She was an active patient, who I am still trying to see once a week until I direct her in how to survive and flourish in the universe. She was in her forties, depressed and anxious.  She had “a little panic attack,” some chest pain and the feeling her breath was cut off. I wasted no time sending her to an Emergency Room, (or, if she really did not feel it was that bad, to an Urgent Care — what we used to call it a “doc in a box”) because it is cheaper, sounds less foreboding, and any doctor who is sentient and has a pulse and is on duty would send her to an Emergency Room if anything was really wrong.

Chest pain or tightness or shortness of breath or a “tight feeling, like a vice” could always be a heart problem, and could always be life threatening until proven otherwise.  I tend to send  even the most mild discomforts of this nature, that people had for years to primary physicians for a “cardiocentric examination.”  For “auscultation,” the old fashioned Latin-origin word for a good listening to the well as generally an electrocardiogram and sometimes even an echocardiogram.

Read more on Don’t Ignore Chest Pain…


Sleep is a complex function.  it is not just biological, but also psychological and social. Your “daily residue;” everything that happened at work or whatever that day, combines with past traumas (which may have been dragged around since childhood) to create what may be disturbing dreams. Read more on Ways I Get Patients Off Of Sleeping Pills…

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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…


97 million Americans with chronic pain and I got a 57 year old screamer in a wheelchair. Back pain, leg pain, pain in places she was not sure of. No, psychiatrists are not supposed to give out morphine.  Yes, I know I have a prescription pad.  But I keep it close to my heart, locked in my file cabinet, or in my purse, because I actually enjoy practicing medicine and do not enjoy the vision of my license certificate on wings on its way out the window. Even if I could have done it fearlessly, I would not have increased her pain medicine.  The more you give, the more they hurt, the more they need.  This is written in a lot of places but you only have to look at the patients who have been created into addicts, and there are plenty of them.

Alternative recommended approach nobody will listen to: A Bryn Mawr college student, apparently not loaded down with clinical cynicism or even clinical experience, came up with this one.

The way it is said is brilliant.  We all act as if we had a pool of attention, and the more of it we place on something that is not pain, the less pain we feel. Experiments cited go from virtual reality to guided imagery to music. Read more on Down With Pain…

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