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This page shows you the most recent publications within this specialty of the MedWorm directory. This is page number 3.

Book News and More
Greetings from Baltimore -- and if you're looking for me at APA in Atlanta this year -- do look for both Roy and ClinkShrink instead--they are both there as APA Assembly members. I decided a while back that a Springtime graduation was all the traveling I wanted to do, and I am pleased to tell you that all went well with my youngest's graduation from #GoBlue.  I enjoyed Michael Bloomberg's commencement speech, the dinners, the celebrating, being with family, seeing my lovely daughter thrive, and knowing that for the foreseeable future, there is no college tuition to be paid.  Young One is off for a couple of weeks...
Source: Shrink Rap - May 13, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

Euthanasia for Reasons of Mental Health
by Craig Klugman, Ph.D. An article in the (UK) Daily Mail this week focused on a Dutch woman who chose euthanasia “after doctors decided her post-traumatic stress and other conditions were incurable.” Under Dutch euthanasia laws, a physician can end a patient’s life with a lethal injection for mental suffering. Her life was ended last year. Euthanasia is when a physician delivers the substance that ends a patient’s life. This is distinct from physician/doctor/provider-assisted suicide (often called aid-in-dying) where a physician makes the means to end life available (often through a prescription) but the patient m...
Source: blog.bioethics.net - May 12, 2016 Category: Medical Ethics Authors: Craig Klugman Tags: End of Life Care Featured Posts Health Regulation & Law Informed Consent Psychiatric Ethics euthanasia Source Type: blogs

Obama and the TREAT Act
I just read an article in the Daily Beast that reads like a better version of something I would write about the value of medication-assisted treatment of opioid dependence.  I appreciate Christopher Moraff telling a story that has been untold far too long, and I hope the story raises questions across the country. But I have something else on my mind that deserves a story of its own.  I am just a small-town psychiatrist in the Midwest, of course, and so I could be missing something.  I watch Veep and House of Cards, but I assume that the political games in those shows are grossly exaggerated.  I’ll offer a bit of ...
Source: Suboxone Talk Zone - May 12, 2016 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine Legal Public policy Suboxone treatment heroin addiction Obama patient cap TREAT Act Source Type: blogs

Could talking about physician burnout create more burnout?
Almost every day over the last few years, someone has written about physician burnout or depression. The problems begin in medical school. A recent paper featured drawings that medical students had done depicting faculty as monsters. One student felt so intimidated during a teaching session that she drew a picture of her urinating herself. The paper equated faculty and residents supervising students to “zombies, vampires, ghosts, and other supernatural figures.” In dealing with the state of the world today, the authors cited a comment by the novelist Stephen King saying that to cope with adversity, people make up horr...
Source: Kevin, M.D. - Medical Weblog - May 11, 2016 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

Let’s apply a little reality to the referrals from the ER
I remember seeing so many charts in my career on which the well-meaning emergency room physician wrote the following:  “Follow up with your primary care doctor.”  Or, if they didn’t have one, “Follow up in one week with a primary care doctor.”  I laughed to myself.  Usually, the people we say that to have either no insurance, inadequate insurance or inadequate motivation to even call the persons to whom we may refer them.  Or they find themselves in an area with next to no primary care physicians to begin with.  Call all you want. It won’t happen. The same thing is now happening as adminis...
Source: Kevin, M.D. - Medical Weblog - May 11, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

I thank my father for the gift of freeze-frame
I settle into the bent-wicker chair on my lanai and try to relax. It’s a perfect island day, the temperature warm, the breeze cool, and I gaze out over the pool to the tops of the coastal mangroves. I’ve just come home from a shift at the local free clinic, and my mind is occupied by the work we did today.  My fourth-year medical students encountered some difficult patients, and we struggled to get them the care they needed. In particular, I spent twenty minutes talking down an angry man with suicidal and homicidal ideation, and as I sink deeper into the fluffy tropical print cushions, I am wondering why I was not afr...
Source: Kevin, M.D. - Medical Weblog - May 9, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Psychiatry Source Type: blogs

99306 CPT ® Code Description, Progress Notes, RVU, Distribution (Level 3 Initial Nursing Facility Care)
< div dir="ltr" style="text-align: left;" trbidi="on" > This 99306 CPT ® lecture reviews the procedure code definition, progress note examples, RVU values, national distribution data and explains when this code should be used in the nursing facility setting (nursing home). & nbsp;CPT stands for Current Procedural Terminology. This code is part of a family of medical billing codes described by the numbers 99304-99306. & nbsp;CPT ® 99306 represents the high (level 3) initial nursing facility care visit (whether you are the attending or a consultant) and is part of the Healthcare Common Procedure Coding System (HCPCS). & nb...
Source: The Happy Hospitalist - May 7, 2016 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs

My double life: Mental illness in the health care
I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have carried the diagnosis of major depressive disorder since I was 11 years old. My family noticed something was wrong well before I was actually diagnosed, and after a few years of going to therapy and not improving,...
Source: Kevin, M.D. - Medical Weblog - May 6, 2016 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

April blogs digest: a DNA quiz, the microbiome, freebirthing, is dancing good for the brain? And more
How much do you know about DNA? National DNA Day is celebrated on 25 April, to recognize the anniversary of the successful completion of the Human Genome Project in 2003 and the discovery of DNA’s double helix in 1953. The goal of this special day is to offer students, teachers, and the public an opportunity to learn about the latest advances in genomic research, and how those advances might impact all of our lives. Take our quiz to see how much you know! Microbiome and the modern environment Journal of Physiological Anthropology published a series looking at the effects of the modern environment on the microbiome, askin...
Source: BioMed Central Blog - May 5, 2016 Category: Journals (General) Authors: Sophie Marchant Tags: Biology Health Medicine blogs digest Source Type: blogs

Caring for people with gender dysphoria
Every once in a while something shows up on Facebook that is worth reading. The other day I ran across a link to the article “Transgenderism: A Pathogenic Meme” by Dr. Paul McHugh. Dr. McHugh is the University Distinguished Service Professor of Psychiatry at Johns Hopkins. Over his long career he has cared for and studied patients with gender dysphoric disorder who present with the... // Read More » (Source: blog.bioethics.net)
Source: blog.bioethics.net - May 4, 2016 Category: Medical Ethics Authors: Steve Phillips Tags: Health Care bioethics syndicated Source Type: blogs

Harvard Medical School Teams Up with Makers of Bacardi Rum, Smirnoff Vodka, Jim Beam Bourbon, and Jack Daniels Whiskey, Providing Great PR at Bargain Rates
Last July, Harvard Medical School and its Cambridge Health Alliance accepted $3.3 million from the Foundation for Advancing Alcohol Responsibility to create an endowed chair in behavioral sciences research at Harvard Medical School and the Cambridge Health Alliance. The Dean of the Harvard Medical School proudly announced the acceptance of this money and praised the Foundation for Advancing Alcohol Responsibility, while acknowledging a long-standing alliance between the two entities: "The Foundation for Advancing Alcohol Responsibility has long been a strong supporter of the research program at Cambridge Health Alliance, p...
Source: The Rest of the Story: Tobacco News Analysis and Commentary - May 4, 2016 Category: Addiction Source Type: blogs

Counseling Schmounseling
I just noticed a couple of my recent posts….  these people have it wrong, and that person has it wrong.  One of these days I really need to print something positive and uplifting.  But not today. Excuse the self-flattery, but I like to think of myself as a physician scientist.  That concept motivated my PhD work, and cost me friend after friend in the years that followed!  A physician scientist isn’t all that difficult to be from an educational standpoint, especially in the age of the internet.  The one thing that is necessary is the willingness, or need, to question every assumption by the media, the gov...
Source: Suboxone Talk Zone - May 3, 2016 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine Public policy Research Suboxone treatment addiction counseling heroin addiction medication assisted treatment Methadone opioid dependence Source Type: blogs

28% Of Referrals To A Mood & Anxiety Clinic Had Undiagnosed ADHD
This study shows what we adult ADHD coaches have known for a long time. Adults who fail to respond to antidepressant therapy may have underlying attention-deficit/hyperactivity disorder (ADHD) and not treatment-resistant depression, as is often assumed, new research suggests. Only 5% of adults have ADHD. But, 28.4% of referrals to a tertiary-care mood and anxiety clinic had undetected ADHD. Also ADHD was also diagnosed in 22.6% of patients referred to the clinic for treatment-resistant depression. Chart of study SSRI Treatment Response may Predict Undetected Attention Deficit Hyperactivity Disorder in Depressed P...
Source: Adult ADD Strengths - May 1, 2016 Category: Psychiatry Authors: Pete Quily Tags: ADD / ADHD Medication ADD / ADHD Treatment adult ADHD anxiety depression dysthymia misdiagnosed undiagnosed Source Type: blogs

28% Of Referrals To A Mood & Anxiety Clinic Had Undiagnosed ADHD
This study shows what we adult ADHD coaches have known for a long time. Only 5% of adults have ADHD. But, 28.4% of referrals to a tertiary-care mood and anxiety clinic had undetected ADHD. ADHD was also diagnosed in 22.6% of patients referred to the clinic for treatment-resistant depression. Chart of study SSRI Treatment Response may Predict Undetected Attention Deficit Hyperactivity Disorder in Depressed Patients. Adults who fail to respond to antidepressant therapy may have underlying attention-deficit/hyperactivity disorder (ADHD) and not treatment-resistant depression, as is often assumed, new research sugges...
Source: Adult ADD Strengths - May 1, 2016 Category: Psychiatry Authors: Pete Quily Tags: ADD / ADHD Medication ADD / ADHD Treatment adult ADHD anxiety depression dysthymia misdiagnosed undiagnosed Source Type: blogs

Addiction Treatment Has it ALL WRONG
Today on SuboxForum members discussed how long they have been treated with buprenorphine medications.  Most agreed that buprenorphine turned their lives around, and most are afraid they will eventually be pushed off the medication.  Most buprenorphine patients described a reprieve from a horrible illness when they discovered buprenorphine.  But most have new fears that they never anticipated– that their physician will die or retire, that politicians will place arbitrary limits on buprenorphine treatment, or that insurers will limit coverage for the medication that saved there lives. I joined the discussion with th...
Source: Suboxone Talk Zone - May 1, 2016 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine recovery Suboxone Suboxone Forum addiction counseling character defects heroin addiction Vivitrol Source Type: blogs

Apr 30, Paul Eugen Bleuler: Today in the History of Psychology (30th April 1857)
Paul Eugen Bleuler was born. A pioneer within the field of mental illness, Bleuler coined the term schizophrenia in 1908 during a lecture at a meeting of the German Psychiatric Association in Berlin. In 1898 Bleuler became director of the Burghölzli (the psychiatric hospital of the University of Zürich, Switzerland.) Among the eminent figures to study under Bleuler at the Burghölzli were Carl Jung, A. A. Brill, Ernest Jones and Karl Abraham. (Source: Forensic Psychology Blog)
Source: Forensic Psychology Blog - May 1, 2016 Category: Forensic Medicine Source Type: blogs

Baby Got NAC
A 21-year-old woman with no past medical history presented to the emergency department for evaluation of an overdose. She was brought in by ambulance after her boyfriend called the police because she admitted to him that she had ingested a large amount of acetaminophen (APAP). The patient was 21 weeks pregnant and admitted to having ingested half of a bottle of extra-strength Tylenol six hours before arrival. The ED contacted the poison control center, and asked if N-acetylcysteine (NAC) is safe in pregnancy and if the dosing regimen changes for the pregnant patient.NAC's Mechanism of ActionAPAP is primarily metabolized by...
Source: The Tox Cave - April 29, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

BioethicsTV: Boundaries are Black and White on Grey’s
by Craig Klugman, Ph.D. Reaching back to its roots, Grey’s Anatomy in its 12th season has been investigating more professional and ethical challenges in medicine. The April 28th episode (Season12: Episode 21) focused on questions of boundaries of why physicians should not treat their loved ones. The first story was about a resident dating a former patient. Since the key term is former such a move may not be a pragmatic choice, but it does not violate professional boundaries (unless the physician is a psychiatrist in which case the APA says it may never be okay to date a former patient).… (Source: blog.bioethics.net)
Source: blog.bioethics.net - April 29, 2016 Category: Medical Ethics Authors: Craig Klugman Tags: Conflict of Interest Featured Posts #ABCGrey'sAnatomy BioethicsTV gun violence medical boundaries professionalism Source Type: blogs

Explaining Schizophrenia
A great short animated video documentary explaining the symptoms and types of schizophrenia. This video is detailed but easy to digest without being dull or pedantic, and offers evidence-based information. (Source: Channel N)
Source: Channel N - April 29, 2016 Category: Psychiatry Authors: sandra at psychcentral.com (Sandra Kiume) Tags: All Documentary brain diagnosis evidence-based psychiatry psychosis schizophrenia video Source Type: blogs

Research and Reviews in the Fastlane 132
This article reviews 10 myths about the UA and UTIs. A common theme that permeates the article is that an abnormal UA is not diagnostic of a UTI: symptoms must be present as well since a significant portion of patients will have chronic colonization. A good lesson to keep in mind the next time you work clinically. Recommended by: Anand Swaminathan Emergency Medicine, Neurology Friedman BW et al. The association between headache and elevated blood pressure among patients presenting to an ED. The American journal of emergency medicine. 32(9):976-81. 2014. PMID: 24993684 More data that BP & HA aren’t related. ...
Source: Life in the Fast Lane - April 29, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine Gastroenterology Neurology Pediatrics Psychiatry and Mental Health R&R in the FASTLANE EBM literature recommendations research and reviews Resuscitation Source Type: blogs

Medicare Access and Chip Reauthorization Act (MACRA) Proposed Rule, MIPS, APM’s and Advanced Care Information
Discussion Welcome news is the elimination of the all or nothing criteria of the meaningful use program. The exclusion of most ACO's under Medicare shared shavings is probably the most controversial part of the proposed rule as health systems have invested millions in the current Medicare shared savings program. That CMS is estimating that 87% of solo practitioners will be paying a penalty will also not be well received. Under MIPS CMS is estimating that non MD providers with the exception of nurse practitioners and physician assistants fare the worst including Chiropractors, Podiatrists and Dentists. Overall the propose...
Source: Policy and Medicine - April 29, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Medical School is NOT where You Learn to be a Doctor
There seems to be a great deal of misunderstanding about Medical School. There are valid questions about curriculum, defined as what should be taught, and when, and who should teach it. But recent calls for students to “gain fluency in [health] systems” are completely misplaced. Here’s why. What do you need to know to be a doctor?” IT DEPENDS. What kind of doctor are you going to be, and what kind of setting are you going to practice in (if you’re going to practice at all)? Because what you need to know to be a self-employed general surgeon in a rural area is completely different from what you...
Source: Musings of a Dinosaur - April 27, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs

Every physician is a wounded healer
I recall during my freshman year in medical school, sitting in class and listening to what were supposed to be 50-minute lectures from people who’d been teaching the same course for years. These were highly educated and intelligent folks; they knew how much material they could cover in 50 minutes. Yet, they frequently went past their time; encroaching on what was for some a badly needed bathroom break, and for all of us a missed opportunity to stretch and clear our heads.  Maybe it was intentional, maybe not; but the message seemed fairly clear: “Your time is no longer your own, and your personal needs are irr...
Source: Kevin, M.D. - Medical Weblog - April 24, 2016 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

Doctor Andrew Wakefield: Hero or Quack?
Conclusion Dr. Wakefield has been demonized by mainstream media and conventional medicine, while he is considered a hero in the holistic community. Is Wakefield a hero or a quack? Only you can decide for yourself.   References: http://www.ageofautism.com/2011/01/autism-advocacy… http://healthimpactnews.com/2014/the-vaccine-autism-cover-up… http://healthimpactnews.com/2014/the-vaccine-autism-cover-up… http://www.naturalnews.com/035513_Andrew_Wakefield_vaccines_autism.html http://www.ageofautism.com/2011/01/autism-advocacy… http://healthimpactnews.com/2014/the-vaccine-autism-cover-up… http...
Source: vactruth.com - April 23, 2016 Category: Allergy & Immunology Authors: Michelle Goldstein Tags: Logical Michelle Goldstein Recent Articles Top Picks Top Stories autism Dr. Andrew Wakefield John Walker-Smith The Lancet truth about vaccines Source Type: blogs

Shrink Rap Turns 10 Years Old Today!
Get out your tuxedos and gowns, the galas are about to begin!Yes, Shrink Rap is now 10! We are the longest running psychiatry blog and with thousands of posts and years of faithful readers, we couldn't be more excited!Okay, so no black tie gala.  We had planned a party with chili and beer and a cake with a duck on it, but a family emergency delayed the event -- to be rescheduled soon.So let me tell you how much I've loved having this blog (a lot) and over the years, there's been a lot of evolution.  I write less than I used to, but I still write.  Clink comes by with updates on conferences and spends more ti...
Source: Shrink Rap - April 21, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

Apr 16, Albert Hofmann: Today in the History of Psychology (16th April 1943)
Eminent Swiss chemist Albert Hofmann experienced the first ever LSD-induced 'acid trip.' Hoffman synthesized lysergic acid diethylamide (LSD) in 1938 but was unaware of its powerful hallucinogenic properties until he accidentally absorbed a small amount of the drug, the effects of which he described as follows. '...affected by a remarkable restlessness, combined with a slight dizziness. At home I lay down and sank into a not unpleasant intoxicated-like condition, characterized by an extremely stimulated imagination. In a dreamlike state, with eyes closed (I found the daylight to be unpleasantly glaring), I perceived an u...
Source: Forensic Psychology Blog - April 17, 2016 Category: Forensic Medicine Source Type: blogs

Pushing 70 and Sharing the Wisdom: Guest Blogger Dr. Bruce Hershfield Shares His Experience with Younger Psychiatrists
The article below is being reprinted from this month's edition of The Maryland Psychiatrist.  Dr. Hershfield shares his wisdom on outpatient treatment of patients, and of running a private practice.  Please note the intended audience for this wisdom is younger psychiatrists, in particular, those just starting out.  I'm not a younger psychiatrist just starting out, and in fact, I'd fail on a couple of these measure -- we all have to figure out for ourselves how best to practice in the context of our personality's and in the context of who are patients are and what they need.  Overall, however, I thought ...
Source: Shrink Rap - April 12, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

Guidance for commissioners of psychiatric intensive care units (PICU)
NHS Clinical Commissioners - This guidance was produced in partnership with the National Association of Psychiatric Intensive Care and Low Secure Units (NAPICU) to support the commissioning of high-quality PICUs and improve patient experience. It seeks to empower and enable commissioners, managers and clinicians to jointly develop high quality PICUs. It provides summary guidance which will assist commissioners to meet the needs of their local population, and achieve the ambitions of the Five Year Forward View focusing on patient safety, clinical effectiveness and patient experience. Guidance Press release (Source: H...
Source: Health Management Specialist Library - April 11, 2016 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Commissioning Mental Health Source Type: blogs

Will Changing Privacy Laws Help Patients?
Over on Twitter, one of my pals, @namipolicywonk wrote: I'm a big proponent of civil rights, but whose rights are we protecting in a situation like this? http://thebronxchronicle.com/2016/04/03/op-ed-eliot-engel-side-families-seriously-mentally-ill-not-mental-health-industry/ …Please do read the article, but in a few sentences, here's the synopsis.  A mom is writing an oped piece about her daughter who lives in a group home in New York and has a chronic mental illness.  The daughter went missing from her group home, off her medications, and reportedly because of HIPAA laws, the group home did not tell the ...
Source: Shrink Rap - April 10, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

Post Bac position available at Duke University
We are looking for a highly motivated recent graduate (BS, BA) to gain research experience in the lab of Prof. Tobias Overath (http://people.duke.edu/~jto10) at the Duke Institute for Brain Sciences. Work in the lab investigates how sounds, from simple sinusoids to complex speech signals, are processed in the human brain via a combination of behavioral (psychoacoustics) and neuroimaging methods (fMRI, EEG).The ideal candidate will have received an undergraduate degree in psychology, neuroscience, biomedical engineering, or a related field, by summer 2016, and will have some familiarity with fMRI, M/EEG, ECoG, and/or other ...
Source: Talking Brains - April 7, 2016 Category: Neuroscience Authors: Greg Hickok Source Type: blogs

BIOETHICSTV: Chicago Med-BIID, post mortem egg retrieval, scope of practice and forgiveness
by Craig Klugman, Ph.D. This week on Chicago Med brought 3 new ethical issues as well as the unsatisfying resolution to a story arc. Story 1 begins with a patient brought into the ED after trying to saw off his arm in the hardware store. The doctors are able to save it but the patient is upset. Dr. Charles, the psychiatrist, realizes the patient suffers from Body Integrity Identity Disorder (BIID) which is characterized by people feeling a part of their body is not theirs.… (Source: blog.bioethics.net)
Source: blog.bioethics.net - April 6, 2016 Category: Medical Ethics Authors: Craig Klugman Tags: Clinical Trials & Studies End of Life Care Featured Posts Psychiatric Ethics Reproductive Medicine BIID BioethicsTV Chicago Med Source Type: blogs

No Escape From Aetna....
On March 13th, I wrote a post: "To Aetna: I am NOT in Your Network about how I was trying to reach Aetna to clarify that I am not a psychiatrist in their network.  I wanted this clarified because I was getting so many calls from people asking to see me because I am listed on Aetna's website.  I called and called again, but the voicemail prompts left me with no where to go.  When I reached a live person, I was told that Network Services would contact me within 48 hours.  That never happened.  I wrote in through their website.  Nothing.  And finally, I contacted the Maryland Insurance Commi...
Source: Shrink Rap - April 6, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

Utah : Just Say "NO!"
This is not a post on abortion.  Let's not even go there.  This is a post on who gets to practice medicine.So Utah passed a law -- signed by their governor after how many years of medical school? -- that mandates doctors to give general anesthesia to women having abortions after 20 weeks of gestation.  Legislators sometimes unwittingly attempt to practice medicine and pass laws that interfere with the doctor patient relationship, but this is the first time I've heard of legislation that demands a procedure that endangers a patient's life.  The theory is that the fetus might feel pain and that general an...
Source: Shrink Rap - April 5, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

Yes, the VA is without doubt the model for American healthcare
Well, let’s consider their actual track record: Shot: The Pentagon reported Friday that 265 active-duty service members killed themselves last year, continuing a trend of unusually high suicide rates that have plagued the U.S. military for at least seven years. http://www.usatoday.com/story/news/nation/2016/04/01/us-military-suicides-remain-stubbornly-high/82518278/   Chaser: A VA suicide hotline designed to help distressed vets, at times instead sent their calls to a voicemail message, provided no immediate assistance, and did not even return some calls, according to a new report. … The crisis center wa...
Source: GruntDoc - April 4, 2016 Category: Emergency Medicine Authors: GruntDoc Tags: Medicine public-health Source Type: blogs

The Accessible Psychiatry Project, Updated & Please Do Comment on the Scattergood Site
Later this month, Shrink Rap will be celebrating it's 10th anniversary!  More later, but we are the longest running psychiatry blog, and we're looking forward to the cake.As you may know, Shrink Rap is part of a larger group of projects that the three of us, in various combinations, work on.  The list has morphed over the years, and the Accessible Psychiatry Project is now up for a Scattergood Innovation Award.  The nominations closed last week, and public comment is not being requested.  We'd love to have our Shrink Rap readers visit the Scattergood site and leave an encouraging comment.  The Scat...
Source: Shrink Rap - April 3, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

The Accessible Psychiatry Project, Updated & Please Do Comment on the Scattergood Site
< br / > < span style="font-size: large;" > Later this month, Shrink Rap will be celebrating it's 10th anniversary! & nbsp; More later, but we are the longest running psychiatry blog, and we're looking forward to the cake. < /span > < br / > < span style="font-size: large;" > < br / > < /span > < span style="font-size: large;" > As you may know, Shrink Rap is part of a larger group of projects that the three of us, in various combinations, work on. & nbsp; The list has morphed over the years, and the < b > Accessible Psychiatry Project < /b > is now up for a Scattergood Innovation Award. & nbsp; The nominations closed last...
Source: Shrink Rap - April 3, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

The unknown impact of changing a person’s genetic makeup
In February 2015, the British Parliament approved the creation of a human embryo from the DNA of three people: mother, father and a donor mother. The modified in-vitro fertilization (IVF) technique, called mitochondrial replacement therapy (MRT), would help some mothers with known rare mitochondrial mutations avoid passing on unhealthy defects. These defects can cause severe or deadly diseases, which are often incurable, such as muscular dystrophy, heart and kidney disease, liver failure and severe muscle weakness. Approximately 99.9 percent of our DNA comes from our mother and father. The donor mother would provide the a...
Source: Kevin, M.D. - Medical Weblog - April 1, 2016 Category: Journals (General) Authors: Tags: Physician Genetics Source Type: blogs

What You See Is Not What You Get - Purdue Pharma Executives Pleaded Guilty, but the Oxycontin Billionaires Went Unnoticed
What you see if often not what you get.   Nine years ago, three top executives of Purdue Pharma pleaded guilty to criminal charges of "misbranding" Oxycontin.  The case appeared to be a landmark.  In previous years, top executives of large health care corporations rarely faced legal consequences when their companies misbehaved.  Yet in the Purdue Pharma/ Oxycontin case, things were not what they seemed.  Maybe that is why this case never did yield a new era of accountability for top corporate health care leaders.Background - the Oxycontin Guilty PleasIn 2007, we posted about the executives' guilty ...
Source: Health Care Renewal - March 31, 2016 Category: Health Management Tags: anechoic effect conflicts of interest deception health care corruption legal settlements marketing narcotics Oxycontin Purdue Pharma Source Type: blogs

BIOETHICSTV: Chicago Med 3/29
by Craig Klugman, Ph.D. BioethicsTV is an occasional bioethics.net feature where we examine bioethical issues raised in televised medical dramas. Tonight marked the mid-season premiere of Chicago Med, a freshman television show that seems to relish throwing professional and bioethical issues at its audience. This week, viewers saw no fewer than 4 ethical challenges. 1. Blood draws for DUI in the ED. The first story was about a young man who crashes his car into a house. He is brought to the ED and needs immediate surgery for internal bleeding.… (Source: blog.bioethics.net)
Source: blog.bioethics.net - March 30, 2016 Category: Medical Ethics Authors: Bonsai Klugman Tags: Featured Posts Informed Consent Media Privacy Psychiatric Ethics BioethicsTV NBCCHicagoMed Source Type: blogs

Medical school has killed my soul. What can I do?
Hi Pamela, I’m a medical student in the UK. Though I’ve only been in med school since September, it has already taken its toll on me. Before I started, I was so in touch with my emotions, spirituality, and nature. Now I feel so empty and desensitized. I hate that when faced with the horrible circumstances of another person, I just don’t feel anything anymore. How can I overcome this? I so badly want to tap into the vibrant me from 6 months ago! Before starting medical school, I was a curious and loving young man. My life hadn’t been plain sailing: I had been through my parents’ divorce as a young teenager; I had ...
Source: Kevin, M.D. - Medical Weblog - March 30, 2016 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

This doctor quit medicine. But she really tried to make it work.
It is exactly 49 steps from my bedroom to my garage.  It is a 23-mile drive to the hospital and 75 steps to the unit.  It takes 10 seconds to walk to the nursing station.  I can measure what it takes to get me to work each morning with absolute certainty.  I know because I have measured it a million times hoping something will prevent me from reaching my destination.  I live 49 steps, 23 miles, 10 seconds and another 75 steps from my job.  And it has taken me over a decade to find the courage to actually quit. I was forty-three years old and five months into my new life when I realized I had to return to my old job....
Source: Kevin, M.D. - Medical Weblog - March 27, 2016 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

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. ----- Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail dot com Our book is out now. (Source: Shrink Rap)
Source: Shrink Rap - March 27, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

It’s time to treat mental illness as seriously as we treat heart disease
I saw a patient last week for her chest pain. A 60-year-old woman came into the hospital because her chest tightened every time she went running. The pain would last about 20 minutes, centered on the left side of her chest, and radiated to her left arm. It lasted until she would finally take a break from running and sit down. “This is classic,” I thought. “Stable angina.” I could now direct my line of questioning for the rest of the medical history to confirm my suspicions. “Any other medical problems? Ever been hospitalized before?” “Well, I had a heart attack two years ago.” “OK, any medications?” “...
Source: Kevin, M.D. - Medical Weblog - March 25, 2016 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

Why doctors kill themselves
x Pamela Wible, M.D., takes on physician suicide in her TEDMED talk (delivered on November 18, 2015). Learn more about Dr. Wible and her talk at TEDMED.com. Full transcription below: I love the three things that people fear the most: death, disease, and public speaking. Here’s how it all started. At four, I was so talkative (and bossy) no babysitter would stay with me. So I tagged along with Mom, a hospital psychiatrist, interviewing suicidal patients. Then she’d drop me off at the morgue with Dad, a pathologist. He’d open these big cooler doors and say, “Good morning! Is anyone home?” then introduce me to his p...
Source: Kevin, M.D. - Medical Weblog - March 24, 2016 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

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 PatientsThe 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 ou...
Source: Shrink Rap - March 24, 2016 Category: Psychiatry Authors: Dinah Source Type: blogs

A medical resident commits suicide. Here’s how one colleague mourns.
In the hour after I heard the news, I experienced the full spectrum of typical reactions to a physician suicide. One end of the spectrum came from the attending in a clinic, who when asked if the residents could go home and mourn their friend who just committed suicide, proceeded to tell me a story of how when her grandpa died before a final exam in medical school. She decided to honor his death by honoring her exam and told me how we need to learn how to be strong and continue learning and taking care of patients. She wanted us to talk about this event, and how we were at fault for not recognizing that our co-resident was...
Source: Kevin, M.D. - Medical Weblog - March 23, 2016 Category: Journals (General) Authors: Tags: Physician Psychiatry Residency Source Type: blogs

If this medical student was a test question, the answer would be depression
I’m not sure when it happened, but driving into the parking lot that cold winter day, I knew it had. Tears welled in red eyes, snot dripped out of my nose. I felt so alone and lost. My whole life I’d wanted this — the drive to the hospital and wondering whether I would change a life. But as I sat in my car, engine off, I didn’t want that dream anymore. I didn’t want to be here, but I also didn’t want to be anywhere else. Did I even want to be a doctor anymore? Regardless of my inward struggle, I was still an overachiever and my shift about to start. I wiped my eyes, blew my nose and stepped out of my car. A...
Source: Kevin, M.D. - Medical Weblog - March 22, 2016 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

He couldn’t eat, drink or work. And doctors couldn’t explain his searing pain. - The Washington Post
Kim Pace was afraid he was dying. In six months he had lost more than 30 pounds because a terrible stabbing sensation on the left side of his face made eating or drinking too painful. Brushing his teeth was out of the question and even the slightest touch triggered waves of agony and a shocklike pain he imagined was comparable to electrocution. Painkillers, even morphine, brought little relief. Unable to work and on medical leave from his job as a financial consultant for a bank, Pace, then 59, had spent the first half of 2012 bouncing among specialists in his home state of Pennsylvania, searching for help from doctors w...
Source: Psychology of Pain - March 16, 2016 Category: Anesthesiology Source Type: blogs

How many more physicians will we lose to suicide?
Almost two years ago I went to the funeral of a medical school classmate.  A little more than three weeks before he had jumped from a parking garage after finishing his clinic.  He had a loving wife and three young children. He had the respect of his colleagues and the love of his patients. There was nothing out of the ordinary in his financial or personal life. It didn’t make sense, but it rarely does. Something broke inside the mind of someone I have always known to be a happy, easygoing person. I don’t know why he committed suicide. It seemed to be related to a recent period of intense, severe depression.  I don...
Source: Kevin, M.D. - Medical Weblog - March 16, 2016 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

Don’t Let the Talking Points Fool You: It’s All About the Risk Pool
Most people are healthy most of the time, and as a consequence, health care expenditures are heavily concentrated in a small share of the population: about 50 percent of the health care spending in a given year by those below age 65 is attributable to just 5 percent of the nonelderly population. The lowest spending half of the population accounts for only about 3.5 percent of health care spending in a year. Deciding how much of total health care expenditures should be shared across the population and how to share it is the fundamental conundrum of health care policy. There is more risk pooling the larger the share of healt...
Source: Health Affairs Blog - March 15, 2016 Category: Health Management Authors: Linda Blumberg and John Holahan Tags: Costs and Spending Equity and Disparities Featured Insurance and Coverage Medicaid and CHIP Medicare community rating Employer-Sponsored Insurance experience rating guaranteed issue and renewal health savings accounts high-risk pools Source Type: blogs