OpenNotes is “a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.”  According to their website, three million patients now have such access, generally online.  Participating institutions include the MD Anderson Cancer Center in Texas, Beth Israel Deaconess in Boston, Penn State Hershey Medical Group, Kaiser Permanente Northwest, and several others. Patients with a premium account in the My HealtheVet program at the VA have access to outpatient primary ...

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Somewhere late morning, after rounding on my first day of internship, I received a call from my sister. “She wants to kill herself. What do I do?” We had been through this before with our mother, fifteen years ago, the week I moved out of her house. She ended up in the psychiatric unit as we packed our bags to move in with our grandmother. This time, fifteen years later, things were ...

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At the recent gubernatorial candidates forum on mental health, Martha Coakley repeated the oft-heard phrase that depression is like diabetes. Her motivation was good, the idea being to reduce the stigma of mental illness, and to offer "parity" or equal insurance coverage, for mental and physical illness. However, I am concerned that this phrase, and its companion, "ADHD is like diabetes," will, in fact, have the exact opposite effect. A ...

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I am a great supporter of mental health research but worry that it has lost its sense of proportion and is chasing the wrong priorities. The really glamorous stuff consumes almost all of the enormous NIMH budget and now has behind it the huge addition of a $650-million private donation aimed at solving the genetics of mental illness. Neuroscience is an extremely easy sell to Congress and rich philanthropists because it promises ...

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It was with much distress that I read a New York Times front page article by Benedict Carey about the heart wrenching plight of the Serpico family in their journey to get proper psychiatric treatment for their two sons. As a child and adolescent psychiatrist who has served children and families for more than 30 years, trained many child psychiatrists, and served as president of the American Academy of ...

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Today, I celebrated mental health care.  And this was after a morning of battling with insurance companies, patching together community care plans, trying to create an inpatient bed for a suicidal patient where none exist, and arguing with agencies for better patient support. I work on a busy inpatient psychiatric unit that provides a daily reminder of the beauty, heartache, and pain that define living with mental illness.  The diverse stories of ...

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I recently read an interesting article in Glamour about why Zosia Mamet, an actress on HBO’s Girls, refuses to “lean in.”  While the column focuses on the influence of modern-day feminism on notions of professional success, her words resonated with me as a medical student and an aspiring psychiatrist.

“I have been incredibly blessed with success in my chosen career. I’ve worked my a** off and had the support and encouragement of ...

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For the better part of the last two decades I have practiced psychiatry in a variety of different American health care systems, and over these years I have, on numerous occasions, heard psychiatric services referred to in manner that imply (often subtly) that such services are not medical care.  These references come not only from patients, but nurses and doctors (including myself) too. “Yes Mr. Jones you need to follow up ...

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I am not strongly against the death penalty on principle or on moral grounds -- assuming, of course, that it could somehow be narrowly and efficiently restricted to a very few egregiously deserving and certainly guilty criminals. I don't even find it particularly appalling (or cruel and unusual) punishment that a killer may have some few minutes of physical discomfort before expiring during a clumsily administered execution. My experience as a ...

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The interview had lasted fifteen minutes so far, and we'd made minimal progress. I was a medical student doing a rotation at a physical medicine and rehabilitation clinic back in my home state, Wisconsin. It was the end of the day; to save time, the senior resident, Paul, had joined me in the exam room so that we could hear Leora's medical history together. A year earlier, Leora, in her mid-fifties, ...

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