Psychiatry Psychiatry RSS feedThis is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

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

de Clérambault, and Enduring Love again
Some more thoughts about the "appendix" to Ian McEwan's Enduring Love, discussed in an earlier post.  The appendix is, or, as it turns out, purports to be, a reprint from the "British Review of Psychiatry", by Wenn and Camia, about de Clérambault's syndrome.  An early review of the book,as you may remember from that earlier post, thought it was the article on which the novel was based.  But others were suspicious, noting that the journal was not one they had heard of, and also that the authors' names were an anagram of Ian McEwan.I was interested to know what would happen if you critically appraised the pap...
Source: Browsing - October 20, 2015 Category: Databases & Libraries Tags: mental health psychiatry Source Type: blogs

A medical student’s psychiatric hospitalization
“You work here?!” I nodded, a hint of a smile revealing my bemusement at his incredulity. “Well … probably not after this.” The other patients in the psych waiting area of the ER nodded in agreement. In my newly issued brown scrubs, stripped of my belongings, I was no longer a research coordinator at a top hospital, but rather one of them. And sadly, they believed being one of them meant you couldn’t be much else. I didn’t add that I was going to be a doctor, but in hindsight I wish I had. I wish I had because it’s wrong that they’d been conditioned to feel that way. I wish I had because, well, it probabl...
Source: Kevin, M.D. - Medical Weblog - October 19, 2015 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

A LIGHT BENEATH THEIR FEET Bridges Between Mental Health, Home Health Workers and Bioethics
A Light Beneath Their Feet is a coming of age story for both a daughter and a mother. Valerie Weiss’s directorial skill is remarkable. She uses a spotlight halo soft focus to keep the viewer tied to the amazing performances of Tayrn Manning (Gloria, the mother)  and Madison Davenport (Beth, the daughter). It is fortunate for the viewer that the director is able to keep up with the sophistication of the script and actors she has chosen to direct. Writer Moira McMahon Leeper has brilliantly clarified an inverted mother and daughter  relationship, occurring against the backdrop of mental illness. This film mak...
Source: blog.bioethics.net - October 16, 2015 Category: Medical Ethics Authors: September Williams, MD Tags: Health Care syndicated Source Type: blogs

The day I went to work and met a real vampire
It all started out seeming like a pretty routine visit. My patient was in her early 30s and had come into the emergency department for weakness and was in no distress. As I was talking with her about her symptoms she would flash the occasional smile. It was then I noticed that she had fangs. Not the kind that some people naturally have from misaligned teeth, but she had really long, sharp canine teeth. She had some tattoos and a variety of piercings, so I just figured that the fangs were also a part of her look, perhaps a new trend that I’d never seen before. She was coherent, articulate, had good hygiene and had no psyc...
Source: Kevin, M.D. - Medical Weblog - October 15, 2015 Category: Journals (General) Authors: Tags: Conditions Emergency Source Type: blogs

Sukkot and last week's Catholic Gospel
Last Sunday, we had for me the harshest Gospel. It was about the man who asked Jesus what he needed to do to have eternal life. Jesus mentions Mosaic Commandments and was pleased by the man's response that he followed them but then was crestfallen when Christ told him to give away what he had to the poor and follow him. The man left. The Jewish holiday of Sukkot happened the week before. In that festival, people sit around outside in a temporary shelter and symbolically are represented by four fruits, one represents Torah learning, another good deeds; one of them however represents being a nothing. All of the individuals o...
Source: a psychiatrist who learned from veterans - October 15, 2015 Category: Psychiatry Source Type: blogs

Sukkot and last week's Catholic Gospel, Mark 10: 17-30
Last Sunday, we had for me the harshest Gospel. It was about the man who asked Jesus what he needed to do to have eternal life. Jesus mentions Mosaic Commandments and was pleased by the man's response that he followed them but then was crestfallen when Christ told him to give away what he had to the poor and follow him. The man left. The Jewish holiday of Sukkot happened the week before. In that festival, people sit around outside in a temporary shelter and symbolically are represented by four fruits, one represents Torah learning, another good deeds; one of them however represents being a nothing. All of the individuals o...
Source: a psychiatrist who learned from veterans - October 15, 2015 Category: Psychiatry Source Type: blogs

People are people — whether manic, suicidal, or delusional — and it is a privilege to care for them
It’s not always obvious. Sometimes patients register with a chief complaint like “headache.” They tell the nurse their head has been hurting for months and deny fevers, etc. They get put in a room, and when you take the history, there’s nothing remarkable until you ask just the right question: “So, what do you think is wrong? Are you worried about anything in particular?” “Well, I think it’s probably the plate they put in my head.” “You have a plate in your head?” “Yes.” “Why? Were you in an accident?” “Well, I was abducted, and I don’t remember much, but I know they put a plate in my head...
Source: Kevin, M.D. - Medical Weblog - October 12, 2015 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

A surgeon conquers her anxiety. See how she did it.
Can anxiety be severe enough to cause a physician to leave medicine?  Absolutely.  I know a number of physicians who have left for this reason.  In my coaching practice I am increasingly aware of the toll anxiety takes on many doctors and am making it my mission to bring more attention to this problem and to find solutions.  The physicians I have talked to are just the tip of the iceberg in terms of those “suffering in silence” from anxiety. For this blog, I interviewed one of my clients who agreed to discuss her difficulties with anxiety.  Identifying details, including her name, have been changed to protect her ...
Source: Kevin, M.D. - Medical Weblog - October 12, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Surgery Source Type: blogs

Narrative Matters: Poetry Meets Health Care
This month you might notice something a little different about the Narrative Matters section of Health Affairs. For October, instead of the personal stories about health care that readers typically find in the section, we’re featuring three thought-provoking poems about health and health care experiences. The poems were submitted as part of our first-ever poetry contest, held earlier this year, which had an incredible response. Out of more than 500 poems submitted, we chose the three winning poems with the help of a panel of poet judges, Hakim Bellamy, Serena Fox, and Natalie Lyalin. With gorgeous illustrations from Bret...
Source: Health Affairs Blog - October 8, 2015 Category: Health Management Authors: Jessica Bylander Tags: Elsewhere@ Health Affairs Health Professionals Narrative Matters Slideshow Narrative Matters poetry narrative medicine patients Source Type: blogs

Enduring love, especially the appendix
I have made reference to this book by Ian McEwan in two previous posts, one about autobiography and biography as health literature, and one about mental health in film.  In that latter post I said I would write about Enduring love again.  Here at last is that post.As an appendix to Enduring love, there is a scientific paper, a case report, about the condition that one of the characters in the story is living with, De Clerambault's syndrome.    A review of the book in Psychiatric Bulletin talks of the book as based on this case report.   But a later letter to the same journal rings an alar...
Source: Browsing - October 7, 2015 Category: Databases & Libraries Tags: critical appraisal mental health Source Type: blogs

What is normal and what is disease?
Future generations of doctors will face different challenges than I did. When I started training, disease was easier to spot than it is now. Today, the line between sickness and wellness has blurred–and it gets blurrier all the time. The quantified self movement stands to make this worse. In a profit-driven healthcare climate, disease feeds the business model. One way to drive sales of drugs and procedures is to create more diseases. And to do that, one has only to medicalize the human condition. Why doctors (and patients) discount the resilience of the human body perplexes me. I had the pleasure of meeting Dr. Allen...
Source: Dr John M - October 7, 2015 Category: Cardiology Authors: Dr John Source Type: blogs

Mindfulness
is paying attention to your thoughts and feelings in the present moment.   It can be a way to develop resilience and cope with the demands of an academic or clinical course.  Here is a not very systematic selection of useful looking links:NHS Behind the Headlines, on mindfulness to prevent a relapse of depression.NHS Choices: Mindfulness for mental wellbeingUseful looking articles include this systematic review of systematic reviews, published in PLoS One by Dutch and American researchers, and a systematic review of mindfulness for reducing stress in health individuals, published in the Journal of Psychosomatic ...
Source: Browsing - September 30, 2015 Category: Databases & Libraries Tags: mental health mindfulness students Source Type: blogs

Remembering Oliver Sacks, A Pioneer Of Narrative Medicine
Hasn’t he brought us through the decades, guiding us stage by stage toward the present? Hasn’t he opened the way toward a health care loyal to the singular stories of those for whom we care? Hasn’t he opened the way toward a kind of writing loyal to the singular situation of those of whom we write? Dr. Oliver Sacks has been an always-present presence for the worlds of literature, medicine, narrative, and health. I certainly don’t know this world of ours without him in it. When he died, even though he had been so tender toward us in his gentle warnings that the end was near, I was shocked. It was as if one of th...
Source: Health Affairs Blog - September 30, 2015 Category: Health Management Authors: Rita Charon Tags: Featured Health Professionals Narrative Matters Quality City Island Columbia University narrative medicine Oliver Sacks Source Type: blogs

How to fix physician burnout? Start with a culture of acceptance and support.
“Thou must be like a promontory of the sea, against which, though the waves beat continually, yet it both itself stands, and about it are those swelling waves stilled and quieted.” – Marcus Aurelius My reaction to this quote, which begins Osler’s Aequanimitas, has changed over the years. When I first heard it, I was filled with a sense of pride and anticipation. I would be that rock, for my patients, for my family, never wavering, never eroding. Eight years on, as I start my career as a practicing internist, I have come to interpret it as a lovely image, and a lovely fairy tale, but just like the idea that a ro...
Source: Kevin, M.D. - Medical Weblog - September 29, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Residency Source Type: blogs

When a doctor is in doubt, she asks a family member
I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting, I admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ usual mental function was prior to their injuries, and so I rely on my knowledge of neuroanatomy, infectious disease, and pharmacology to guide my work up. However, I have learned that asking the patient’s family members about what they were like (in their he...
Source: Kevin, M.D. - Medical Weblog - September 24, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

Turn That Door Around - A Physician Substantially Tied to the Pharmaceutical Industry Nominated to Run the FDA
It seems to be the season of the revolving door in health care.  The latest version got some media attention, because it involves one of the most important health care leadership positions in the US government, the Director of the Food and Drug Administration (FDA).  However, the case actually seems much more serious than what the media has recently reported.The BasicsFor an introduction, we turn to the Wall Street Journal from September 15, 2015:President Barack Obama plans to nominate the prominent cardiologist and medical researcher Robert Califf as the next commissioner of the Food and Drug Administration, th...
Source: Health Care Renewal - September 24, 2015 Category: Health Management Tags: boards of directors CME conflicts of interest FDA key opinion leaders logical fallacies revolving doors Source Type: blogs

Seeking help for mental health problems: Change the culture for providers
“I don’t need meds,” the young psychology major told me confidently. “Or therapy really. Maybe I’ll just touch base with you every once in a while. I should be able to handle this on my own.” The young woman’s physician had been concerned enough in a recent visit about this patient’s panic attacks and passive suicidal ideation to refer her to meet with me for a primary care psychology consultation. Yet just a few weeks later, she sat in front of me letting me know that she can “handle” these problems. For better or for worse, this young woman picked a terrible day to talk about “handling” concerns w...
Source: Kevin, M.D. - Medical Weblog - September 23, 2015 Category: Journals (General) Authors: Tags: Physician Medical school Psychiatry Source Type: blogs

When In Doubt, Ask A Family Member
The post below ran on September 9 on Better Health. I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting I admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ usual mental function was prior to their injuries, and so I rely on my knowledge of neuroanatomy, infectious disease, and pharmacology to guide my work up. However, I have learned that asking the patient’s fa...
Source: Disruptive Women in Health Care - September 22, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Health Professions Patients Source Type: blogs

A Quiet Turn of the Revolving Door - Director of NIMH to Go Directly to Google Life Sciences
Amidst a lot of health care news, the job plans of Dr Thomas Insel, currently the director of the National Institute of Mental Health (part of the US National Institute of Health) made a very small splash.  The most comprehensive account was in the New York Times.Dr. Thomas R. Insel, the director of the National Institute of Mental Health, announced on Tuesday that he planned to step down in November, ending his 13-year tenure at the helm of the world’s leading funder of behavioral-health research to join Google Life Sciences, which seeks to develop technologies for early detection and treatment of health problems.A...
Source: Health Care Renewal - September 18, 2015 Category: Health Management Tags: NIH NIMH revolving doors Thomas Insel Source Type: blogs

You can’t tell whether a psychotherapist is impaired
Two of the most commented posts on my blog are about charging patients for missed sessions and how psychotherapies end.  As there is no single correct approach to either of these, there’s plenty of room for practices legitimately to vary, and plenty of room for patients, i.e., most of my commenters, to express their likes and dislikes.  By my reading, many commenters assume that cancelation and termination policies mainly feed their therapists’ wallets; they tend to dismiss clinical rationales that are not obvious common sense.  I’m often drawn to defend the field and their therapists, and to point out th...
Source: Kevin, M.D. - Medical Weblog - September 15, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

When In Doubt, Ask A Family Member
Photo Cred: Max S. Gerber I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting I admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ usual mental function was prior to their injuries, and so I rely on my knowledge of neuroanatomy, infectious disease, and pharmacology to guide my work up. However, I have learned that asking the patient’s family members about...
Source: Better Health - September 9, 2015 Category: American Health Authors: Dr. Val Jones Tags: Health Tips True Stories ARU Autism Brain Injury Family Input Inpatient Rehabilitation IRF Mental Status Changes Stroke Source Type: blogs

Do physician health programs increase physician suicides?
How do we care for the people who care for us? As doctors, we’re immersed in pain and suffering — as a career. We cry when our patients die. We feel grief anxiety, depression — even suicidal — all occupational hazards of our profession. A recent Medscape article on physician health programs suggests the people who are here to help us may actually be doing more harm than good. And they may even be increasing physician suicides. Both doctors I dated during medical school died by suicide. Eight physicians killed themselves in my town alone. I’ve become a specialist in physician suicide. My cell phone ha...
Source: Kevin, M.D. - Medical Weblog - September 7, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

How can we measure the doctor-patient relationship?
Sixty years ago, before he became a controversial figure in the field of psychiatry, Dr. Thomas S. Szasz co-authored an article for the Archives of Internal Medicine (now JAMA Internal Medicine) on “The Basic Models of the Doctor-Patient Relationship,” which is well worth reading today, particularly for those who believe that patient empowerment/engagement is a novel and disruptive innovation of our digital times. The paper is describing three distinct relationship models (i.e., active-passive, guidance-cooperation, mutual participation) and how they flow and morph into each other based on patient ability/preferences, ...
Source: Kevin, M.D. - Medical Weblog - September 6, 2015 Category: Journals (General) Authors: Tags: Policy Primary care Source Type: blogs

Physician burnout starts in medical school. But it doesn’t have to.
I collapsed onto the rickety cot in the hospital on-call room. It was 3 a.m. Over the last twenty hours, fueled only by coffee and occasional bites to eat, I had done morning rounds on my patients, assisted with appendix and gall bladder surgeries, inserted and pulled tubes into and out of bodies, cut open a large intestine filled with feces, took patient histories in clinic, attended afternoon teaching, and finished four urgent consults in the emergency room. Just another day in the life of a clinical trainee. But when I look back on that night during medical school, I don’t remember feeling as excited as I normally fee...
Source: Kevin, M.D. - Medical Weblog - September 5, 2015 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

Is patient-centered care part of the problem?
What is the difference between a health care system and a Burger King? In a health care system, you can’t always have it your way. At some point in our training, most physicians are introduced to the Institute of Medicine’s landmark report on Crossing the Quality Chasm. The report outlines 6 key elements that are necessary for providing high-quality care: safety, timeliness, effectiveness, efficiency, equitability and patient centeredness. Although I recognize that outlining the 6 goals is a noble attempt at helping mend a broken health care system, I have to admit that, as a practicing psychiatrist, nothing is more cr...
Source: Kevin, M.D. - Medical Weblog - September 4, 2015 Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs

The Measure of a Physician: Albert Schweitzer
By RICHARD GUNDERMAN, MD There are different ways to take the measure of a life.  John Rockefeller, the richest person in the history of mankind, once asked a neighbor, “Do you know the only thing that gives me pleasure?  It’s to see my dividends come in.”  Television magnate Ted Turner once said, “I don’t want my tombstone to read, ‘He never owned a network.’”  And musical artist Lady Gaga has described her quest as “mastering the art of fame.”  But wealth, power, and fame are not life’s only metrics, and September 4 marks the 50th anniversary of the death of one of the 20th century’s brightes...
Source: The Health Care Blog - September 3, 2015 Category: Consumer Health News Authors: Simon Nath Tags: Physicians THCB Albert Schweitzer Care of Distress Richard Gunderman University of Strasbourg Source Type: blogs

How PAs Factor Into Improved CMS Patient Satisfaction Scores
When I started work as a certified physician assistant (PA-C) 30 years ago, I provided health care for the homeless as the medical officer for an outreach mobile health team in Brooklyn, N.Y. I literally treated patients on the street, and patient satisfaction was measured by having them simply tell me they felt better. Today patient satisfaction is being dissected and analyzed many different ways by physician offices, hospitals, and Accountable Care Organizations (ACOs), driven largely by the Centers for Medicare and Medicaid Services (CMS) and a policy to tie reimbursement to patient perceptions and compliance with clini...
Source: Health Affairs Blog - September 2, 2015 Category: Health Management Authors: Dawn Morton-Rias Tags: Equity and Disparities Featured Health Professionals Hospitals Organization and Delivery Quality ACOs CAHPS HCAHPS patient satisfaction physician assistants Source Type: blogs

Why these medical interns did not die in vain
About a year ago, I wrote a piece on my blog called “How to Welcome Incoming Residents.” It was about my struggle with getting the right messaging, messaging about the reality of stress during residency and the necessity of incorporating self-care and outreach to others. This year at orientation, in addition to adding the great suggestions posted by readers of the article, I took a different tack. It was imperative. There was a huge elephant in the room. As most residents and fellows — and their educators — know, the medical community of New York City was rocked by the suicide deaths of two interns in the s...
Source: Kevin, M.D. - Medical Weblog - August 30, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

The constant fear of losing a patient to suicide
This article was originally written on August 11, 2015. My psychotherapy supervisor taught me a tip during residency: to pay close attention to the very first thing a patient says, and more importantly, the last topic they bring up towards the end of session. (Because it’s likely that the subject weighing most heavily on their mind is too uncomfortable to discuss at the very beginning.) I struggled to come up with a topic to discuss on my blog today.  At first, I uploaded chipper, smiley pictures taken from a recent spontaneous trip to the coast, but there was something about my grin and carefree expressions that ...
Source: Kevin, M.D. - Medical Weblog - August 28, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

How a physician recovered from the vicious cycle of addiction
I was an overachieving, well-rounded and sagacious undergraduate student. I majored in psychology, minored in biology and was an active member of the Psi Chi honor society. I was drawn to the study of psychology, and fascinated by the complexities of mental illness. I became certified as a research assistant and spent many hours with severely depressed individuals, who had become crippled by their illness. I was intensely intrigued by their unique histories, their trials, and tribulations. I felt an intense desire to help and to become a positive part of their struggle back to mental health. Thus, with a solid focus and po...
Source: Kevin, M.D. - Medical Weblog - August 27, 2015 Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs

Narrative Matters ‘The Next Chapter': The Winding Road Of Mental Health Recovery
There’s a lot under the surface of life, everyone knows that. A lot of malice and dread and guilt, and so much loneliness, where you wouldn’t really expect to find it, either. — Marilynne Robinson, Gilead More than two years ago I published, “How ‘Person-Centered’ Care Helped Guide Me Toward Recovery From Mental Illness,” an account of my three psychiatric hospitalizations as an adolescent. The impetus for this essay, which appeared in the March 2013 issue of Health Affairs, stemmed from two separate, distinct, but unified places: my work as a researcher in the mental health field and my own fir...
Source: Health Affairs Blog - August 24, 2015 Category: Health Management Authors: Ashley Clayton Tags: Equity and Disparities Featured Health Professionals Hospitals Insurance and Coverage Narrative Matters Organization and Delivery Payment Policy Population Health Quality abuse Ashley Clayton depression healthcare providers Mar Source Type: blogs

What causes toxic stress in medical school and how to fix it
For two years, I served as a representative to my medical school’s student affairs committee.  My job was to convey medical student concerns and problems.  As part of that role, I had a lot of time to think about how and why many medical students experience depression and stress. Two recent articles have led me to write about the issue now: “10 simple solutions to stop medical student suicide,” and, “University of Kentucky trustees asked to revoke medical privileges of controversial surgeon.” Many see medical student mental health as a simple problem: bad doctors and bad residents are mean ...
Source: Kevin, M.D. - Medical Weblog - August 20, 2015 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

Research and Reviews in the Fastlane 096
This study assessed the speed and accuracy of medication administration in simulated pediatric resuscitations. 10 teams consisting of physicians and nurses participated in a cross over study, so that they did one simulation with the new syringes and one without. Time to delivery of medications was quicker with the new syringes (47 versus 19 seconds, a difference of 27 seconds; 95%CI 21-33 seconds). Teams were also more accurate using the new color-coded syringes, with dosing errors occurring 17% of the time with the conventional approach and 0% of the time with the new syringes (absolute difference 17%; 95% CI 4-30%). Obvi...
Source: Life in the Fast Lane - August 19, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma EBM Intensive Care literature R&R in the FASTLANE recommendations research and reviews Respiratory urology Wilderness Medicine Tagg Source Type: blogs

Open Payments Data 2014 Suggest Downward Trend in Clinical Research Spending
Could the Sunshine Act be creating an unintentional downward trend in clinical research? An analysis of the U.S. government’s Open Payments database shows that industry spending on U.S-based clinical research has dropped 32 percent in the first year-over-year comparison since Open Payments data started to be collected. The results are published in the August issue of Life Science Compliance Update, a monthly newsletter published by Policy & Medicine. The analysis shows that drug and device manufacturers reported about $1.5 billion in research payments from August through December 2013, the first reporting period unde...
Source: Policy and Medicine - August 18, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

The Moral Imperative for Bioethics: Get Out of the Way
As a companion piece to last week's post on the miserable, parasitic institution of modern bioethics, here are a few apropos comments from Steven Pinker: Have you had a friend or relative who died prematurely or endured years of suffering from a physical or psychiatric disease, such as cancer, heart disease, Alzheimer's, Huntington's, Parkinson's, or schizophrenia? Of course you have: the cost of disease is felt by every living human. The Global Burden of Disease Project has tried to quantify it by estimating the number of years lost to premature death or compromised by disability. In 2010 it was 2.5 billion, which means ...
Source: Fight Aging! - August 17, 2015 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Is the crusade against pill mills turning into a witch hunt?
I care for a 65-year-old woman suffering from sarcoidosis affecting her lungs, her skin, her bones, her nerves, her blood chemistries, her kidneys, her colon and her mind. She has gone from an active spouse, mother, grandmother, tearing up the dance floors with her husband, to a home recluse calling friends to drive her to medical and care appointments while ambulating with assistance of another strong individual supported by a 4 wheel walker with a seat. She describes her foot pain as feet burning on fire. An evaluation with the Cleveland Clinic and ultimate biopsies of her skin and nerves led to a diagnosis of severe sma...
Source: Kevin, M.D. - Medical Weblog - August 16, 2015 Category: Journals (General) Authors: Tags: Meds Pain management Source Type: blogs

Breaking The Graduate Medical Education Policy Logjam
This report proposed major reforms which would create a GME system with greater transparency, accountability and strategic direction that aligns with national needs. Stakeholder response to the IOM Report currently is being evaluated by Congress in the Health subcommittee of the House Energy and Commerce (E&C) committee. Their input from various stakeholders has been complex and lacking in consensus, thereby perpetuating the GME policy logjam, creating a daunting challenge and thereby decreasing prospects of any comprehensive legislative GME reform in this session of Congress. Since the introduction of the “resident ...
Source: Health Affairs Blog - August 12, 2015 Category: Health Management Authors: Richard Rieselbach, David Sundwall, Kenneth Shine, Ted Epperly and Byron Crouse Tags: Costs and Spending Featured Health Policy Lab Health Professionals Medicaid and CHIP Medicare Organization and Delivery Population Health Quality COGME HHS House Energy and Commerce committee IOM report MACRA Primary Care Rur Source Type: blogs

Advancing Integrated Behavioral Health Care In Texas And Maine: Lessons From The Field
Conclusion Texas and Maine are among the many states in which foundations have supported the establishment and spread of integrated care through grants, augmented with learning communities, policy advocacy, and evaluation. The evaluations related to initiatives that promote integrated care already reveal critical elements that facilitate successful integrated care and will develop more refined lessons as integrated care becomes the standard of care across America. Sharing lessons learned across states can accelerate the spread of integrated care until it becomes the standard of care. Related Resources Cohen, Deborah. Addre...
Source: Health Affairs Blog - August 11, 2015 Category: Health Management Authors: Becky Hayes Boober and Rick Ybarra Tags: GrantWatch Health Professionals Organization and Delivery Behavioral Health Health Care Delivery Health Philanthropy integrated care Maine Mental Health Primary Care Texas Workforce Source Type: blogs

Mental health on, or in, film
A conversation at home about F.D.C. Willard reminded me of Ian McEwan's novel "Enduring Love", for reasons which will become apparent in a later post.  There is brief mention of this novel in an earlier post about autobiography and biography as health literature, as it is a novel that deals with mental health issues.Looking for material on the web about the novel, I found the Minds on Film blog from the Royal College of Psychiatrists, which has an entry about the film of the novel.  This blog has been going for five years (there is an index, by health condition, of the first five years) and features structured re...
Source: Browsing - August 11, 2015 Category: Databases & Libraries Tags: dementia mental health psychiatry Source Type: blogs

10 simple solutions to stop medical student suicide
Medical school graduation: Time to celebrate our brand new doctors! Except for the families who can’t celebrate their child’s graduation. Or their child’s marriage. Or their child’s birthday — ever again. Like Michele and John Dietl. They lost their son, Kevin (pictured above), just weeks before graduation. Now they cling to online condolences and family photos. And to the never-ending question: Why? I’ve become a sideline specialist in medical student and physician suicide. Why? Mostly because I can’t stop asking why. Why both classmates I dated in medical school died by suicide. Why we lost three docto...
Source: Kevin, M.D. - Medical Weblog - August 8, 2015 Category: Journals (General) Authors: Tags: Conditions Medical school Psychiatry Source Type: blogs

A Chronology of Legionellosis Outbreaks in the United States
The following chronology of significant legionellosis outbreaks in the United States is abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2]   (Primary references available on request) 1949 – An outbreak of presumed Pontiac fever among steam-condenser cleaners was confirmed retrospectively. 1957 – An outbreak (78 cases, 2 fatal) of legionellosis at a packing plant in Austin, Minnesota was confirmed retrospectively. 1965 – An outbreak (81 cases) at a psychiatric hospital in Washington, D.C. was confirmed retrospectively. 1968 – An outbreak of relatively mild legionellosis ...
Source: GIDEON blog - August 8, 2015 Category: Databases & Libraries Authors: Dr. Stephen Berger Tags: Ebooks Epidemiology ProMED Legionellosis united states Source Type: blogs

The Stanford Prison Experiment film: An Essential Teaching Tool
By Craig Klugman, Ph.D. In teaching research ethics, there are a few “classic cases” that we offer students as examples of where human subject research went wrong: Tuskegee Study of Untreated Syphilis, the Nazi medical experiments, Willowbrook Hepatitis Experiments, human radiation experiments, and (now) the Guatemala syphilis study, among others. When discussing social science examples, the two studies that are usually taught at Milgram’s obedience studies and Zimbardo’s Stanford Prison Experiment. As an undergraduate at Stanford, my Psychology 101 teacher was Philip Zimbardo.… (Source: blog.bioethics.net)
Source: blog.bioethics.net - August 4, 2015 Category: Medical Ethics Authors: Craig Klugman Tags: Featured Posts Human Subjects Research & IRBs Informed Consent Psychiatric Ethics Research Ethics Stanford Prison Experiment Source Type: blogs

On The Internet
Of course there are patient archetypes.  We all use them.  I mean, there is the old lady that is super sensitive to even the smallest dose of just about every medicine.  The psychiatric patient whose allergy list runs a mile long.  The drug seeking guy that swears his pills were stolen from his suitcase yet again.My favorite is the widowed war hero.  His unrequited love for his deceased spouse pervades most visits.  He writes poetry and can carry a note to operatic proportions.  He is kind and humble.  He lives lost in a world of dreams and sweat memories.  He is both jovial and...
Source: In My Humble Opinion - August 3, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs

What young children can learn from Inside Out
This summer’s Disney-Pixar movie Inside Out makes us think about our thinking. But, I wonder, first of all, “Can we even think about our thoughts?” In fact, over the summer with campers at Lausanne Collegiate School, beginning with junior kindergarten to grade 7, I was teaching them how to observe their thoughts: a course in mindfulness and meditation for children. We begin by sitting up tall, like a tree. Then we become still, like a mountain. Then we “go inside” like a turtle in a shell. By this time the children are sitting upright cross-legged on the floor or feet hanging on a chair, motio...
Source: Kevin, M.D. - Medical Weblog - August 2, 2015 Category: Journals (General) Authors: Tags: Conditions Psychiatry Source Type: blogs

Over-Reliance on Tests: Why Physicians Must Learn to Trust Themselves & Their Patients
The post below ran yesterday on Better Health. I met my newly admitted patient in the quiet of his private room. He was frail, elderly, and coughing up gobs of green phlegm. His nasal cannula had stepped its way across his cheek during his paroxsysms and was pointed at his right eye. Although the room was uncomfortably warm, he was shivering and asking for more blankets. I could hear his chest rattling across the room. The young hospitalist dutifully ordered a chest X-Ray (which showed nothing of particular interest) and reported to me that the patient was fine as he was afebrile and his radiology studies were unremarkable...
Source: Disruptive Women in Health Care - July 28, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Consumer Health Care Health Professions Patients Policy Source Type: blogs

Over-Reliance On Tests: Why Physicians Must Learn To Trust Themselves And Their Patients
I met my newly admitted patient in the quiet of his private room. He was frail, elderly, and coughing up gobs of green phlegm. His nasal cannula had stepped its way across his cheek during his paroxsysms and was pointed at his right eye. Although the room was uncomfortably warm, he was shivering and asking for more blankets. I could hear his chest rattling across the room. The young hospitalist dutifully ordered a chest X-Ray (which showed nothing of particular interest) and reported to me that the patient was fine as he was afebrile and his radiology studies were unremarkable. He would stop by and check in on him in the m...
Source: Better Health - July 27, 2015 Category: American Health Authors: Dr. Val Jones Tags: Health Tips True Stories Blood Tests Correct Diagnosis False Negatives False Positives Lab Tests Physical Exam Radiology Trust Source Type: blogs

I tried not to let a drug rep influence me. But he probably already did.
I attend pharmaceutical dinners every once in awhile because: 1) I like to stay up to date with all the new drugs (or just a slightly modified version of the generic, but with a much fancier name and packaging); 2) Though I’m several years out of medical school/residency, one thing I have maintained from those formative years is the mentality where I’d never pass up a free meal. I know that pharmaceutical sales representatives (also known as drug reps) have been banned and limited in several institutions, and I completely understand the reasoning (it has been shown that drug reps’ marketing tactics inf...
Source: Kevin, M.D. - Medical Weblog - July 24, 2015 Category: Journals (General) Authors: Tags: Physician Psychiatry Source Type: blogs

John McCain vs. Trump
The Senator is a war hero because as a Navy pilot of his rank he was exempted from flying above a certain parallel in attacking North Vietnam. Obviously defenses near Haiphong were better and flying further North was more dangerous. He declined the privilege of flying in more relatively safe areas only and was shot down. Yes, his behavior in captivity plays some role in his being considered a hero, but it starts with his willingness to take risks in the attack. Trump on the other hand plays on feelings of anger and humiliation while seeming to lead people into more dangerous areas. (Source: a psychiatrist who learned from veterans)
Source: a psychiatrist who learned from veterans - July 24, 2015 Category: Psychiatry Source Type: blogs

Project ECHO: Force Multiplier For Community Health Centers
Even with the Affordable Care Act, millions of Americans struggle to access health care when they need it. A huge part of the problem is a lack of both primary care and specialty providers in rural and other underserved communities. Without local providers who can meet patients’ needs, health care coverage does not necessarily translate to access to care. Developing Health U.S., the GE Foundation’s signature health program, strives to help as many people as possible gain access to health care by partnering with community health centers around the country. Community health centers are the backbone of the health care saf...
Source: Health Affairs Blog - July 20, 2015 Category: Health Management Authors: David Barash Tags: Drugs and Medical Technology Equity and Disparities GrantWatch Health IT Health Professionals Quality Access Community Health Centers Health Philanthropy Innovation Physicians Primary Care Safety Net Source Type: blogs

In Alzheimer’s Disease, Caregiving May Be Just As Trying As the Disease Itself
The post below originally appeared on HuffPost’s Living Healthy blog on July 15. When most of us think of Alzheimer’s disease, our first thought isn’t usually of the quiet caregiver alongside the patient, devoting their time to helping someone living with the disease. But caring for someone with Alzheimer’s disease is often a full-time job, taking its toll on the caregiver. According to AARP and the National Alliance for Caregiving, the “typical” family caregiver is a 49-year-old woman who takes care of a relative. Nearly 25 percent of America’s caregivers are millennials (adults a...
Source: Disruptive Women in Health Care - July 20, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Aging Caregiving Chronic Conditions Alzheimer's disease Source Type: blogs