19 posts tagged “psychiatry”
I don't really need to be here. They made me come.
From a woman who believes that her best friends are stealing from her, playing mindgames with her, to make her have a nervous breakdown.
They are after my money.
She doesn't want to tell, but during the course of the interview it slips out that she's been committed to treatment, twice, against her will.
I don't ever want to be locked up again.
Yet, other than this one delusion, she could be any of us. She dresses herself every morning, goes to doctors, pays her bills. After every few minutes, she insists,
I'm not crazy, I know that.
Why, then, does she ask me the question when stepping out the door?
Tell me, doc, am I losing my mind?
He's had ten heart attacks. He is thirty eight years old.
The first one hit when he was twenty six. It changed the happy-go-lucky guy with a cannabis tattoo into a depressed loner.
His mother died in her twenties of the heart attack. His sister, in her thirties. His two children have also had them. He worries about them at night. Sometimes, he smokes.
Three years ago, he was told he had a month to live, maybe less.
'I'm still here.' He grins at me.
His heart is mostly gone now. He's been admitted, but no surgeon will touch him.
He and I sit and trade jokes while the specter of death stands between us. How do I offer this guy an anti-depressant? Instead, I shake his hand. He thanks me for my time. I walk outside and move on to the next consult.
Some days, I don't like medicine that much anymore.
She had been evaluated by a senior resident and transferred to me for further management. He had started her on an anti-depressant that she quit taking before she saw me.
It raised my blood pressure too much. My body is so damaged, I have to be very careful.
We talked about various medications. I would offer one, she would look it up in a Physician's Drug Reference, and refuse it, citing all the possible side effects.
I referred her for therapy. After a few unsuccessful appointments, I offered to terminate our med-checks. If she wasn't comfortable taking medications, why be billed for them?
Well, maybe I'll try this medicine. I trust you.
We made an elaborate plan. She started taking a small dose. It seemed to work.
Very slowly, I titrated up the dose. She became less worried about side effects. She started to smile. At her last visit, she told me she was getting back in touch with her family.
I upped the medicine to standard dose, and asked her to call me if she had any concerns.
Today, she came back after a missed appointment.
I've been taking a stimulant. It helps me take care of my family.
I mentioned concerns for her blood pressure, her history of drug problems, the possible effects of taking stimulants as needed. I wondered why she hadn't called me.
Oh, but you told me not to worry about it too much.
I had a sinking feeling in my stomach even before I asked her the next question. Was she still taking the anti-depressant?
No. It made me feel funny.
And just like that, we're back to square one.
*All identifiers have been changed to protect privacy.
My psychotherapy supervisor is a great teacher, somebody who can draw thoughts out of you that you didn't know existed. Today, I discovered that the idea of being a 'provider' taking care of a 'client' is not a comfortable one. I believe that a doctor patient relationship is much more than a provider-consumer relationship. My patients have a right to make their decisions and to be fully informed, but that does not diminish my responsibility towards them. With the malpractice risks, its more common to see physicians asking patients to take more and more responsibility for tough decisions, even when patients clearly say, 'I don't know. I want you to decide.' I've seen doctors shake their head and say, 'I can't make that decision for you'.
According to Dr. M, my supervisor, our roles change with every stage in life. From being dependent on our parents for every need to being independent to taking care children who are dependent on us. Until we fall sick. Then we regress, and start looking for somebody to take responsibility, and that's where the the physician steps in. While we have moved away from the classic paternal position of the physician, the 'position of greater responsibility', if you will, still lies with the physician. This is the psychodynamic perspective, and it may not work in every situation. But it works for me, no matter which side of the desk I'm on.
What works for you?
As an educational endeavor, our department is organizing movie nights every other week. People gather together to watch a movie related to mental health. There is food beforehand and a discussion afterwards. This is what we saw tonight.
Afterwards, we talked about Asperger's syndrome and teen angst and right and left brain hemispheres.
I'm still baffled.
Yesterday was the call from hell. I discharged two patients, saw seven in the ER, admitted five. Everything from drug-induced psychosis to schizophrenia to a stroke. ( The patient had a stroke. Call a neurologist. Do NOT call a psychiatrist to make your diagnosis for you, ER people.)
I worked non-stop for twenty hours straight. Then I went to bed.
And woke up three hours later to sign out to today's team.
Tomorrow, I have another twenty four hour call. Then I do house call for consults all next week, and consult call all through next weekend. Gah.
Hubby is on call today. I plan to sleep all day if I can.
I miss Vox...read all the neighborhood posts earlier this morning but could not think of decent comments to write.
Time to recharge my brain.
Running late for the morning research seminar, I have twenty minutes to see the new patient on the floor. Time enough, I think, as I walk in the door.
'Hi, I'm Dr. P, I'll be taking care of you while you're here on our unit.'
She asks for my credentials. I hand her my ID card.
'So, you're a resident.' She might have said vermin.
Uh oh. 'You'll be meeting a senior attending physician later. May I ask you a few questions?'
'Let me tell you something first. You are supposed to be a professional, but your behavior is not. You need to make better eye contact like I am making with you. You also need to stop jerking your head.'
So much for 'empathic' nodding. She goes on for the next five minutes, hard to interrupt.
I already have a diagnosis. Which is good, because she'd rather see a more professional doctor. Later, she tries to incite other patients to a non-compliance strike. Fortunately, her abrasive manner pushes them away. She plays the piano all day long and sings in the hallways. We spend a lot of time calming down other patients.
My attending offers to transfer her to another resident's care, but I can't let this one go. I go back the next day.
'You can be my doctor. I come from a good family. I can see that you are a genius, too. Amen.'
We bargain over medicines. She refuses the sedative she takes at home but agrees to take the mood stabilizer. I couldn't care less about the sedative; the battle is won.
Three days later, she's still grandiose and demanding. But its getting better.
[printed with permission, identifying details changed]
At Furious Seasons, Phillip Dawdy talked about the stabbing of a psychologist in NYC, going by the assumption that the murderer was a patient. That let loose a furore of protests/angry comments/anti-psychiatry posts. He followed with a post about the disturbing comments, generating more comments in turn.
Both the posts and the comments are variously informed, angry, mocking, bizarre, and quite a few are insightful. Recommended if you have an open mind and hard stomach (quite a few readers were angry/disappointed enough to stop following Dawdy, it seems.)
Judith Warner wrote an article on Overselling Overmedication. Phillip Dawdy posted a rather vitriolic post in response. She referred to Peter Kramer's review of Charles Barber's Comfortably Numb- How Psychiatry is Medicating a Nation. He returned to Barber's essay in Washington Post.
Interestingly, all these articles seem to make valid points. I find myself agreeing to parts of all, all of none.
- Medications help those who are sick.
- There are those who are not sick/do not need medications for their brand of sickness, but get medicated anyway.
- Medications have side effects.
- There is much more to recovery than just pills.
- Doctors and patients need to be more judicious in prescribing and taking of pills, respectively.
- America's mental health care system is all effed up.
Go read if thats what you want to do on a Saturday morning.
The New Jersey Law Journal published this story.
The plaintiffs are suing in federal court in Newark, N.J., on behalf of their minor children, who have been denied benefits by Horizon Blue Cross Blue Shield of New Jersey.
Horizon claims that the children’s online writings, as well as journal and diary entries, could shed light on the causes of the disorders, which determines the insurer’s responsibility for payment. New Jersey law requires coverage of mental illness only if it is biologically based.
Horizon claims the eating problems are not biologically based and that the writings could point to emotional causes. It contends that access to the writings is especially important because the court has barred taking the minors’ depositions.
How to protect your (and your family's ) health information.
-- via psychcentral.com
Hi. I'm a psychiatrist. Your doctors asked me to come by and see you.
Why? Do they think I'm crazy?
No..well, they wanted to see if we could talk about your alcohol use, and if we could help you in any way.
Hm.
So why are you here?
Pancreatitis.
And do you know what's causing the pancreatitis?
The drinking.
Hm..so what would you like to do about it?
Nothing.
Do you think quitting might help?
Yes, I guess.
Would you like to get better? Or is that something that doesn't matter right now?
Oh, hell yeah, I want to get better.
So, in order to get better..would you like to quit?
Not this time.
[ I'm so tired.]
