What defines a competent psychiatrist?  To staunch critics of the field, perhaps nothing.  Some believe psychiatry has done far more harm than good, or has never helped anyone, rendering moot the question of competency.  What defines a competent buffoon?  A skillful brute?  An adroit half-wit?  Having just finished Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, a reader might easily conclude that psychiatric competency is ...

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On my voice mail is a message from Donald Wyatt. He doesn't often call, but every Monday morning he comes to see me at the Louisville, Kentucky, mental health clinic where I'm a social worker. His message is brief: "I'm not feeling well, and I am planning a trip to either St. Louis or Elizabethtown." I smile, wondering at the odd pairing. Elizabethtown is a small city of 50,000 people. And, well, ...

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Our current health care system will fail; it’s simply a matter of time.  Yet the delivery of efficient, quality, and progressive health care is quite possible once we shift our thinking.   A true paradigm shift in medicine begins with first establishing that each pillar in health care has an equal responsibility in making a new system work:  patients, providers, and places (facilities). This article pertains to only the provider portion. As ...

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Whatever happened to “first, do no harm?” One of the findings included in a Senate investigative committee’s report on the U.S. government’s post-9/11 torture program was that it was designed by two psychologists.  They were paid “$80 million to develop torture tactics that were used against suspected terrorists in the wake of the September 11 attacks on the Pentagon and the World Trade Center” -- including “waterboarding and mock burial on some of ...

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Atul Gawande posted a series of tweets, based on findings in the Senate CIA torture report, about the significant role physicians and psychologists played in torture. He comments, “But the worst for me is to see the details of how doctors, psychologists, and others sworn to aid human beings made the torture possible.” Agreed. Upon reading how these professionals used their knowledge to torture their fellow human beings I felt disappointed, ...

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Tupperware-640x424 A letter received by Pamela Wible, MD. Dear Pamela: I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is ...

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shutterstock_160740506 It is estimated that approximately 14 percent of U.S. physicians in training are depressed and another 10 percent experience suicidal ideation.  Some 400 U.S. physicians take their own lives each year.  Hampering efforts to deal with such problems is the stigma associated with them.  I knew a top medical student who was reluctant to seek mental health care in part because ...

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Dr. Kenneth Azar, a mentor of mine at the old Georgia Regional Psychiatric Hospital in Augusta, Georgia, told me something once that has always stuck with me. He told me that in the early years of his practice, when he was living and working out in Idaho, that he was one of a very small handful of psychiatrists who served the whole state. If an adult with psychosis needed to be ...

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The recently released report, Shooting at Sandy Hook Elementary School, from Connecticut's Office of the Child Advocate offers a searing in-depth account of the holes in our mental health care system. The report is careful to point out that no causative link exists between their findings and the events at Sandy Hook. However, this in-depth investigation offers an opportunity, if we are able to hear and take action on its ...

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36 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 ...

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