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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"Most EDs do not have separate secure areas in which psychiatric patients can be held. They typically don’t have a psychiatrist immediately available to evaluate the patient and provide guidance on management, and they do not have extra nursing staff to monitor often unpredictable patients.” This was a comment on one of my blog posts. Well, we have been talking about the way psychiatric patients get to the ED and ...

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Recently, Dr. Mike Sevilla decided to hang up his podcasting mic, his blogging tools, his Twitter creds, and his Facebook presence, all in one fell swoop. Find out more about Mike the man, and why he decided to take this drastic action, at his website. Now, I have known Mike for some time on Twitter primarily, where we will sometimes comment back and forth about issues of the day ...

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“Well then, if you won’t prescribe the Xanax for me, I guess I’ll just have to get it off the street.” “If you send me home, I promise you’ll be reading about me in the obituaries tomorrow.” “I’m in terrible pain. You have to treat me. You have to give me narcotics. If you don’t, I’ll call the state medical board and report you.” I hate to be manipulated. Hate. It. There is a certain ...

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There was the time I was hugging a trashcan in the lobby of the community hospital ED just a few blocks from my house. Not because I have a molded plastic fetish or because I like the smell of trash, mind you. I had an itinerant renal calculus, otherwise known as a kidney stone that was moving through my urinary system. It. Hurt. Like. Hell. I. Wanted. To. Die. I was throwing up ...

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Okay, so this morning I want you to think about something with me. I want you to be honest, as honest as you can, as I will be with you too. Deal? We can’t move forward until you agree. Right. What do you feel when you’re driving along, you come to the next busy intersection, stop for the red light, and see that homeless guy? You know the very one I’m talking ...

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The ED is a hectic place. Sore throats. Heart attacks. Dog bites. Broken bones. Strokes. Major trauma. If you work in an ED, you see it all. And then some. Is it any wonder then, with the potential for literally thousands of medical and surgical problems to stumble through the doors of an ED, that hospitals and the bodies that accredit them demand strict, regimented, standard, reproducible emergency assessments ...

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shutterstock_69074263 It is hard to see a child in pain. I have seen quite a few children in the emergency departments of South Carolina in the past three years, more than I could have imagined just a while ago. Now, in the interest of full disclosure, I am not a child psychiatrist by trade. Like any general psychiatrist, my training provided me with didactic ...

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So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room at the door that has a small chicken-wire reinforced tempered glass windowlette in it and is ajar just enough to let you see the shiny black shoe of the security ...

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We doctors who specialize in psychiatry have a sacred trust. We are given the opportunity to talk to people who are hurting every day, people who trust that we will listen to them, try to understand them, not laugh at them, and not think that they are stupid, crazy, or horrible. A tall order, granted, given that we hear stories that sometimes border on the unimaginable, bizarre and otherworldly. This ...

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It was a simple enough store front. Unassuming, paint chipping a little but a clean parking lot outside the low one story building. I went in and walked down the rickety ramp, then sat down on a hard-backed wooden chair next to a tired, worn couch with a hideous print and stuffing peeking out of the ripped seams at the front end of both arms. She was in the office ...

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These days, the world is a very scary place. You go to school. You go to school some more if you can afford it and you feel so inclined. Then, if you’re one of the really crazy ones like me, you go to school some more. Somewhere in that late night caffeine and chili cheese fries induced sophomoronic (no, do not adjust your set) craziness, something starts to click. At least ...

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I am guilty of neglect. I’ll admit it. I’ll own it. I’ll embrace it. When I am doing a consult now for one of many hospital emergency rooms, I am sent a pretty standard package of history, nurses notes, doctor’s assessment, physical exam report, lab results and other information that I review prior to actually seeing the patient on the screen and doing my own assessment. Now, on a day like today, ...

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He was just a kid. Fifteen I think, something like that, too young to have experienced too much in life at that point, but old enough to die by his own hand. His father, only a year and change older than me, had already dealt with some issues of his own. Diabetes, a member of his family on both sides for generations, had already taken its toll on him by the time ...

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I am so glad that I’m only a partially conflicted, semi-neurotic, intermittently confused middle-aged psychiatrist. It would be so much harder to be a young guy, just coming out of residency, trying to decide what to do and how and where to do it. The stress! When I finished training, career paths were relatively easy to research, vet, and decide upon. You could go into private practice, in a group or ...

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Years. Years of learning that the smallest details of a patient’s life can be the most compelling and important part of their story. Years of listening to to tales of love, anger, and loss until the patterns become less daunting and more obvious. Years of hearing things that are so bizarre, so far-fetched, so on the fringe of humanity that nothing surprises anymore, but everything still fascinates unceasingly. Years of trying every new thing ...

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You know the headlines. You read them and hear them and see them every day. Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage. A family including mother and young children in a van are ...

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"51-year old female presents today with ..." Funny, the vast majority of my clinical notes last week began with that phrase, give or take a year or two. Women in their fifties who saw me in the clinic, who I spoke to via television in my telepsychiatry practice, or who I interacted with in some other way. It struck me as odd that so many women of similar age came to ...

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