The practice of medicine has changed enormously in just the last few years.  While the upcoming implementation of the Affordable Care Act promises even further—and more dramatic—change, one topic which has received little popular attention is the question of exactly who provides medical services.  Throughout medicine, physicians (i.e., those with MD or DO degrees) are being replaced by others, whenever possible, in an attempt to cut costs and improve access ...

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Much of the debate over the future edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has centered on what disorders will be added, modified or dropped. But lost in the discussion is a change that will align disorders along a developmental continuum—one that looks at them across the lifespan. This shift will provide clinicians with a critical perspective that until now has been missing. Historically, disorders were classified ...

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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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Bath salts are a relatively new group of designer drugs sold as tablets, capsules, or powder and purchased in places such as tobacco and convenience stores, gas stations, head shops, and the Internet. They are stimulants that mimic cocaine, lysergic acid diethylamide (LSD), methamphetamine, or methylenedioxymethamphetamine (ecstasy). According to a recent article in the Journal of Psychosocial Nursing, the most common bath salts are MDPV, mephedrone, and methylone. These drugs cause ...

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An article in the New York Times recently described the increasing use of stimulant medications such as Adderall and Ritalin among high-school students.  Titled “The Risky Rise of the Good-Grade Pill,” the article discussed how 15 to 40 percent of students, competing for straight-As and spots in elite colleges, use stimulants for an extra “edge,” regardless of whether they actually have ADHD. I’ve written about ADHD.  It’s a real ...

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Going to the doctor can be confusing.  Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors.  While I think it's wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask.  There is nothing specific ...

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When asked what makes for good patient care in medicine, a typical answer is that it should be “patient-centered.”  Sure, “evidence-based medicine” and expert clinical guidelines are helpful, but they only serve as the scientific foundation upon which we base our individualized treatment decisions.  What’s more important is how a disorder manifests in the patient and the treatments he or she is most likely to respond to (based on genetics, ...

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“What about combined psychiatry-family medicine-neurology-internal medicine programs?  Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?” Every April, I field such questions from a slew of rising fourth year students who have become, to their surprise (and sometimes dismay), passionately interested in psychiatry. Psychiatry is a shortage specialty and psychiatric issues rank high among the challenges facing medical care systems here and around the world. For ...

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I recently attended my first AA meeting. It surpassed many of my expectations; however it ruined others and left me slightly dumbfounded. My imagination, with the help of television and movies, painted a picture in my mind of what an AA meeting would be like. It portrayed a room filled with people that obviously looked like addicts; unkempt appearances, borderline offensive hygiene, and at least one person emitting a radiance of ...

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All kinds of behaviors can have an effect on your weight, and the solution to each is different. Maybe portion size is your biggest issue. Maybe it’s hard to get moving, even though you know you need to get some exercise. Maybe you have a sweet tooth that you can’t shake. Maybe you’re completely stressed out, and you never get a decent night’s sleep. Maybe you are a nighttime snacker. Or ...

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Two weeks had passed before I learned what happened. I hadn’t seen him in several months. At our last meeting, the trees were full of red and orange leaves. He, as usual, was not interested in talking to me. He was sitting in front of a closed shop. “Hi. How are you?” “Fine.” People in the neighborhood took care of him. Surrounding him were several plastic bags holding neatly stacked styrofoam containers filled with soup. ...

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For anyone in the helping professions, compassion fatigue is a common occurrence and a clear signal to take better care of your own needs. Compassion fatigue is when you find yourself challenged to care about your patients in the way you know is proper and expected in your position. One of the key components of quality healthcare is the ability for you to connect with your patients and for them to ...

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My psych final was this morning, which I am 90% confident I did well enough on to pass the class (which is all I need to be satisfied).  Considering I counted watching “Girl, Interrupted” as studying, I say that’s not too bad. I felt like there were many necessary topics left out of our behavioral medicine and psychiatry course.  One of the many: sexual assault. For the past eight years I have ...

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“Um—Hi there, I’m a, uh, you know.  Medical student. First year. For, you know, the Patient-Doctor—err, Patient-Physician course—” The nurse smiled and turned to a woman of shorter stature with bony, scrunched- up shoulders. “Mary, do you want this first year to interview you?” Mary was about to set foot in the lounge when she heard this. She let out a sigh and faced me. Her eyes looked worn; I could tell ...

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I keynoted at a conference a few weeks ago. As usual, as the date approached I felt the pressure intensify. It’s much better than when I first started public speaking years ago. For my very first paid speech, which was in front of several hundred people, I shook for the three months leading up to it – some days when I got really worked up it was actually a challenge ...

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The first time I met Tom his head was on the table at the Christmas banquet held by the mental health support program where I worked. He was sitting next to his wife, who worked on the staff. Tom’s alcoholism soon brought him into the program, fractured his marriage, and I became his first case manager. The alcoholism had roots in childhood abuse.  Years of drinking followed, with hospitalizations, chaos and ...

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As most of the electrophysiology (EP) community is aware, device and lead recalls are a reality in today’s EP practice. In the last 5 years, both Medtronic and St. Jude Medical have had significant lead failure issues. The public responses to these recalls have been varied and quite different. As physicians who care for device patients, we must learn to quickly sort through the rhetoric put forth in the New ...

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Even though I love my job, I’ve been feeling a little burned out lately. I think it comes from being stretched too thin, which is something I’ve coped with off an on ever since med school. As the saying goes, there are never enough hours in the day, and sometimes that really gets to me. While my practice is incredibly important, I also place a lot of value on my family. ...

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The healthcare needs and challenges presented by the nation’s returning veterans are complex and critical. That’s not news to all, yet not all clinicians realize how close and relevant the issues actually are.  More than half of all returning veterans are treated outside of the military healthcare system and the VA, which means community-based clinicians are on the front lines of care delivery to veterans. Very often, this also now means that ...

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According to an article entitled, Binge Drinking Common Among Adults, "about one in every six U.S. adults binges on alcohol." According to the article, "binge drinking -- defined as at least four drinks in one sitting for women and five drinks for men -- carries substantial risks and high costs. It accounts for more than half of the estimated 80,000 annual deaths and three-quarters of the $223.5 billion in economic ...

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