shutterstock_82606081 A disclaimer before I even get started on this post. Some of you who know me or work with me will think that by writing this post I am talking about you or even attacking you. I am not. If you’re especially sensitive, don’t read any further. I am simply writing something that has been kicking around in my head for a long ...

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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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Floor technician. Environmental technician. Life coach. Investment and retirement strategist. Facility safety coordinator. Interventional cardiologist. Cardiothoracic and vascular surgeon. Neurodevelopmental psychologist. Are we hiding behind out words? Worse yet, are we afraid to be who we really are? Maintenance man. Trash man. Knowledgeable and experienced friend. Salesman. Security guard. Doctor. Psychologist. I see it every day. Someone comes to me for a run-of-the-mill mental health problem, absolutely nothing to be ashamed of, and asks for help. For whatever reason, when we get to the social history ...

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She looked like a whipped puppy that had had a garden hose turned on it and slunk off to a far corner of the yard to dry out in the sun. She sat there, wizened but hard, thin and wiry, dressed in standard issue blue emergency room scrubs, thin tanned face, long stringy, wet prematurely gray hair falling limply around her shoulders. She looked down at the floor, but when her ...

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One good thing about doing anything for three decades or longer is that you get to see cycles and repeated events, things that fail and things that work. I hope that over the last thirty years of learning about psychiatry and mental health (and yes, I am still learning and hope to acquire that one last little piece of knowledge on my deathbed) that I have paid attention to the ...

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As a psychiatrist, I was trained to begin the mental status examination and overall assessment of my patient as soon as I greeted them in the waiting room. Even now, three decades after finishing medical school, I follow almost the same sequence of actions in my day-to-day interactions with my patients that I did as a resident in training. Granted, there are now electronic medical records and I rarely come ...

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We’re all waiting for something. As kids, we waited for the time that we could do it ourselves, go it alone, tie our own shoelaces, order our own food off the menu, take our baths by ourselves, and walk up and down the street or around the mall without parental supervision. We were kids. We didn’t yet have enough life experience or enough insight to realize that the time we occupied, ...

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I had had a long day yesterday, starting with a trip up the interstate to Columbia to meet with other medical chiefs from around the state of South Carolina to discuss the issues that affect the practice of psychiatry in the mental health system today. We had struggled with the electronic medical record, Medicare paybacks, e-prescribing, CPT coding, content of notes, billing time, and motivating our medical staffs to accept the ...

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shutterstock_145081756 I was a junior medical student, wearing a short white coat, pockets stuffed with reflex hammer and spiral bound Washington Manual of Therapeutics, rubber tourniquet and pens and pads. I was on a rotation out at the Dwight David Eisenhower Army Medical Center in Augusta, Georgia. DDEAMC was not too far from my home away from home, the Medical College of ...

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It happened out of the blue, as such experiences often do. I had parked my car and was walking a short distance from the public parking deck on a covered concrete sidewalk, past the open expanse of lawn and twinkling Christmas lights in front of the hospital. I was going to visit a friend who had just had surgery, and it had been quite some time since I had been in ...

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“I don’t get no respect!” -Rodney Dangerfield He was a little guy, munching on the taco lunch that his mother had brought into my office for him, his younger sister and herself. I was a little miffed, I won’t lie, that the family knew they had an appointment with me right after lunch, but they decided to make the appointment itself lunch. I tried to concentrate on my interview questions and assessment, shredded lettuce ...

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I have been visiting different sites and having staff meetings with different groups of clinicians since I came back to my psychiatric services chief job recently. I have noticed something that is very important to the smooth operation of a mental health center, and most likely any health care facility you might look at. In order to do the best job possible and help the most people who need us, we ...

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Once upon a time I saw a patient for followup, a woman I had seen for several visits in the past. She had voiced the usual oft-heard complaints about insomnia, changes in appetite, lack of energy, diminished interest in pleasurable activities, and other associated symptoms of chronic depression. Most of these had been addressed and had gotten at least partially better, to the point that her overall quality of life ...

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I love football. There is one thing that I absolutely believe to be true about the sport I love. Any given team can beat any other team on any given day. Sometimes my love of sports and the little metaphors that sprout from it spill over into my workspace as well. At the end of each shift I work in telepsychiatry, one of the last things I do is complete an electronic log of ...

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I received a very intriguing question the other day. “What happens when someone despicable, someone who has committed some horrible act or made some terrible decision, comes in for evaluation or treatment and you have to see them?” I have been asked to see child molesters of the worst kind, men (usually) who have done things so vile to children that it would make your stomach turn to hear about them. Having ...

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So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species? Is it the severity of psychotic illness? The rampant drug and alcohol use that starts now when kids are pre-adolescent? Is it the broken families that are producing another generation of children who ...

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“Yeah, Doc, I drink. I drink a lot. Some nights I drink a case of beer and a half pint. Can’t sleep if I don’t drink. Relaxes me. Pure and simple. Numbs me up like novocaine.” A toothless grin. “It’s the feeling of floating away. I don’t know, I just keep coming back to it. Stuff goes in, feel a little flushed, a little rush, then I go somewhere else, you know? ...

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I have been asked one question about my work in telepsychiatry more that any other, hands down. “Can you really help a mental health patient like that, through a television screen?” The quick and dirty answer? Yes, absolutely. The extended answer? Read on. Psychiatry is an intensely personal specialty. It requires knowing yourself as a doctor, as a therapist, as a consultant, and as a person more than any other kind of medical practice I ...

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It is tempting to use our sense of sight to make snap judgments about people, places and things. Think about it. When you walk into a restaurant, if you see a sparkling clean dining room, you probably assume that the kitchen looks the same and that the food will be prepared in a clean, safe environment. When you see a well-dressed pilot and crew walking onto an airplane that has been ...

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A commenter recently asked the other day about staging patients, especially mental health patients, in the hallways. This is sometimes done, along with triage and initial assessments, because of the very real lack of appropriate space in a busy, full emergency room. What do I mean by this? Well, as any of you know who have ever been to the ED for anything at all, once you get through the front ...

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