Keep ridin’ that dependency train, see where it takes ya!

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Take a stand against dependency before it consumes you!

Hi ho, hi ho, it’s gone from work I go…

Oh, and to Edward Snowden out there in Russia, take my advice, you sacrificed your life to do what is right and responsible, so don’t wait for the majority of selfish ignorant bastards who have no clue what you have appropriately done to even pause to think to thank you, no, they’ll just keep on dependin’ on that criminal element they call “leaders”

You want something to read?  Got 300 plus posts that might actually have an interesting point of view to teach and, gasp, maybe have some possible positive impact for someone.  But, you gotta read ’em, I can’t hold the screen and read to you!

Try this one first:

http://cantmedicatelife.com//?s=Friedman%27s+Fables&search=Go

won’t take long, you can still catch your show on the tube!

Bye!

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An addendum to an earlier post, the pending demise of Community Mental Health Clinics.

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Demise of Community Mental Health Clinics, Psychiatry is a lost cause

Yes, this was the same picture as the below post from less than 4 weeks ago,

http://cantmedicatelife.com/2013/12/20/community-mental-health-clinics-are-a-dead-concept/

Well, just to remind readers without duplicating from above said post, I don’t think the intended concept of Community Mental Health Clinics will serve responsibly, simply because the whole process is so skewed to just giving people what they want, which defeats the purpose of mental health care.  And now, here in Maryland, there is serious talk about making marijuana legal, and with the logarithmic growth of primary addiction patients already inundating mental health services to treat substance abuse/dependency, just imagine what the surge of pot smokers who experience new/pronounced mental health will do to such clinics?

As I wrote earlier last year how psychiatric private practice is now dead, here are the nails for CMHCs, bit simplified as I am tired and having to prepare for another week of being a drug dealer for dozens of patients at the current clinic:

1.  Addiction patients as noted above.

2.  Personality Disordered patients as a primary diagnosis, who are not only over medicated as medications won’t treat a personality disorder problem, but, I know in my heart that many psychiatric medications are contraindicated in Axis 2 disorders, and not just the controlled substance ones.  Antidepressants and antipsychotics can really disrupt such patients, but, another post in and of itself.

3.  Providers who can’t say no, who won’t say no, and don’t know how to say no.  Oh, and providers who won’t hold patients accountable for poor choices and follow up uncooperation.  After all, therapists are just the go between for setting up those “Med Evals”, eh?

4.  Administration who makes psychiatrists glorified janitors, hires anyone who claims to have a skill in providing therapy, and considers support staff anyone with just 2 arms and legs and a head who can speak basic English and show up for work.  Note NOT on time is not an essential for employees these days.  It’s just about billing and making sure not to run afoul of state/federal guidelines as set for clinics.

5.  EMRs.  I think anyone who has either had to type or been sitting on the other side of the desk and staring at the back of a computer screen understands what this means.  How many seconds of eye contact in an office visit have you had as a patient with a psychiatrist using EMR  these past couple of years?

6.  Medications.  The primary purpose, and now with samples dwindling in number and access, the beginning of rioting once patients finally accept that free meds are a past concept.  I am not going to address the frank drug seeking, see 1. for the addiction component, and that is already a short form answer.

7.  Change.  Or really, no interest in change.  With the logarithmic growth of SSI and SSDI applications for treatable illnesses, and how so many are being approved, what is the interest to get better?  This is a nail at one end of the coffin.

8.  DSS and the Legal System.   State interferences and forensic referrals are also growing, again, logarithmically, and what does that do for invested providers who are trying to treat just those people who actually want to come to the clinic?  Isn’t it fun to have to meet with patients who are told “if you don’t see the psychiatrist and take meds, you will a.  lose your kids b.  go off welfare  c.  go back to jail  d.  go to prison  e.  be hospitalized, albeit briefly as there are no hospital beds to access these days for extended periods of time.

9.  Perhaps really 8a., but, being asked to treat chronically ill patients who have avoided Conditional Release or Assisted Outpatient Treatment, these are patients who should remain chronically hospitalized and yet, thanks to that mutli-syllable word we all know and love as deinstitutionalization, are forced on the CMHCs.  And forget expecting ACT programs to step in and be effective substitutes, because they are being inundated with the forensic population who are bumping the real intended targets of the chronically mentally ill.

10.  Finally, fellow physician colleagues who have no clue what to do in order to be responsible and effective advocates for the system.  Nah, I have worked with people who would honestly write any prescription for a patient simply because the patient asked for it, and then write for polypharmacy that would kill an elephant, but, many of these patients coming in and taking literally dozens of pills at times have been desensitized and developed remarkable tolerance to survive the prescription pad encounter, but now it is the Escribe computer link.  Oh, and the charting by many of my colleagues, well, they better hope they are never in court having to defend themselves and asked to read something by the plaintiff’s lawyer that turns out to be what they wrote as an alleged contact note.

Let me give you an example of some I have read in the past 4 years, a bit compacted, but, that was the note:

“S:  pt with no complaints, stable, no side effects of meds

O:  mental status unchanged, no abnormalities new or problematic.

A:  unchanged

P:  continue as planned, medications for 3 months.”

That has been an actual progress note by colleagues these past years, both in CMHCs and even in private practices.  Oh, and you get a copy of a medication sheet that is just a continuation of ” Meds A, B,C as is for 3 months”, no strength, no quantity, sometimes even the spelling is undecipherable, or better yet, they forgot they made a medication change and still document a medication the patient has not been of for months.  One time, for over a year!

So, there are your 10 nails, 4 on each side and one each in the middle of each end.  Where do you want this buried?

Next to shame and humility, common sense, and pride and ownership?  Oh, I am sorry, those are unmarked graves, so I guess when you start digging, hope you don’t hit another burial site.  Don’t worry, our predecessors who buried those other things probably didn’t even put them in a coffin, so, we are being at least a bit more respectful here!

Final comment, if you are going to a CMHC and aren’t seeing a therapist at least every 1-3 months, you are violating the protocol for standards of care set by all states for mental health care.  So, you should ask yourselves, how are you seeing a psychiatrist alone for months to years and not worried about it?  I’d ask the clinic, but, you wouldn’t like their answer.

Thus until I find one that not only gives me the right answer, but practices it as well, I am just a temp.  Sorry to any patients who see me for care in your travels, but, at least you now know why it is temporary.

Hey, remember, it will be unmarked!

Yeah, let’s legalize pot, per Bob Dylan, “Everybody must get stoned”! Idiots!!!

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Consequences of marijuana use from Colorado legalization 2014, pending casualties from the State of Maryland Democrat Party

So now Maryland is considering legalizing marijuana.  I say do it.  Really, legalize pot use, just see how Colorado is literally cashing in just after 1 week, as the idiots who are our politicians, and they are idiots who rule this state, just see a financial grab and want to pounce on it faster than you can say “light up!”  And then WHEN the consequences play out, and hopefully real fast, it will bury these idiots who think they will stay in office until they die.  Oh, and they will die, because once their political careers are over, they are dead, because they can’t rule any more, and once a person realizes they are useless and have no purpose, they die.

Yeah, harsh and insensitive.  Sums up the mentality of those who are entrenched politicians here in Maryland, some in office for more than 30 years now.  Like that Rain Tax, Marylanders?  Yeah, I’m sure you do, every day it rains it brings smiles and good cheer!

Think I hate the political powers that rule Maryland?   Supermajority rule is just crushing for any and all who are autonomous and independent, and the only way I see for change to honestly and effectively happen is for entrenched incumbents to either die by natural causes preferably as I never advocate for violence, or, have their careers killed by supporting and then enforcing a legislative agenda that ends up to be so heinous, so foul, so disruptive to society, and the idiot politicians who just wrap themselves around the flag of the law they themselves proposed, enacted, and enforced, they don’t see the consequences until figuratively it slaps them in the face!

So, legalize pot here in Maryland, please!!!  And when the first pothead kills or injures a VIP or group of people, especially involving children, and then the majority of citizens who really don’t want pot around them, just the debate to be over, realize the apathy and indifference has a cost, well, just remember who proposed the idea, who pushed for it mercilessly and minimized any fall out, and then tried to profit from it as ruthlessly and insensitively as drug dealers do now.

Then what do you do, Maryland Citizens?  Oh yeah, you’ll reelect the same idiots who further ruined your lives.  Hey, first Casinos, then the Rain Tax, what does it take to make people realize politicians have no freakin’ clue?  Maybe when they do something that kills your kids, your friends, or ruins your career.  Nah, even then partisan agendas trump common sense in 70% of the idiot electorate that exists in this state!  Just remember how Martin O’Malady felt the Baltimore Detention Center fiasco that involved the inmates literally running that asylum, remember this pathetic quote?

from the below first link, “The indictments are, he (OMalley) said, “a very positive development” in the state’s effort to eliminate gangs behind bars.”

http://articles.baltimoresun.com/2013-04-30/news/bs-ed-omalley-prisons-20130430_1_city-jail-baltimore-city-detention-center-black-guerrilla-family

Oh, and the Washington Post’s take:  http://www.washingtonpost.com/local/maryland-could-have-acted-quicker-to-prevent-baltimore-jail-scandal/2013/06/08/b42f5f94-cfc9-11e2-9f1a-1a7cdee20287_story.html

And this guy wants to be President next.  Frightening?!

Oh, by the way, looking forward to the first MVA casualties in this state after the TENS of thousands of illegal aliens who are applying for legitimate licenses here in Maryland are on the roads.  You would think that would make honest and responsible people be very concerned, but, let’s add the use of pot with these drivers too.  Carnage has to be outrageous and obscene to be appreciated, eh?

End with this link to wish you all well this weekend:

http://www.foxnews.com/opinion/2014/01/10/america-ill-prepared-for-marijuana-mayhem/?intcmp=HPBucket

and this too from Fox:

http://www.foxnews.com/us/2014/01/10/colorado-pot-shops-likely-targets-cartels-say-experts/

Hey, it’s just an organic product of nature, where’s the harm?

I hope every pot proponent finds out brutally how stupid they are!!!

Addendum:  then there is this idiot shill from the Baltimore Sun who sells the Democrap shit so well, thanks for reinforcing my above points, DAN!

http://www.baltimoresun.com/news/maryland/bs-md-rodricks-0109-20140109,0,3499771.column

And this guy writes op-ed pieces advocating for the addiction population.  Wonder what stock options he has in the Substance Abuse industry.

More idiots, unfortunately writing their idiocy for the masses to read!

300th Post. Probably will be more than 300 words.

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do business models apply to the health care system?, Linda Stroh & "Trust Rules" book, who can you trust

So, after 200 posts in about 10 plus months, I have done another 100 posts in the past 3 months.  A lot to say, relate, rant, comment, educate, enlighten, annoy, and just pontificate?  Yeah, that last one is probably on the mark, pontificate.  Well, so what to pontificate here on the 300th post?

I think it dawned on me after finally finishing this book, sadly I started about 3 years ago, if not a bit longer, but found it on my window bench in the bedroom a couple of weeks ago and read the last three chapters.  The book?

It is a really good read, the chapters are short, concise, and frankly, the author just puts it out there as is.  From what I have learned about myself and my work as a psychiatrist, especially the last ten years, it has been about trust, or much more so a lack of trust from what I have seen, heard, and survived in my various travels as a practitioner.  But, first let’s get back to what she wrote, very aptly in the last chapter, and I include the key pages below:

I was worried it would not be legible, but it basically is!  At the top of page 148 were the list of things per the heading on the previous page of “Have we gone too far?” in lack of effort in not differentiating good guys from bad guys in our lives.  Read those examples, it goes along with past posts about our incessant and clueless tolerating of incompetence, irresponsibility, and more so of late just plain criminality.  And that is what disturbs me the most these days, among colleagues especially, this “legitimizing”, or “rationalizing”, or just pathetic “apologizing” for idiocy, insensitivity, and lack of accountability seen not only in patients who really do know better, but also with our peers in the profession who are just being plain criminals too much of the time now.  But, is it so outrageous or disruptive to the profession to call inappropriate behaviors, actions, and blatant interference for what they are at the end of the day?  If not outright antisocial/sociopathic, how much better to label it gross negligence or pervasively clueless, and more often at least self serving??

Unfortunately, I know I work with a sizeable percentage of colleagues who are just whores and cowards.  That word “whore” has gotten me in trouble in the past at other sites, but, I researched what the term meant, and for awhile used the word “mercenary” in place, but, why not use a word that evokes a reaction one feels needed, if the term fits?

You decide, I will use my usual source here on the net, Merriam Webster, and look at “whore” first:

Definition of WHORE

1:  a woman who engages in sexual acts for money : prostitute; also :  a promiscuous or immoral woman

2:  a male who engages in sexual acts for money

3:  a venal or unscrupulous person

 See whore defined for English-language learners »

See whore defined for kids »

Examples of WHORE

1. <a historic district of the seaport that was once notorious for the whores who gathered there>
2. <a society in which men commonly regard women as either Madonnas or whores>
3. For writers, to blurb or not to blurb can be a tricky matter. … Blurb too often, or include too many blurbs on your book, and you might get called a blurb whore. —Rachel Donadio, New York Times Book Review, 17 Aug. 2008

That third one, “unscrupulous person”, I think applies to my concerns here.  Unscrupulous colleagues, doesn’t that work for some reading here?  Well, then there is “Mercenary”:

Full Definition of MERCENARY

:  one that serves merely for wages; especially :  a soldier hired into foreign service

 See mercenary defined for English-language learners »

See mercenary defined for kids »

Examples of MERCENARY

1. an army of foreign mercenaries

And that is why I came to the conclusion that “mercenary” doesn’t fit what my “whore” colleagues are doing of late, whether they be just providers in communities, or the big wigs in academia or the APA.  No, it isn’t just about wages anymore, that would be true for what people were doing when managed care first started (and yes, there will be some cursing here, as it applies to the tone and intent of this post) fucking with both psychiatry and mental health in general.  But for the past 10 years or so, it has decompensated to just unscrupulous, self serving, and almost complete LACK of advocacy or accountability for choices in the office, in the field of opinion making, and the authority figures setting standards of care and direction of practice seen as allegedly acceptable and tolerable.

So, how does this fit into the TRUST issue noted above in the book reference?  Well, I have come to not trust much of what I have worked with in my travels, and boy, have I learned that alone from much of my Locum Tenens work, as a temp doc, why so many sites who are turning to temp docs have trouble landing a permanent provider with a soul and dedication to the practice of psychiatry as intended.  From administration on down to a sizeable amount of employees, people are not committed to the principles of health care, but just cost and profit at the end of the day, if not just minimizing effort to get through an 8 hour work day.  Most (about 90%) of who I have interacted with aren’t evil, or just soulless and corrupt, but, they don’t understand or just won’t stay in the boundaries of doing what is right and responsible.  No, we are in a culture of logarithmic growth of doing what is popular, easy, and convenient.  And isn’t that what whores and cowards do in the end?

If you don’t know, I wrote what I still feel is a good post for my 100th one, I link below:

http://cantmedicatelife.com/2013/05/05/my-100th-post-is-it-a-milestone-or-just-another-number/

I don’t like to link my own posts, but for the flow of this one, I will go against my nature and do so to help readers follow my thinking and past writings.  Anyway, as I wrote there, I have seen things you people would not believe.  A great line from the Rutger Hauer character in “Blade Runner” at the end of the movie.  And it is not pretty or enjoyable to even consider what I could relate.  How it leads to the TRUST issue here.

What concerns me the most, as a provider and in some form a protector for the patients we really do serve, albeit with boundaries and limits to not corrupt, be corrupted, or take advantage of patients, if I have issues trusting other providers and the administration that runs the health care environment providing for patients/communities, then who in the hell can the patients turn to in times of need, crisis, and possible risks for their lives?  That bothers me to have to worry about something that should be a minimal element of a risk to patient care, much less be one at all!  That is NOT an indictment of all of mental health care, but, I wish I could say it is a trivial concern.  No, mental health care has too much discord and tolerated interference to practice fully as intended, and needed.

Getting back to Stroh’s book, she talks in a couple of chapters about needing to trust OURSELVES, and she uses a Trust Rules Self Questionnaire I include below to help on step back and contemplate what has to be a basic question that coincides with what I tell patients, and sometimes other colleagues if I sense struggles in them, “BEFORE WE CAN SAVE OTHERS, WE OURSELVES HAVE TO BE SAFE”, so I hope you might consider taking the survey as honestly and candidly to know who you are to yourself:

I think to be the best person you can be, you have to know what are your core principles, your basic values and instinctive responses and expectations of yourself, and then extend it to those immediately around you who are supports and crucial elements to your day to day needs.  When you read her book, I think you will realize that if you have compromised your own basic beliefs/principles, or just fallen into the common trap of popular/easy/convenient, it creates an inherent uneasiness or dissatisfaction within yourself, but, it may not be so conscious or acceptable to realize and admit.  Hey, I’ve been there, so it is ok to consider lapses in commitment and intent.

So, what can a guy or gal do when trust has been so compromised in one’s travels in a profession or ongoing pursuit of importance?  Well, start with knowing what to trust, and not compromise on that expectation.  For me, I will stick to Locum work for now, I have little faith for now that I can find a place to work for a prolonged period of time with most who will commit consistently on what is right and responsible.   I know I do take pride and ownership in what I do as a psychiatrist, doctor, and health care provider.  I believe in the Hippocratic Oath, and feel those principles and commitments to what being a doctor demands of the physician and expectations of the patient should NOT be compromised, or just decompartmentalized to fit systems or expectations that aren’t true health care needs and boundaries.  Hey, I have no tolerance of trying to make the business model square peg crash through the round hole that is the health care model.  They don’t fit, and I feel the business model is black and white, hence with edges, while the health care model is round and inclusive of the concept of gray.  Everyone is an individual, not the mold of one “cookie cutter” shape or a widget!

As I wrote years ago in a letter to the editor of the Baltimore Sun, “if you want to profit, invest in oil, not blood!”  Boy, has that letter been prophetic to what health care has deteriorated to since.  Too many people see health care as a money maker, and isn’t it incongruent to make money and still provide as realistic a limitless system one wants to access in health care options and interventions?

Think about that some more, can you make money and still instinctively feed the system to provide care and compassion?  I honestly do not think they are synergistic agendas; at some point to purely profit, something that is a cost will be minimized or just be plainly cut to make sure money goes into a wallet, not a system for the masses.  Profiting is contradictory to doctoring.

And now I step down from the soap box.  Hope the reference above is of interest, and hope you give thought to not only who around you do you trust and know it is right, but, also do you trust yourself.  Tough question, but perhaps even a tougher answer!

I leave you with a favorite picture that reminds me of times of enjoyment, and with it being so damn cold of late, motivation for Spring to be soon!

Be safe, be well, and be true to yourself!

A nice article about Adult ADD that promotes skills, not pills

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Adult ADD article in Scientific American Mind 2014, need for pills and skills in ADD, opiate abuse consequences

This was the cover picture for the article “ADHD Grows Up” by Tim Bilkey, Craig Surman, and Karen Weintraub, in the Jan/Feb 2014 issue of Scientific American Mind.  It is a good read, and I include a cut and paste I did from the middle of the article that stresses medication alone won’t impact fully on legitimate ADD in adults.

Here it is:

It seems readable to me, so I hope you read it!  Again, if you have read here with any regularity, I am an outspoken advocate for patients being in therapy as much as any use of ADD meds, and I am equally an outspoken critic of the “Gimme drugs as I tell you I have ADD” crap that is prevalent these days, but even moreso in the counties around Washington DC.  I worked a year in Montgomery County in a private practice, and quit when 20% of the new referrals in the last 6 months there were for ADD seeking medication patients.  Now I am at a CMHC in Frederick County, a definite bedroom community for DC, and is nothing less than pathetic having picked up a colleague’s patient load that over 33% are on stimulants, mostly Adderall, and on dosages I am waiting for patients to drop dead from cardiovascular collapse, with many of them over 45 years old!  Why do I say it that way?  These patients don’t want to hear I am not happy being asked to continue these absurd prescriptions, much less dosages.

Below is the link to the article, but realize they at Sci Am MInd only give you a preview, but, check it out, there are other good articles in there too about women and men can’t be just friends, role of chronic traumatic encephalopathy from head injuries in sports, and the role of talking to yourself.

the link:  http://www.scientificamerican.com/article.cfm?id=adults-can-have-adhd-too

Oh, I’ll end with this from the issue too, not surprised I note it, eh?

Enjoy, and don’t be afraid to seek out treatment from various sources, including yourself!  Change starts from within, so want it, do it, be it!

“I maintain that little should trump the very significant downside of active psychiatric disorder during pregnancy.”

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Lee S Cohen MD and advocating for antipsychotic medications in pregnancy, Use of antipsychotic medications in pregnancy

Those who have read past posts at this blog may have come across some comments I have made about treating women in pregnancy.  Well, if you haven’t, let me repeat what I will say until I retire, or die:  medicating women is a last choice, way before therapy and other non pharmacological options are first exhausted, unless, the woman is a risk to herself, her baby, or others.

I think it is that simple, if it can be said that way, and yet, I think the pharmaceutical industry has corrupted such common sense over the past 15 or so years, and so now you read what I consider, more often than not, the most disgusting and pathetic rationalizations being uttered in print and in person by colleagues claiming otherwise.  That above quote titling this post is by Lee S Cohen, MD, how he ends an article in an issue published by Clinical Psychiatry News entitled “The Bipolar Report”, and Cohen’s article is “Atypicals during pregnancy:  What do we know?”

Oh, and here it is, interestingly first published back in August in Clinical NEUROLOGY News, why as it appears moreso fit as a psychiatric article is a bit baffling, but I don’t know the intent, just that it is now in a psychiatric periodical 4 months later.  That is a bit of a red flag to me:

http://www.clinicalneurologynews.com/views/commentaries/single-article/atypical-antipsychotics-during-pregnancy-what-do-we-know/e39a2d80fc7a921589c1ecdf808aaf2c.html

Which in his credentials at the bottom certainly are an interesting statement too:  “He (Dr Cohen) is the principal investigator on the National Pregnancy Registry for Atypical Antipsychotics, which is sponsored by MULTIPLE MANUFACTURERS OF ATYPICAL ANTIPSYCHOTICS.(capitalization by me)“

Anyway, I have told you what I believe to be the standard of care, and I just want to ask anyone interested out there, who is willing to bet their license, their standing among colleagues, oh, and how about the safety and well being of the fetus and he/she’s future after birth that psychotropic medications have less risks as made out to be?  Dr Cohen writes in the latter third of the commentary this:

“Given the importance of treating psychiatric illness during pregnancy and the evolving data that illustrate the adverse impact of untreated psychiatric illness on a wide range of neonatal and obstetrical outcomes–and on increasing the risk for postpartum psychiatric illness–one could consider a risk-benefit decision that places the use of atypical antipsychotics as not contraindicated.”  

(I block quoted this to make it stand out, especially that ending, “…places the use of atypical antipsychotics as NOT contraindicated.”

So, with this in mind, I hope readers will give me some latitude that my interpretation of Dr Cohen’s end sentence in his commentary is basically saying, in my words here, “TREATING A WOMAN WHO IS PREGNANT HAS MORE RISKS TO NOT TREAT THAN TO GIVE HER, AND THE FETUS, PSYCHIATRIC MEDICATIONS LIKE ATYPICAL ANTIPSYCHOTICS, WHO’S HISTORY OF RESPONSIBLE AND APPROPRIATE INDICATIONS HAVE BEEN REPEATEDLY AND MORE OFTEN CORRECTLY CHALLENGED AS NOT SO RISK FREE AS THE MANUFACTURERS HAVE TRIED TO UNSUCCESSFULLY MAINTAIN IN NUMEROUS LAW SUITS IN THE PAST 10 YEARS.”

With that history of late, you want to be advocating for these medications to be used in a population with much to lose as much that can be gained?  Wow!

But, you know what, here is the clincher in how absurd colleagues are in writing how safe these medications are, as written in a separate piece  taken from the October 2013 Brown University Psychopharmacology Update, in their review of Habermann, Fuhlbruch, et al article “Atypical antipsychotic drugs and pregnancy outcome” in the Journal of Clinical Psychopharmacolgy, volume 33: pages 453-462 of same year;  I scanned the page to show I am not making this up:

I put an asterisk by the comment in question, but will retype it here if you have trouble reading it:

“They concluded that SGA’s (atypicals) with the largest amount of positive experience in pregnancy, including quetipine, risperidone, and olanzapine, can be considered the treatment of choice for pregnant women who require antipsychotic therapy.  FOR THOSE RECEIVING THIS TREATMENT IN THEIR LAST GESTATIONAL WEEK, THE AUTHORS RECOMMEND THAT DELIVERY OCCUR IN A FACILITY THAT INCLUDES A NEONATAL INTENSIVE CARE UNIT.” (again the capitalizing is mine)

Are you kidding me?!  To say in one breath that these meds meet a standard of safety to use in pregnancy,and then try to casually say that women should be delivering at hospitals with neonatal ICUs, just in case of a consequence occurring, is a trivial detail??

I leave it to you to figure out what the hell is being said here in these “opinion” pieces aimed at colleagues who prescribe.

Just remember this from me, I am NOT saying don’t medicate pregnant women with documentable psychiatric illness who are struggling and at risk to not finish a pregnancy if not other serious consequences to themselves or others around them, but, this is not the type of academic research and opinion that gives me comfort and support to do so without reservation.

I just wonder, would any of these doctors advocating use of antipsychotics in pregnancy, would they come out in print and state they would support their pregnant spouses/significant others, or themselves as women physicians, in taking these medications if the indication warranted the script?

In there lies the true answer of commitment and confidence.  I wouldn’t ask my wife or daughters to do so, not until I see less invasive interventions used first!

Just.  My.  Opinion.

Some tidbits from The Week magazine worth the read.

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Tidbits from The Week Magazine for Dec 31 2013 issue

The year end issue of The Week came, and felt these few pages were of interest.  First the Health & Science section had some psychology related points:

Take note that Tylenol is mentioned as a Good and a Bad, as you will read below.  I found the piece about Pessimism to be of interest, as while I see myself as an entrenched realist, well, some frame my perspectives as pessimism.  Boy, so you get to live longer and be jaded about it…

Then the bad portion of the section:

Most of these have a psych bent, I was a bit incredulous to the commentary about “marrying the wrong person”, I mean, sorry, but a big “Duh” there.  To all readers out there, read the Energy drinks commentary, it is on the mark, and the part about teens adding stimulants with caffeine, well, how do you spell ‘ludicrous” these days?

Finally, there was a page summarizing statistics, and I include it for the following:

a couple of points in there that were

1.  offensive:  49% of adults are texting and driving?  Time to make this charge a felony, I mean, if the research shows it to be as dangerous as driving while intoxicated, what do we do with those charged with DUIs, and

2.  illuminating, “Washington is what keeps them (Americans) up nights”, maybe I can’t medicate sleep if the pervasive worries have some merit, eh?

But, the beginning of the page says it all:  “How are we feeling?  Pretty glum.”

Well, here is the current events post for the week, no pun intended there.

By the way, are 10% of you really looking at your phones during sex?  Is there a new twist to “sexting” I haven’t heard about yet?

Just can’t find a way to title this post tactfully.

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"give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime", The costs of dependency

Happy New Year.  So what is different this year from last year?  Numbers.  A renewed hope for positive change.  Tax code modifications.  The impact of Obamacare.  A year closer to retirement.  Whatever.

I have had this comment gnawing at me for the past week plus, and will share it now, to lead into a post I really could not find a title that wouldn’t be profoundly annoying or just outright outrageous.  It came from a therapist bringing a patient to the clinic front desk and I heard this uttered from the provider:  “so, what’s a good day and time to set you up for a med eval?”

A med eval, is that how much I have been dumbed down to as of 2014?  I don’t even count as a provider to help make a diagnostic impression, to assess for a treatment plan.   Nah, I am just here to set up patients with the right meds.  Gee, just like buying a set of tires, or, that right kitchen counter, or perhaps bring it to a medical analogy, what is the right plastic surgery to improve an image?

No, it is bigger than that, I see mental health just morphing into Dependency Clinics, as I have said before, and isn’t that terrible?  Get the patient on those drugS to make them feel better, to stop those pesky symptoms, to correct all those stressors that are just a biochemical imbalance.  People come to CMHCs in growing numbers to be on pills, and boy, if you don’t give them what they WANT, and that is not a typo, it is more and more not about needs but just plain WANTS, they have less hesitation to be rude, dismissive, and this past Monday, one decided to be just threatening and disruptive to the whole clinic.

Well, here is an analogy to hopefully get readers to stop and ponder, to reflect, to reconsider, what is it this culture is looking for these days?  I think it comes down to this:

That is me, not literally fishing mind you, but I am the person looking for something hard to catch, to “hook” something can be so beneficial and nurturing, not simply as a meal, but a process to carry further and be beneficial.  Unfortunately, what do the rest expect and do:

They are just there in numbers expecting to be figuratively fed, if not literally, and note none are standing next to me wanting to help, to learn, to absorb what the process entails.  NO, this is a culture of metastatic dependency, and it is detrimental to not only themselves, but to all the dependents expect to do for them.  And too many providers just buy into it HOOK LINE AND SINKER (you had to see that pun coming, eh?).

You can’t medicate life, as the title of the blog notes, and yet, more and more expect it, and don’t want to renegotiate what has to be done.  What happens when the fisherman can’t throw out the line again?

That moment is coming.  Can you learn how to “fish” for answers and options on your own?

It won’t come out of a pill bottle, count on it!