Polypharmacy was once the exception in psychiatry; now it seems to have become the rule. Patients frequently are taking 3, 4, even 5 psych meds at one time. And often it’s primary care doctors, not psychiatrists, who are doing the prescribing -- usually without adequate training in psychiatry. Some polypharmacy is rational -- e.g., a patient with bipolar disorder who receives the combination of antidepressant and mood stabilizer. But most polypharmacy is ...

Read more...

Psychiatry was my first clinical rotation, and I did not know what to expect when I began. When I initially got assigned to the dialectal behavioral therapy (DBT) team, I had no clue what that would entail beyond working with some borderline patients and that the preconception of borderline patients is that they can be “the most difficult” patients to help due to their intense emotional instability, chronic feelings of ...

Read more...

I’m looking at a pile of little boy clothes outside my back door this morning. It often looks like this if we forget to clean up. My kids shed their clothes almost as soon as they are home in search of water play of some sort: hose on the slide, sprinklers, water gun fights. They are supposed to put their clothes in the hamper. That obviously doesn’t always happen. This ...

Read more...

Benjamin, Jr. was the apple of their eye. He was cute and inquisitive, and smart. Very, very smart. The minute he took his first breath into this world, his mom and dad had already ordained him as a future MD. He would become a doctor and follow in his father's steps. No questions asked. He would become the second MD in the family. Every birthday, his parties were doctor-themed: kiddie ...

Read more...

I grew up thinking an “illness” was either a fever or croup. Illness was a stuffy nose -- a sick day, an excuse to miss a day of school. At 18 years old, “illness” took on an entirely different meaning. Illness meant waking up from a coma, learning that my stomach exploded, I had no digestive system, and I was to be stabilized with IV nutrition until surgeons could figure ...

Read more...

A primary care physician named Ashley Maltz recently discussed advantages and disadvantages of a cash-based practice. I appreciate her evenhanded tone: She prefers this model yet expressed concern for patients who can’t use it. In the comments section, several physicians extolled the virtues of cash-pay, but patients were mixed. It’s attractive for those who can afford it, while it worries, and maybe angers, those who can’t. I enjoy the personal and patient benefits of a mostly cash-pay psychiatric practice (I ...

Read more...

One of the episodes of the Walking Dead was titled “JSS.” In this brutal episode, one learned by the end of the show that one of the characters, then others after her, had learned that all they could expect to do for the moment was JSS, or just survive somehow. I met a patient recently who embodied that mantra. Small, petite, with stringy hair and sun-browned skin, she did not look the ...

Read more...

This past month I had the opportunity to present at a medical conference; my research topic was burnout and depression in osteopathic family medicine residents. A variety of attending physicians and residents stopped by my poster, excited to see this topic being brought to light. With the recent rise in physician dissatisfaction and suicide, there has been increased attention to finally start addressing this issue. I was super excited about giving ...

Read more...

Again and again in therapy I find myself emphasizing the distinction between feeling an emotion and acting on it. Many patients, and non-patients too, take undue responsibility for their emotions, as though feelings were volitional behaviors, the result of a choice.  Often there is a stated or implied should: “I should feel this, not that.”  Note how commonly people blame themselves for feeling, or not feeling, a certain emotion: “I should be more grateful after all she’s done for me.” “It’s wrong of ...

Read more...

Mental health issues are something I’m passionate about and have a lot of experience with, both professionally and personally. One of the biggest lessons I’ve learned over the years is how complicated and broken our mental health system is. When one or even multiple parts aren’t functioning at their highest level, we end up with a fractured system and patients falling through the cracks. One chasm in our mental health care ...

Read more...

38 Pages

Most Popular