Physician suicide 101: Secrets, lies and solutions This article adapted from a lecture presented by Pamela Wible, MD, at the 2014 American Academy of Family Physicians Scientific Assembly in Washington DC. Why did you go to medical school? I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I’m unhappy with the direction ...

Read more...

Every time there is a terrorist act or a mass murder, reporters start calling with questions on the psychiatric diagnosis of the perp. The default position seems to be that every religious extremist or political fanatic or mass murderer must be crazy. How else to account for their weird behavior? Naming a diagnosis somehow satisfies a deep human need to explain what otherwise seems an unexplainable act. But names can only ...

Read more...

While studying for my recertification exam as required by the American Board of Pediatrics, I came across this question:

 A 7-year-old girl is having difficulty establishing relationships with other children despite repeated opportunities to do so. The girl prefers to stay near her mother or her teacher and will avoid other children. She sometimes cries and can be difficult to calm down after being dropped off at school, so her mother frequently remains ...

Read more...

After the latest school shooting, social media accounts should be monitored In the wake of the latest school shooting in the state of Washington, much attention has been paid to the shooter’s (Jaylen Fryberg’s) Twitter account. In fact, after a school shooting, social media sites are typically the first place that people go to learn about the assailant. While this is understandable, one has to wonder if any of these school shootings ...

Read more...

There will never be any compromise acceptable to the die hard defenders of psychiatry or to its most fanatic critics. Some inflexible psychiatrists are blind biological reductionists who assume that genes are destiny and that there is a pill for every problem. Some inflexible anti-psychiatrists are blind ideologues who see only the limits and harms of mental health treatment, not its necessity or any of its benefits. I have spent a good deal ...

Read more...

Before the Internet age, people with excessive and irrational worries about their health (we called them “hypochondriacs”) went to their doctors for reassurance. Today these patients still schedule appointment -- often with exasperating frequency -- with their primary care physicians when they’re concerned about an unusual lump or vague symptom. But most likely they’ll have first consulted WebMD or the Mayo Clinic website and come up with a differential diagnosis of their ...

Read more...

Suicide puts the medical profession in a difficult position Recently, I wrote about the importance (and difficulty) of maintaining a healthy lifestyle as a resident. Now, I’d like focus more specifically on the toll that residency -- and in general, a career in medicine -- takes on a health care provider’s mind and soul. As you may have heard, in August two young physicians decided to end their lives. No one can ...

Read more...

Lesson learned: Not everyone is crazyLesson learned: Not everyone is crazy An excerpt from The Spattered White Coat: Intense experiences which formed a young doctor. I'll never forget one of the first patients I interviewed. When I went to get him, I could see him sitting in the waiting room, looking around and scratching his arms repeatedly. He was a very ...

Read more...

Polypharmacy, or use of multiple psychiatric drugs, for treatment of attention deficit hyperactivity disorder (ADHD) is on the rise. A recent study compared treatment with basic therapy (stimulants plus parent training) with augmented therapy (those two plus risperidone, an atypical antipsychotic). The study concluded that treatment with risperidone was superior. When children show dramatic improvements in behavior on risperidone, now being prescribed with increasing frequency for ADHD and a range ...

Read more...

Please don’t call call me a “prescriber.” Yes, I know it’s easier to say “prescriber” than “psychiatric nurse practitioner or psychiatrist.” The word “prescriber,” however, puts severe limits on what I can do and how I can help. You may believe that, because I have a license to prescribe medications, that’s all I choose to do. In fact, you may believe that’s all I know how to do. Psychiatrists can do a lot more than that. As ...

Read more...

26 Pages