accepted at other top medical schools, but that he went to Duke because the only way they could attract African American students was by giving large scholarships.  That gives you a hint as to what the environment was like.  So it's not surprising to read that Tweedy was standing with a classmate, purposefully dressed in a polo shirt and khaki's, only to have the professor walk into the lecture hall and ask if he was there to fix the lights.  Ugh.  So not specific to psychiatry, but a good read with important insights into how racial issues play out in medicine.  

Moving on to fiction, you may remember Pete Earley from Crazy: A Father's Search Through American's Mental Health Madness.  Pete is a mental health advocate, but at night, he steps into a phone booth (remember those?) and steps out dressed as a novelist.  Paired with Newt Gingrich, this fabulous novelist duo has now written 3 books in a series: Duplicity, Treason, and now Vengeance.    They follow Major Brooke Grant as she travels around the world chasing the Falcon, a dangerous terrorist who ultimately knocks off everyone Brooke loves (or almost).  Vengeance is by far the best of the three books, and I don't want to say too much, because it's a better read without the plot spoilers.