I recently read a heart-wrenching series of reports on doctors not believing women.  I thought this sort of value judgment was outmoded, finding it hard to believe in this century and in this country. I have had at least a few experiences within the last year of patients who I sent back to the primary care physicians who referred them to me.  I simply felt that although the primary physicians had in every case told the patient it was “all in your head” and sent them to me for care, I had found signs indicative of physical illness and wanted them to have a further workup.

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“I don’t like other women.  They gossip.  I hate gossip.  I think they should all go pound sand.” No, it is not a patient who said this. It was my (Great-) aunt Etta, who wore her hair like “Bride of Frankenstein.” She had been militant about her disdain for “gossip,” and certainly wore a bitter expression on her face most of the time.  But she would not tell the little girl I was then any more of her story.

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“Happy families are all alike; each unhappy family is unhappy in its own way.”

So begins the novel Anna Karenina. However, if Leo Tolstoy tagged along with me when I’m summoned to come rescue a clinic with troubles, he would doubtless come up with a similar observation about happy clinical staff and unhappy clinical staff.

In my role as a consultant – spending a relatively brief amount of time in a clinic to help it get on track and solve problems – I see troubled staff and administrators.  Unfortunately, I’m not called in to observe happy clinics and partake of celebrations of success.

Each clinic has its unique challenges and problems.  And although they ARE problems, it’s the unique part that intrigues me.  After all, the problems are severe enough that they are willing to pay me to come untangle the mess. Read more on Surviving In The Society of Women…

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She was a woman in her early seventies. She looked tired, almost haggard, although neatly dressed.  She had obviously seen a lot of hardship in her life, but she wore it well.  She looked like someone you could trust, a “salt of the earth” kind of person.

It is unusual to see a senior come to a psychiatric clinic for the first time.  We see women of all ages, it is true; about 70% of the psychiatric patients in most average (not Department of Veterans Affairs) medical clinics are female.

Empty ChairShe had been referred by a general physician who could do nothing for her headaches.  He had wisely decided that starting her on any kind of potentially addictive painkiller was a very bad idea.

I took a detailed history.  It seemed that the headaches came on when her husband yelled at her or threatened her.  He did that often enough.  He was of some kind of northern European origin.  She had married him after the death of her first husband in an accident; her first husband had been her real love-match.  But she was a traditional housewife, who wanted to keep house more than anything in the world.

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