Diagnosis

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I was at a Midwestern medical center, taking internal referrals.  The referring physician was a medical doctor I had never heard of.  Of course, there was no information about why a 70 year old grandmotherly woman with white hair and a surprisingly pleasant smile had been referred.

She told me she had headaches.  She was very happy that she did not have one on that day.  They were horrible and even an emergency room injection of narcotics did not do anything for them once they started.  They were variable, sometimes brief and sometimes lasting a whole day.  They could be on either side, or both, but most often cut a line from above one ear to above the other ear.  They were getting worse and quickly.

One of the smartest things anyone ever told me (It was an ancient professor in France, who was so experienced he had to say smart things once in a while) was that if a patient could not be diagnosed, or did not make any sense, just spend more time with the patient and get more history.  He said that very often patients knew exactly why they had the problems they had. Read more on Unconventional Cure — Leave The Headache Behind…

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He was a new patient to a community clinic.  They warned me to be careful with this 48 year old, thinking he was “really crazy, schizophrenic or something.”  The social worker had tried to do the intake and told me he was confusing, “not your average bear.” Strangely enough, most of my female staff already had told me they were attracted to him; an unusual state of affairs.

I was struck first by his clothes and demeanor.  A little like Michael Douglas as Gordon Gekko.

This is not usually what new patients look like, schizophrenic or not, when they come in. No wonder the front desk staff already had a crush on him (“sigh!”).  We didn’t get men in designer suits in these parts. Read more on Otherwise, The Patient Was Normal…

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One of my special shrink magazines had a story headlined: “DUI offenses may signal untreated Bipolar Illness” in the November 2009 issue.

Since you have to sign up for a free account to read the article, and since they prefer you be a mental health professional, I’ll just tell you about it.

I don’t think you have to have twenty years of medical school and psychiatry training to reach the conclusion that anyone who has DUIs — especially a bunch of DUIs — should be screened for bipolar disorder.  This radical conclusion was reached by Dr. Mark J. Albanese of Harvard Medical School and his colleagues report. Read more on Dual Diagnosis — Two Ways To Describe One Thing…

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I looked at her, better dressed than most of the folks at the clinic where she was seen, with an open mouth.  I had to take a few extra minutes to figure out what I was going to say next.  In case you have not guessed, that is pretty far from my usual state.

“I have a chemical imbalance,” she said.  She looked a little like Sharon Osbourne, hip and trendy but expensively dressed.  “He gave me some medicines that really helped, like Xanax and Ativan, and either of those would be just fine.”

Medicate

I freely admit that psychiatric diagnosis and treatment have a long way to go to meet either the organic precision of the surgical specialties or the subjective enthusiasm of the non-prescribing mental health professionals, such as psychologists or psychotherapists.  But there are practitioners out there who are either so indifferent or so pressured that they rattle off words without meaning and give prescriptions that hinder more than help.

Read more on Chemical Imbalance — A Mythical Diagnosis…

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