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This page shows you the most recent publications within this specialty of the MedWorm directory. This is page number 2.

Delirium and Physostigmine: ECG helps in Management
This patient took an unknown overdose and was delirious.  The axillae were dry.  Due to delirium and dry skin, there was suspicion of anticholinergic toxicity.Here is his ECG:There is sinus tachycardia.  There is also some QRS widening and a large R-wave in aVR, and an rSR' (RV conduction delay) in lead V1.  The QRS duration is 107 ms.  There is QT prolongation as well, with a computerized (Bazett) QTc of 480 ms (prolonged).The prolonged QRS and RV conduction delay make this very suspicious for Na channel blockade, and, most worrisome, for tricyclic antidepressant overdose (TCA).Do we treat the del...
Source: Dr. Smith's ECG Blog - March 7, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

An alcoholic patient, and his effect on a medical student
This article originally appeared in uvm medicine. Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 6, 2015 Category: Journals (General) Authors: Tags: Education Emergency Hospital Medical school Source Type: blogs

Does medical student debt lead to suicide?
Every year 300 to 400 physicians commit suicide. More than 10 percent of doctors are thought to have depression, a frequent precursor to suicide. Rates of depression and suicide among physicians are higher than in the general population. Many reasons including stress, heavy workload, sleep deprivation, lack of autonomy, and lack of outlets for personal care may contribute to higher vulnerability in doctors. High-profile suicides this past year by medical residents have led to a slew of articles on depression and suicide in physician. Curiously missing from the conversation is financial strain, particularly debt. Co...
Source: Kevin, M.D. - Medical Weblog - March 6, 2015 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

Top stories in health and medicine, March 6, 2015
From MedPage Today: Trends in Teen, Young Adult Suicide Differ by Gender. Patterns of suicides among adolescents and young adults changed dramatically from 1994 to 2012, with major gender differences in these 19-year trends. Early Hot Flashes May Predict Heart Disease. Early-onset and frequent hot flashes and night sweats in women were associated with poorer endothelial function. Hepatitis E Vaccine Has Lasting Effect. A vaccine against hepatitis E (HEV) provided protection against the virus for more than 4 years. Getting Inspired About the Lean, Mean PCMH. As we continue planning our first patient-centered medical home ...
Source: Kevin, M.D. - Medical Weblog - March 6, 2015 Category: Journals (General) Authors: Tags: News GI OB/GYN Psychiatry Source Type: blogs

Collaborative Care
When asked about how NIMH research can change mental health care, I have a short list of “best hits” that I offer as examples. High up on that short list is collaborative care. Developed initially for treating depression, collaborative care integrates mental health and primary care to provide patient-centered, comprehensive, accountable care. To ensure that patients receive comprehensive and evidence-based care, each patient has a team, including primary care providers and mental health specialists, monitoring progress, with clinical and community support for reaching treatment goals. Not only does each patient’s tre...
Source: NIMH Directors Blog - March 5, 2015 Category: Psychiatry Authors: Thomas Insel Source Type: blogs

Increase the minimum wage for better mental health
There are many good reasons for Congress to enact President Obama’s proposal to raise the Federal minimum wage to $9 per hour.  Many of these reasons, from economic stimulus to possible reductions in gaping income inequality to much-needed financial relief for working families, have been extensively discussed in the public sphere.  However, one important benefit of increasing wages has not received enough attention: improving mental health. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 4, 2015 Category: Journals (General) Authors: Tags: Policy Psychiatry Source Type: blogs

The ACA’s Hospital Tax-Exemption Rules And The Practice Of Medicine
The Affordable Care Act (ACA) and related regulations include obligations for nonprofit (and some government) hospitals to provide benefits, such as free care, to their communities. On their face, these new obligations seem a valuable response to longstanding concerns of some legislators, litigators, and scholars that some nonprofit hospitals are really ‘for-profits in disguise’ and to the related calls to eliminate tax-deductions for gifts to nonprofit hospitals. Moreover, the requirements have been lauded for their potential to improve public health, particularly in leading to better consultation and collaboration wi...
Source: Health Affairs Blog - March 3, 2015 Category: Health Management Authors: Jill Horwitz and David Cutler Tags: All Categories Business of Health Care Health Law Health Reform Hospitals Policy Source Type: blogs

Is Internal Medicine MOC necessary?
Maintenance of certification is, in my opinion, a good idea. While I had significant concerns about the structure that the ABIM was using, the idea that we have an obligation to maintain our knowledge. I believe that the only legitimate argument is in the definition of how one documents maintenance. The ABIM had two major problems to address. The first issue that they are working vigorously to improve is the criteria for MOC. I have written often about how I would document maintenance. I hope the performance improvement concept is taken out of MOC because we are subject to too many performance report cards already. While ...
Source: DB's Medical Rants - March 2, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Just in the Nic o’ tine
A 21-year-old man presented with palpitations, tremulousness, nausea, and vomiting. He reported ingesting one 14 mg nicotine patch in a suicide attempt. Initial vital signs include heart rate 132 bpm, blood pressure 140/80 mm Hg, temperature 37°C, respiratory rate 26 bpm, and pulse oximetry 100% on room air. Physical examination is remarkable for agitation, fine resting tremor, tachycardia, and pressured speech.   The lethal dose of nicotine is estimated to range from 1 mg/kg to 10 mg/kg. Reports of nicotine toxicity have occurred with the ingestion of as little as one whole cigarette or three cigarette butts in children...
Source: The Tox Cave - March 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Things we might have done differently: High School
#1 is finishing High School. Some good things have happened in High School, but if we could rerun the tape we’d have tried something different — perhaps a local charter school that specializes in autism disorders.The Junior and Senior years have been remarkably weak. I think this is partly due to local conditions; we’ve seen problems with leadership, policies, and funding — particularly funding and support for class aides.I don’t think that’s the whole story though — I suspect very few schools or school districts have figured out how to manage special education for ages 16-19, particularly in integrated setti...
Source: Be the Best You can Be - March 2, 2015 Category: Disability Tags: adolescence adult education school Source Type: blogs

Crowd Sourced Suckers
“What do you think of this?” writes a friend: …[A]n untraditional approach to medical diagnosis that is helping solve the country’s most difficult medical mysteries and creating real miracles. This is the description of something called CrowdMed, the latest version of getting doctors to provide services for free. Thus my short answer about what I think of it: not much. To be fair, and because I had a few minutes of free time, I went and checked it out. Patients submit questions about their medical condition(s), accompanied by varying levels of supporting detail, and “medical detectives”...
Source: Musings of a Dinosaur - February 27, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs

Promoting Amphetamines for Over-Eating - What Could Possibly Go Wrong?
In this study, about 5% of patients given any dosage of Vyvanse had to discontinue its use because of adverse effects.  3/196 patients initially randomized to Vyvanse had serious adverse effects, and one patient died, apparently of an amphetamine overdose.  Oddly, the article declared that the one death, due to methamphetamine overdose, was thought by a study investigator not to be related to treatment with another amphetamine, lisdexamfetamine.  That makes little sense, given that in a randomized controlled trial, the presumption is that differences in groups given different treatments were caused by these ...
Source: Health Care Renewal - February 26, 2015 Category: Health Management Tags: clinical trials conflicts of interest deception evidence-based medicine FDA marketing Shire stealth marketing Source Type: blogs

Mortality and Mental Disorders
It’s easy to overlook the most important health statistic of the past century. Life expectancy has increased dramatically in the U.S., from 51 years in 1910 to nearly 79 years (81 years in women, 76 years in men) in 2010.1 (Source: NIMH Directors Blog)
Source: NIMH Directors Blog - February 26, 2015 Category: Psychiatry Authors: Thomas Insel Source Type: blogs

Preventing deaths in detention of adults with mental health conditions
Equality and Human Rights Commission (EHRC) - This publication is the final report of an inquiry into non-natural deaths of adults with mental health conditions who have been detained in England and Wales. It focuses on prisons, police custody and psychiatric hospitals, as every year hundreds of deaths occur in these settings and these deaths are later deemed to have been preventable. Report Supplementary documents EHRC inquiry (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - February 23, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Mental Health Patient safety Source Type: blogs

When patients’ anger leads to murder
When we perceive any object of a familiar kind, much of what appears subjectively to be immediately given is really derived from past experience. – Bertrand Russell, The Analysis of Mind I’ve learned a few more things about Stephen Pasceri, the man who murdered a cardiovascular surgeon in Boston recently.  He had money troubles involving credit card debt.   He declared bankruptcy at one point.  He tried to get John Kerry, the senator, to fix an $8,000 hospital bill.  He also has family troubles.  He sued his own aunt and uncle over a property dispute.  He seems to have been an angry and impulsive man. Conti...
Source: Kevin, M.D. - Medical Weblog - February 17, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

Karl Bonhoeffer
Many years ago I read a lot about Dietrich Bonhoeffer, the minister and theologian.  His ideas about the church and Christianity I found interesting, and I was also interested in his involvement in plots to kill Hitler.  He was executed in 1945 for that involvement.  And so I discovered that his father, Karl (1868-1948) was a psychiatrist.  And because at the time I worked at the Royal Society of Medicine Library in London, which was (and is) a research library of historical record which kept all sorts of things, and we had Index Medicus in print and Medline on CD Rom, I could find material about h...
Source: Browsing - February 15, 2015 Category: Databases & Libraries Tags: medical history Nazi Germany psychiatry Source Type: blogs

The $5.3 Million a Year Government Bureaucrat - The Top Administrator, or CEO of a "Government Entity," Charlotte-Mecklenburg Hospital Authority, "Doing Business as" Carolinas Healthcare Gets a Raise
The pay given to top managers of health care organizations continues its seemingly inexorable rise, and the justifications for it seem to be increasingly perfunctory.  However, a closer look at individual cases can generate even more questions about how we got to this pass.  Our latest example arises from a recent news article about the compensation of top managers at Carolinas Healthcare.   CEO Pay Levitating Since 2009 In 2011, we started following executive compensation at the hospital system now known as Carolinas Healthcare. Our posts in 2011, 2012, and 2013 all fit the same pattern.The total compensati...
Source: Health Care Renewal - February 12, 2015 Category: Health Management Tags: Carolinas HealthCare Charlotte-Mecklenburg Hospital Authority executive compensation government managers ' coup d etat public hospitals Source Type: blogs

Can use of an occupational justice model in an American context result in accusations of professional misconduct?
Conceptual practice models are interrelated bodies of theory, research, and practice resources that are used by OTs to guide practice (Kielhofner, 2009). One such conceptual practice model is the Occupational Justice Model (Townsend, 1993; Townsend and Nillson, 2010).  According to these sources, the Occupational Justice Model is framed around the concept that injustice occurs due to inherent governance and social structures that allegedly restrict the occupational performance of some populations and individuals.Concepts associated with occupational justice models have filtered into some official documents of the Amer...
Source: ABC Therapeutics Occupational Therapy Weblog - February 12, 2015 Category: Occupational Health Tags: OT Education OT practice philosophy Source Type: blogs

Medtronic Settles $2.8 Million Off-Label Suit Over Neurostimulator Promotion
Minnesota-based medtech company, Medtronic Inc., has agreed to pay $2.8 million to resolve allegations that the company promoted its neurostimulator device for unapproved chronic pain treatment. According to the complaint, originally filed by former Medtronic sales rep Jason Nickell, Medtronic sales staff were directed to sell the device at discounted prices to pain management doctors. Nickell also alleged that sales reps promised physicians could “make upward of $10,000 profit on each patient, while adding only minutes to the procedure" by using a billing code meant for an FDA-approved use. Neurostimulation provides pai...
Source: Policy and Medicine - February 11, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

In times of stress, remember who is behind the mask
As clinicians, we often forget or become desensitized to the image that society has of medicine and doctors. Alongside teachers and scientists, we are seen to be among the most trustworthy of professionals, yet our morale is low, with almost 50 percent describing it as “low” or “very low.” You can imagine, then, why I often describe medicine as a forest: beautiful, scenic and picturesque from afar but potentially hostile, and even lethal, inside. From a distance, the forest is amazing to behold, but inside, from time to time, its inhabitants — and we all know this feeling far too well — grow tired of be...
Source: Kevin, M.D. - Medical Weblog - February 10, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Psychiatry Residency Source Type: blogs

Immune to Stress?
Some of us seem to cope better with life’s hard knocks than others. One might assume that the secrets to understanding these individual differences in resilience must be sought in the brain. Maybe not. (Source: NIMH Directors Blog)
Source: NIMH Directors Blog - February 10, 2015 Category: Psychiatry Authors: Thomas Insel Source Type: blogs

Prescribing off-label: It’s gotten out of control
Doctors prescribe way too many medicines for patients who don’t really need them. A lot of the pressure comes from intense drug company marketing. Some comes from patients who aren’t happy leaving the office without a pill. And doctors have too little time with each patient to explain non-pill solutions to problems. Wild prescribing is not new. For thousands of years, doctors have given patients useless (and often quite harmful) drugs and patients have taken them. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source...
Source: Kevin, M.D. - Medical Weblog - February 6, 2015 Category: Journals (General) Authors: Tags: Meds Medications Psychiatry Source Type: blogs

Precision Medicine for Mental Disorders
Precision medicine seems to be the new hot topic in the research world. President Obama spoke about precision medicine in his State of the Union speech (Source: NIMH Directors Blog)
Source: NIMH Directors Blog - February 3, 2015 Category: Psychiatry Authors: Thomas Insel Source Type: blogs

Psychiatry is devalued: And patients suffer because of it
This past week I spoke with a patient who noted that since his wife’s death six months ago, he had lost 40 pounds, slept a maximum of four hours nightly, and stopped enjoying activities he used to take pleasure in. He found it difficult to concentrate at work, and getting out of bed each morning was described as his greatest struggle. While relaying this story, the man was on the verge of tears. His voice was soft and pleading; he needed help. While the exact line between a “normal” grief reaction and new-onset major depression is controversial, my attending explained to this patient that — given the length and...
Source: Kevin, M.D. - Medical Weblog - February 2, 2015 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

Always Err on the Side of Compassion
The best piece of marital advice I’ve ever heard came from an ex-priest, a kind and gentle man who has been married to his bride for longer than I’ve been alive. “Always err on the side of compassion,” he told me when I called him up all upset one afternoon after my husband and I got into a fight. I don’t even remember what the fight was about. Something stupid. But I remembered his advice and I’ve been trying to apply it not only to my marriage but to my life, in general. In fact, it has become my mantra. Always err on the side of compassion. It sounds so easy, but is so difficult to execute. The mo...
Source: World of Psychology - February 1, 2015 Category: Psychiatrists and Psychologists Authors: Therese J. Borchard Tags: Depression Disorders General Health-related Motivation and Inspiration Personal Bipolar Disorder Cognitive Behavioral Therapy Intrusive Thoughts Major Depressive Disorder Mood Disorder Psychomotor retardation Seasonal Affective Dis Source Type: blogs

The APA and The Helping Families in Mental Health Crisis Act
If you are not familiar with Representative Tim Murphy's legislation to overhaul America's broken mental health system, this post isn't for you.  The legislation died when congress convened, but Rep. Murphy is planning to reintroduce the legislation to this congress, and he has 115 co-sponsors for the bill.  In the last session, APA took no stance on the bill; they wrote a letter supporting the idea of legislative change and said they looked forward to working with Murphy on this.  Rep. Murphy has said that the new legislation to be proposed will have some changes, changes that APA finds more in alignment wi...
Source: Shrink Rap - January 31, 2015 Category: Psychiatrists and Psychologists Authors: Dinah Source Type: blogs

Doctor Evil
This is extremely disgusting. Doctors in California, who receive payments and other benefits from drug companies, have been prescribing anti-psychotics to kids in foster care -- kids who are not psychotic at all, but who are being drugged into a stupor in lieu of properly addressing their behavioral problems. According to the investigation by the San Jose Mercury News, drug companies spent $14 million from 2010 to 2013 to bribe doctors into making these prescriptions.According to the investigation, nearly 25% of California foster children age 10-18 were prescribed antipsychotic drugs. I have written about these drugs here ...
Source: Stayin' Alive - January 30, 2015 Category: American Health Source Type: blogs

The day the music died and how a hospital lost its joy
There’s a great song by Don McLean called “American Pie.” The chorus talks about “the day the music died.” I thought about that song in my hospital a couple years ago, when the music died there, too. I’ve noticed that our physician burnout and nurse frustration have increased in the years since the music died. Could it be a coincidence? Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - January 30, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

It’s All In Your Head
The following post originally ran on Disruptive Woman to Watch Lisa Suennen’s blog Venture Valkyrie on January 26th. “Mental health needs a great deal of attention. It’s the final taboo and it needs to be faced and dealt with.” That quote is from the great philosopher and clinician, oh wait I mean 80’s post-punk rocker Adam Ant. Seriously. But he is so right on. Back in 1998 I was part of the management team of a company called Merit Behavioral Care, also once known as American Biodyne. The company was the first of its kind: a company that delivered what we now know as population health for people with menta...
Source: Disruptive Women in Health Care - January 30, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Mental Health Source Type: blogs

The power of the specialist physician — and stewardship
My latest column over at theHeart.org discusses the disordered balance of power in the doctor-patient relationship. As most of you know, I harbor strong biases about the quality of medical decisions, especially in the elderly. Attached. Yes, I am attached to the issue of decision quality. Nearly all of electrophysiology, and much of cardiology, involves preference-sensitive decisions. This means doctors are called to align treatments with the goals of the patient. We hold great power; we must use it justly and wisely. My latest essay arose from an unusual source. The prominent medical journal Circulation Outcomes publishes...
Source: Dr John M - January 30, 2015 Category: Cardiology Authors: Dr John Source Type: blogs

The Ignorance Project
Attending the World Economic Forum this past week, I was struck by two trends. The first was that brain research has emerged as a hot topic. Not only was brain science or brain health a new theme at the meeting, research on the brain emerged in discussions about next generation computing, global cooperation, and even models of economic development as well as being linked to mental health or mindfulness. In a meeting frequented largely by economists and business leaders, I was surprised by the number of non-scientists who have become enchanted by brain science. Clearly this is the era of the brain, with mental health now pa...
Source: NIMH Directors Blog - January 29, 2015 Category: Psychiatry Authors: Thomas Insel Source Type: blogs

Wall Street Journal readers weigh in on PAS
Last Saturday, the Wall Street Journal carried an excellent op-ed piece, “Dr. Death Makes a Comeback” (subscription required), by Dr. Paul McHugh, former chief psychiatrist at Johns Hopkins Hospital.  In it, Dr. McHugh opposes physician-assisted suicide (PAS), making three key points: The practice will tend to spread beyond terminally ill people to those who are “treatable but mentally troubled.”  He appeals to the experience in... // Read More » (Source: blog.bioethics.net)
Source: blog.bioethics.net - January 29, 2015 Category: Medical Ethics Authors: Jon Holmlund Tags: Health Care Allocation / Access / Public Health bioethics end of life Health Care Practice syndicated Source Type: blogs

Top 10 PTSD Blogs of 2014
Post-traumatic stress disorder (PTSD) often is linked to military veterans, but it can affect anyone following a traumatic event. There are five subtypes: normal stress response, acute stress disorder, uncomplicated PTSD, comorbid PTSD and complex PTSD. Sleep disturbances and flashbacks, where the sufferer relives the trauma, are hallmarks of the disease. PTSD has several other symptoms, some of which overlap with other disorders. These include a loss of interest in regular activities, feeling depressed, anxious and difficulty concentrating. A person with PTSD may find it difficult to relate to loved ones. Instead they are...
Source: World of Psychology - January 29, 2015 Category: Psychiatrists and Psychologists Authors: Kim Lyon Tags: Best of the Web Brain and Behavior Disorders General Mental Health and Wellness Military Psychology PTSD Stress Trauma Violence and Aggression abuse best ptsd blogs combat veterans Complex post-traumatic stress disorder Postt Source Type: blogs

Research and Reviews in the Fastlane 068
Welcome to the 68th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the...
Source: Life in the Fast Lane - January 29, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care LITFL Microbiology Psychiatry and Mental Health critical care examination LITFL R/V R&R in the FASTLANE recommendations Review Source Type: blogs

Infestation Anxiety: The Enemy Within
As Ebola fears wane, don’t be fooled. The next great threat is always upon us. There is a little-known psychological disorder called “Ekbom syndrome” in which a person believes that insects are crawling underneath their skin. Patients often tear their skin off in an attempt to extract the invisible vermin. Even though it’s a rare disorder affecting about 100,000 Americans, somehow we can all relate to the maddening anxiety of those afflicted. There is something universally cringe-worthy about the experience of infestation. I was reminded of this during the Ebola scare that swept the nation over the past few...
Source: World of Psychology - January 28, 2015 Category: Psychiatrists and Psychologists Authors: Evan Fisher Tags: Brain and Behavior General Green and Environment Health-related Psychology anxiety Collective Unconscious ebola Fear Foreign Policy Immune System infestation News Media Object Relations Sensationalism social media Source Type: blogs

Treat the diagnosis or the person?
 I happily return to Jung. I am reminded of this quote: It is generally assumed in medical circles that the examination of the patient should lead to a diagnosis of his illness, so far as this is possible at all, and that with the establishment of the diagnosis an important decision has been arrived at as regards prognosis and therapy. Psychotherapy forms a startling exception to this rule: the diagnosis is a highly irrelevant affair since, apart from afixing a more or less lucky label to a neurotic condition, nothing is gained by it, at least as regards prognosis and therapy...The content of a ...
Source: Jung At Heart - January 28, 2015 Category: Psychiatrists and Psychologists Source Type: blogs

New book on neuroplasticity by Norman Doidge: The Brain’s Way of Healing
Rewired: Learning to tame a noisy brain. (Or, how you can use the power of neuroplasticity) (The Globe and Mail): “His first book popularized the idea that the brain is actually a dynamic, adaptive organ with incredible potential to change. Now, Dr. Norman Doidge is sharing incredible stories of recovery from the sci-fi-like frontier of energy-based therapies… It was Doidge, a psychiatrist and faculty member of both the University of Toronto and Columbia University’s Center for Psychoanalytic Training and Research, who introduced the lay reader to the revolutionary idea that the brain is not fixed, that it is neuropl...
Source: SharpBrains - January 28, 2015 Category: Neurologists Authors: SharpBrains Tags: Cognitive Neuroscience Education & Lifelong Learning book brain Brain-Plasticity neuroplasticity neuroplasticity book Norman Doidge book Norman-Doidge The-Brain-That-Changes-Itself Source Type: blogs

Medical conferences feel like funerals. Here’s why.
A friend just got back from a big medical conference at a fancy hotel. The cleaning ladies actually pulled her aside to ask, “What’s with all the grim faces and sad eyes?” Do doctors realize medical conferences look like funerals? That’s what the cleaning ladies think. I bet they’re not the only ones. Why do medical conferences feel like funerals? Maybe because doctors are dying by suicide at twice the rate of their patients. Why? The truth is doctors are dying from despair. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how...
Source: Kevin, M.D. - Medical Weblog - January 27, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

A Quick Guide to Identifying the Mentally Ill for Puposes of Preventing Gun Violence.
I often hear people talk about how we have to keep guns away from the mentally ill.  A judge friend recently said it quite bluntly, "What's the issue with guns and the mentally ill?  They shouldn't have them." A cousin posted a link to a story about a man who killed his family and then himself.  Cousin commented, "We have to find a way to keep guns from the mentally ill."  The article mentioned nothing about a history of mental disorder or psychiatric treatment or distress in the man who killed his family and himself; people were shocked, there was no clear motive, the gun was owned legally.  Grant...
Source: Shrink Rap - January 26, 2015 Category: Psychiatrists and Psychologists Authors: Dinah Source Type: blogs

The gifts of burnout: An evolutionary wake-up call for doctors
It has been fourteen years since I graduated from the University of Michigan Medical School. I have journeyed far from the field of medicine, and yet my heart keeps hearing the call to return to my physician communities and share what I have learned. I simply cannot ignore my sense that the pain within our health care system – now felt at every level, including patients, physicians, and payors — is a resounding call to wake us up to our next stage of evolution. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: K...
Source: Kevin, M.D. - Medical Weblog - January 24, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

Funding Science
Several papers in the past few weeks have commented on the dismal state of funding for U.S. biomedical research1,2,3,4 (Source: NIMH Directors Blog)
Source: NIMH Directors Blog - January 23, 2015 Category: Psychiatry Authors: Thomas Insel Source Type: blogs

The Dzhokhar Tsarnaev defense: Will marijuana play a role?
January marked the start of what promises to be a four-month public reckoning: the trial of alleged Boston Marathon bomber Dzhokhar Tsarnaev. If the press reports about the evidence against him are accurate, most of the trial will not be about guilt or innocence; it will be about sentencing. Not a who-done-it, but a why-done-it. If Tsarnaev is found guilty, the death penalty will be on the table, and the proceedings will turn to a grave question, part jurisprudence, and part moral philosophy: Is this defendant the most evil and culpable of all? A human being who deserves the most severe of all punishments? Continue readi...
Source: Kevin, M.D. - Medical Weblog - January 20, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

Healthcare Update Satellite — 01-19-2015
Penicillin allergy? It’s associated with increased bad outcomes, but not for the reasons you think. The allergies themselves are mostly not allergies. And no, “my mother said I had a rash when I was a baby” isn’t an allergy. However, when compared with patients who don’t have penicillin “allergies”, patients with penicillin allergies have longer hospital stays and are between 14% and 30% more likely to get resistant infections while in the hospitals – possibly because the penicillin “allergic” patients are being treated with much stronger antibiotics that kill of...
Source: WhiteCoat's Call Room - January 19, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Holmes in the Bus in Baghdad
I was reading Sherlock Holmes (A Scandal in Bohemia) in the bus when a desire took a hold of me, the desire of becoming as perfect as he was in observation of details around him, so as I put down the book for a while and started observing the details that surrounded me. Thanks God the speakers were off. They look much better off in the sun. A heel of a shoe has found its role in this bus. At the end of the short story Holmes didn't shake the hands of king of Bohemia although the king had presented his hand. All that Holmes asked for was to guard the photo in his personal belongings, as if he was thinking tha...
Source: psychiatry for all - January 19, 2015 Category: Psychiatrists and Psychologists Source Type: blogs

My strange dream about Isis
Lately I read some articles in Arabic journals about terrorism. About what is happening in Syria, Iraq and lately, in France. Yesterday I dreamed as if seeing visually an article. If we were living in the ancient times I would be regarded as a prophet seeing a message from God. It was symbolic although I didn't get all the symbols. Here is the dream:"It is in an airport, a child in a wheelchair pushed by her mother, approaches in their walking by hazard a slim talk black man who looks like Sotigui Kouyate.He is so slim and wearing suspenders. The girl doesn't like the suspenders and thought that they look silly so she star...
Source: psychiatry for all - January 16, 2015 Category: Psychiatrists and Psychologists Source Type: blogs

Top stories in health and medicine, January 15, 2015
From MedPage Today: CDC: Most Nosocomial Infections Fall. Rates of most major types of healthcare-associated infections have declined markedly in recent years. RA Patients More Likely to Abandon Remicade. Rheumatoid arthritis (RA) patients were more likely to discontinue infliximab (Remicade) than adalimumab (Humira) and etanercept (Enbrel) in the first year of biologic treatment, and were more likely to stop adalimumab than etanercept. Vyvanse Effective Option for Treating Binge Eating. Adults with binge eating disorder treated with lisdexamfetamine dimesylate (Vyvanse) saw improvements in binge eating behavior and its ...
Source: Kevin, M.D. - Medical Weblog - January 15, 2015 Category: Journals (General) Authors: Tags: News Infectious disease Psychiatry Rheumatology Source Type: blogs

From Interprofessionalism Lite to the Real Thing
By: Jessica Early, a nurse practitioner fellow at the West Haven Veterans Affairs Center of Excellence in Primary Care Education (CoEPCE) During my time in nursing school, the constant refrain was that interprofessional teamwork is the foundation of patient-centered care. In lectures and seminars, we were told that, as nurse practitioners (NPs), our effectiveness depended on collaboration with all members of the health care team—social workers, RNs, physicians, and specialty providers. Ironically, we were encouraged to develop the communication and teamwork skills needed for this collaboration in a classroom full of ...
Source: Academic Medicine Blog - January 15, 2015 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective Center of Excellence in Primary Care Education health care teams interprofessionalism patient centered care Source Type: blogs

Graduate Medical Education: The Need For New Leadership In Governance And Financing
In conclusion, we have recently proposed rejuvenating COGME with expanded resources and membership. If accomplished, COGME should be able to serve the role recommended for the GME Council described in the IOM report, thereby creating new leadership for GME reform. As an immediate first step, we have proposed reauthorization of the THCGME program, with Medicare GME funding appropriated to assure sustainability. This small addition to the Medicare budget would have great value by encouraging optimism within this program’s broad constituency that the importance of ambulatory training is now recognized by Congress. Furthermo...
Source: Health Affairs Blog - January 14, 2015 Category: Health Management Authors: Richard Rieselbach, David Sundwall, and Kenneth Shine Tags: All Categories Disparities Hospitals Medicaid Medicare Physicians Policy Primary Care Workforce Source Type: blogs

The lovely wife on the psych ward
I have one thing to say about Mark Lukach's essay, "My lovely wife on the psych ward."  That one thing is: Read it!  It's beautiful.  Mr. Lukach does a masterful job of describing his feelings as he plows through two months' long episodes of psychosis with his wonderful wife. When a friend gives him a copy of R.D. Laing's The Divided Self: An Existential Study in Sanity and Madness, Mr. Lukach learns about the world of anti-psychiatry and psychiatric survivors.  He struggles through with wanting to be a good husband, to help his wife get better, but he questions whether what he is doing is right, and he...
Source: Shrink Rap - January 14, 2015 Category: Psychiatrists and Psychologists Authors: Dinah Source Type: blogs

What does it mean to be a competent psychiatrist?
What defines a competent psychiatrist?  To staunch critics of the field, perhaps nothing.  Some believe psychiatry has done far more harm than good, or has never helped anyone, rendering moot the question of competency.  What defines a competent buffoon?  A skillful brute?  An adroit half-wit?  Having just finished Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, a reader might easily conclude that psychiatric competency is a fool’s errand.  From directing dank 19th Century asylums, to psychoanalyzing everyone for nearly a...
Source: Kevin, M.D. - Medical Weblog - January 13, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs