Lucia Sommers of the department of family and community medicine at the University of California, San Francisco commented on my last post, noting that clinical uncertainty among primary care physicians (PCPs) is usually regarded as tolerable at best.  She was delighted that I called such uncertainty intellectually attractive, and something to embrace in psychiatry.  Sommers and her co-author John Launer recently published a book that argues for managing clinical uncertainty in primary care using ...

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Hitting rock bottom can change lives for the betterHitting rock bottom can change lives for the better An excerpt from Hope For Addiction: Help and Hope for Families of Those Struggling with Addiction. The law states that no one can be forced into treatment against their will unless they are at risk of harming themselves or others (this varies by state, but the laws are very similar ...

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From MedPage Today:

  1. Reaching Out to Smokers Boosts Quit Rates. Simply offering smoking cessation treatment proactively to all the smokers in a healthcare system meaningfully boosted the quit rate, a VA trial showed, while details emerged on provisions for coverage of such interventions in the Affordable Care Act (ACA).
  2. Lung Cancer Screening Versus Smoking Cessation? When the Medicare advisory panel voted against covering lung ...

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From MedPage Today:

  1. The 5 Big Surprises in Code Denials. An April 30th post on the Physicians Practice website, "5 Common Medical Practice Denials and Remedies: March 2014" has a nifty info-graphic which synthesizes Centers for Medicare and Medicaid Services (CMS) data from the month of March in 2014.
  2. Treat Car Crash Pain Early On, Lest It Linger. Widespread pain that persists a year ...

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After every mass murder, the question everyone asks is why it happened. How could anyone possibly be so violent, or so evil, or so out of control, or so crazy as to engage in the wholesale and indiscriminate killing of a bunch of people who are usually complete strangers? In some cases, there are longstanding preexisting warning signs: a history of mental illness, substance use, isolation and/or estrangement; the repeated experience ...

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A few years ago I wrote that uncertainty is inevitable in psychiatry.  We literally don’t know the pathogenesis of any psychiatric disorder.  Historically, when the etiology of abnormal behavior became known, the disease was no longer considered psychiatric.  Thus, neurosyphilis and myxedema went to internal medicine; seizures, multiple sclerosis, Parkinson’s, and many other formerly psychiatric conditions went to neurology; brain tumors and hemorrhages went to neurosurgery; and so forth. This leaves psychiatry ...

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This article is making the rounds among physicians on Twitter. Much of the information in the article, unfortunately, is accurate. For some of the reasons stated there, I left the “traditional” health care system and pursued work at the “fringe.” Part of this is due to my clinical interests: I like working at the intersections of different fields. For example, I like the intersection of psychiatry and hospital medicine, which is called 
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Sluggish cognitive tempo may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered. And I have seen some beauts during my forty years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by "experts" brim full with diagnostic exuberance -- sometimes well meaning, sometimes influenced by extensive drug company affiliations -- and always ungoverned by simple common sense, a respect for ...

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In my 30 years as a practicing psychologist, I’ve seen a lot of patients with many diagnoses. In that time, I’ve seen treatment approaches evolve.  Periodically, when news of a mass shooting makes the headlines, the dialogue about mental health will rise to the top of the national agenda, but -- in general -- we still have a long way to go in our attitudes toward mental illness. I think it’s ...

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From MedPage Today:

  1. Small Practices: Down but Not Out. Emily Briggs, MD, MPH, is all too familiar with the decline in small physician practices.
  2. IV Ketamine Rapidly Effective in PTSD. Patients with moderate to severe post-traumatic stress disorder (PTSD) symptoms showed rapid and substantial relief with a single intravenous dose of ketamine in a pilot randomized trial.
  3. Missed Doses Cripple Postop DVT ...

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