Doctors

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He was just 18. He had been followed by child psychiatry with a diagnosis of depression. He had long refused to take any pills.  As far as this poor, agricultural county was concerned, I was just seeing him so I could bill MediCal and fatten up the county coffers. The previous psychiatrists had simply noted he was depressed, was not suicidal, and refused any participation in his own treatment.

He was a young man of few words, with a common Hispanic name.  He sat there and twirled one of his lush curls. It became pretty obvious he wasn’t going to give me a complete history.  He said he would never take pills, not ever. To his credit, he did say I could talk to his mother, if I wanted to, but he had to be in the room and hear what she said. Someone brought her to me, from the waiting room.  She spoke only Spanish; fine with me. I learned my Spanish mostly from my patients, who in that time and place could rarely communicate well in either Spanish or English. His mother was charming, really grateful that I wanted to talk to her. She kept complimenting my clothes and elegance. I told her it was all thrift shop.  I doubt she believed me. Read more on Diagnosis From The Guts…

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My telephone was cradled between my left ear and my shoulder, as I pounded the keyboard of the sluggish rural county computer with one of the requisite patient visit fill-in-the-blanks atrocities — er, I mean “reports.” Finally, I heard the person I was waiting for pick up the other end.
“Hello,” I said. “Is this doctor A…….(name unpronounceable to native speakers of English)?”
-“Yes,” he answered, “I am the only doctor here.”
“This is Doctor Goldstein. I am one of the psychiatrists at the county mental health clinic.”
-“Really? And you call me?” Read more on The County Mental Health Clinic’s Referral…

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One of the themes that keeps coming up in those little “newslets” for 15 minutes of Continuing Medical Education each is that systematic screening for several serious diseases, like cancers, is simply not as efficient as one wishes it were. At the very least, in terms of cost, it rarely pays. Sometimes people try to identify a subset of people who should be screened; but all too often, even that is a daunting task.

Some stalwart and doubtless realistic physicians sometimes suggest–screen patients who ask for it. This seems strikingly similar to the young doctor in Amiens who told me, that if he wanted to build a practice and feed his family, he had to give everyone antibiotics. It is that ancient trend of anti-intellectualism, patients who second-guess the doctor, people who are worried about their health– And yet, these people could argue that (they have paid their health insurance and earned what they think is good care), and they are individuals and not statistics. Read more on When To Screen For Things Medical That Could Kill…

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If I haven’t convinced everyone yet, I don’t know how.

I have written on this before.

Vaccination keeps kids alive.  Kids who could die dead as door nails from preventable diseases.

Vaccination has very few side effects. Read more on We Can Fix This Vaccination Bit…

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I grew up with the Reader’s Digest, although I do not think that was what my parents had in mind.

I was a very early reader. I had the activity pretty much nailed by the time I was three. I could even do phonetic “sounding out” of words, as well as the obsessional “dictionary searching” that I now do on line. I also had an obsessional interest in books intended for “bigs.”

The Reader’s Digest, to which my parents had some kind of a lifetime subscription or something, was consistently to be found on top of my mother’s bedside table — which had actually been her old “hope chest.”  I would “borrow” the current copy of the Reader’s Digest in the morning when they were still asleep, and generally return it before they would wake.

I will admit I had promised them to ask about anything I did not understand, but I have no memory of ever having to do so. Read more on Facial Diagnosis…

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My preceptor in child psychiatry at the University of Kansas (Wichita) was easily the most respected psychiatrist in the region. Former chief of the residency training program, he was not at all the fanatically-publishing academic type I would find in psychiatric departments elsewhere.

He was eminently practical. Nearing retirement and clearly at the top of his game, he was known to be someone who really did straighten out troubled kids.

Me, there were times he gently chided me because of my theoretical and academic concerns which were not always of practical use. Read more on Responsibility for Veterans…

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Many years ago, Paul J. Fink, M.D. was head of the American Psychiatric association, and made a remark in a speech which I have never forgotten, although I can’t find the text of the original speech.

He said something to the effect that prostitution and psychiatry had the same problem — the amateurs think they are as good as the professionals.

I can’t give any kind of a reasonable assessment of how this would apply to professional prostitutes.  It seems to me as if there is a tremendous amount of information available to anyone who seeks it with assiduity.  Besides, I am unaware of structured training, university degrees, or licensure or any kind of proof of skill for professional prostitutes.

As for psychiatrists, I am constantly amazed by how many people are unaware of what we really do.  Misinformation abounds in the media, films especially. Read more on Leave Medical Comments Out Of Politics…

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Huffing

Whatever job I take, my husband says I basically function as a teacher.  There probably is some truth in this, and I seem to be forever reminding people that the verb “doceo,” the Latin verb “to teach,” is the word that the English language word “doctor” comes from.

Most of us doctors have little time for the teaching function.  This is not exactly what insurance pays for.  The internet is an explosion of information that absolutely dwarfs the ancient library at Alexandria.  Although I wish more people would be more aggressive about finding and using that information, I understand there is so much information that people don’t know who to believe.

That is the place where people should bombard their doctors with information they want clarified. Read more on Huffing…

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We are in an era when all reporting — wire services, networks, whatever — looks the way tabloid reporting did when I was small.  Aggressive, emotional, mostly verbal renderings of disasters that are meant to strike terror into the heart of the reader.  Sometimes, something miraculous or near miraculous.  Once in a while in this constellation of stories there is something “inspiring.” We all need inspiration.  It is tough to define and highly individualistic.

I actually like this definition more than others: That “feeling of enthusiasm” that makes you “do” or “create” something. Read more on We All Need Inspiration — Here Is Today’s Dose…

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I am an expert on this — Anti-overweight discrimination.

First, from my practice.  I remember a woman in her forties I saw in Oklahoma for a routine antidepressant renewal who told me that she had a cardiac condition and had been to her primary physician (this is back in the prehistoric days when I took insurance) and he had told me it was her own fault she was overweight and she was risking her life by doing nothing about it.

She was not suicidal.  She told me she would never see that doctor again.  And she was not going to take any heart medicine. Read more on Anti-Obesity Discrimination and Obesity Treatment…