Diagnosis

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It is a sad fact of modern life that it takes tragedy to bring important information to the notice of the general public.  In this case – the death of a young person participating in sports. Read more on Sports Dangers Are Too Often Revealed In Tragedy…

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I Am A Doctor, But I Don’t Play One On TV

Personality-wise, the cranky and inconsiderate title character of the hit TV series House, MD are mirror opposites.  I actually LIKE people – especially people who need help (patients).

Obviously many people enjoy this series, since it is one of the highest rated. But for me, the challenge is to out-diagnose him.

In case you’ve never watched, the formula for each episode is a seemingly straight-forward illness, which (of course) is the wrong diagnosis.  The rest of the show is slapping another diagnosis on the patient, and testing the patient, which makes the patient worse.  Read more on Being Locked-In May Not Be So Bad For Everybody…

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If this is the first time you’re reading my blog – Welcome!

If not, you know that I’m … ummm … mature and that I’ve been restless enough to study many branches of medicine.

My current credential is in psychiatry, and like Rodney Dangerfield, we shrinks “Don’t get no respect.” Read more on Researchers Are Short-Sighted When Looking At Data…

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After studying in several institutions of higher learning in several nations, I always feel strange when I learn something from television.  Especially network daytime television.

When my husband attended elementary school in rural Kansas, he tells me that the school nurse checked the kids for head lice. In mine, in suburban Boston Massachusetts, it would have taken the school nurse a whole year.  So in third grade, when I happened to be in public school for a little bit, my humongously obese but friendly schoolteacher checked the whole class and found two kids out of about thirty and sent them to the nurse.  Me, she told me to brush my hair a lot because my curly frizz got tangled. Read more on Killing Head Lice With An (Expensive) Sledge Hammer…

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Recent research by the Centers for Disease Control and Prevention’s National Center for Health Statistics has confirmed a longstanding trend — namely that whites live longer than blacks pretty much consistently, and have for a long time. People have attributed this to the increased difficulty of containing blood pressure in black people — probably a genetic difficulty– which leads to increased rates of both stroke and of heart disease. Both have long been established as being deadly. Plenty of well meaning people have at least tried to deal with this. One of the well-meaning people is me. Many times I have seen people of color for other reasons, checked their blood pressure, been concerned, and referred them to appropriate blood pressure followup by general medical personnel. Of course, I have no way of knowing how many (if any) went where I told them, but I tried.  

I mean, I would tell them, “If there is something extra that can be done to make sure you are around for a  few more years, to see the grandchildren grow a bit or whatever is precious, then it should be done.”   I usually have no problem getting the person to agree, at least in my presence. Menthol cigarettes are a different kind of issue, and therefore a little tougher to be unequivocal about. Read more on Ban Menthols? Our Government To The Rescue!…

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THE PLACE: Medical school, France
THE TIME: 1975

I have survived the “concours,” a competitive examination that I would compare to an intellectual equivalent of “American Gladiators” and through human dissection, the anatomical study of a human who previously walked the Earth.

An Accurate Diagnosis Is The Basis Of All Treatment

An Accurate Diagnosis Is The Basis Of All Treatment

Now our class is now going to start doing medicine with real, live people.
The excitement is great on our first day of an immense multispecialty class that will take the year, called “Semiologie.” The best English equivalent I can think of is “diagnostic signs.” We each receive notebooks and documents throughout the year that are signed off on by professorial-level clinical teachers who are doctors and have practices.

Read more on Nothing Happens If The Diagnosis Is Wrong…

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“I wants me some of them-there antidepressant pills.”

He was a 47 year old good old boy of the sort I had treated in Oklahoma and other rural parts west –a real cowboy. He had herded animals and done the rodeo and all of that.

No, he had never seen a psychiatrist before, ever.  He had been out crying on the front porch, and it was a next door neighbor who had somehow convinced him that there were medications and he did not have to tell his whole life story to get pills. Well, maybe that would work with a general practitioner, but he was not only disappointed but also angry that it was plainly NOT going to work with me. Figuring he had been had, he broke down and told me the story.  I could understand at once why he had been reluctant to get into this, for we went through half a box of Kleenex while he gave me a plot that was worthy of a tear-jerky country song. Read more on A Cowboy’s Lesson — Antidepressants Won’t Work Well With Alcohol…

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Mostly everyone who knows me knows I love performance of “funny” things, had a brief run as a stand-up comic, all of that.  But once when I told one of the nurses who I had been working with that I wanted to learn more about “clowning” — meaning classic clowning, costume, makeup, like at the circus — it was plain from her facial reaction that I had struck terror into her. She stammered, “I hope you are not going to do any of that stuff here. I am really scared of clowns.  I ran away from one when I was little and clowns still make me really uncomfortable.” Of course I told her I would not do anything that could scare her. I have to admit this affliction was unknown to me in the world of psychiatry.  I guess it just isn’t anything anybody would come in and request treatment for, at least not yet.  I suppose they would just avoid circuses.

They call it coulrophobia, and it is allegedly ranked among the top ten most common specific phobias by somebody, although I certainly could not find it in any such list.  I have never seen a patient who came in with this one as the chief complaint, which means people probably see some kind of non-medication prescribing health professional if they see anyone at all.  I mean you can find people on the street or among your friends who are uncomfortable around something — fear of spiders or fear of open spaces. Those are far more likely to be in the top ten.
Read more on Fear of Clowns…

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My weakness for the “classical arts,” in a world where “beats” pass for music and random words pass for poetry, is known to anybody who knows me. There are a couple of people who discuss classical arts with me in secret, at work or play. Like the opera “Carmen.”  I think it is the favorite of a lot of people.  Even though it was written in French by Georges Bizet, the use of traditional Spanish musical songs and dances gives it more snappy tunes than even George M. Cohan could cram into one show.

I was minding my own business and singing the habanera to myself. “For love is like a gypsy child/ who has grown up without any rules…”

I told a counterpart in my own profession. “Carmen is a model to all Spanish borderline personality disorders.  A perfect model.” Read more on Borderlines In Song And Story…

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She was 28 and pretty and sweet and came in for depression.  It was only systematic questioning that confirmed she was manic-depressive. Actually her next-door neighbor had seen a television show on manic-depression and had made the diagnosis a couple of years before, long before this woman had ever seen a psychiatrist.  Her episodes had curiously enough been regarded more as amusing than as dangerous, so nobody had ever done anything about treatment.

By the time I knew anything about her, she had already had one child, and was pregnant with her second.I always believe in coordinating forces with the obstetrician/gynecologist when caring for a pregnant woman.I rarely get phone calls returned, but this is the way it should be, especially if someone has brought up the question of psychotropic drugs. She had never seen a doctor; her first child, and this one, had been delivered by a nurse practitioner midwife. The one thing I am absolutely sure this woman did better than any physician (except me) is answer phone calls. She was obviously thumbing through the old chart on the other end of the line when she told me: “After the birth of her last child she ran after her husband with a kitchen knife.  She destroyed a bunch of stuff in the house.  We did not know whether or not to believe the husband.  After all, he had a serious history of drug abuse.  They were sent to counseling; there is nothing more in the notes.”

It took all I had to keep from yelling into the phone at the top of my lungs. Read more on “Postpartum Psychosis”…

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