Nobody, but nobody, including a president of the United States, can tell a doctor what to ask about in an assessments.
Assessments are supposed to be in the strictest confidence, for openers. Anything else would be against the rules of medical confidentiality. Patients have a right to be seen alone. The doctor has a right to decide what needs to be said.
I can imagine the 2nd ammendment rights activists bursting a blood vessel if doctors are reqiured to survey patients about the guns they own and how they use them. The requirement to have doctors do this would be — most everyone will agree — anti-American.
This being said, a question about firearms is and should be standard psychiatric practice. When you are dealing with suicidal patients, which happens all too often in psychiatry, and the patient says that he or she is thinking about this, then it is absolutely essential to know if that
Filed under Government by on Jan 23rd, 2013. Comment. 
In this life, everything should be as simple as it is, but not simpler. That includes this questionnaire study about marijuana as an “exit” drug for substance abuse. This article hit a nerve because there are issues here I have come up against before. And I mean “against.” I don’t mean to say it isn’t “good science;” it is. I’m talking about the emotional resistance to the idea that detoxifying from a medication can be comfortable, painless, and effective. I see this coming like I see the sun rising in the morning, because I have been to this place. A few years ago, I found myself in an informal banquet room across the parking lot from a hotel type establishment in a touristy part of San Diego. There was a woman rep from the drug company, Hythiam. She wasn’t an ex beauty queen like most reps, but a fairly credentialed therapist who actually knew what she was talking about. My husband was there with me; a younger, chubbier, and more naïve me – therefore, less authoritative.
These Hythiem/Prometa folks had a great schedule of IVs that removed physiological cravings for various substances of abuse, including methamphetamine. Basically, they use safe and older type drugs intravenously for a lovely pharmacological intervention. The cravings stop, and the person does not “need” to use the drug. Neither they nor I was stupid and naive enough to think that was all you had to do. Aftercare was important and I was ready to jump in. They recommended vitamins — I recommended lots of vitamins, high dose, and chelated to cross the blood-brain barrier. But these addicted folks needed “prosthetic lives.” When all you can muster goes to satisfying a craving or a need, there are not many hours left in the day for work or relationships. I helped with this, too. Some people had problems, but they were mostly because of the psychosocial void left when they did not go for drugs, and their inability to fill it. I worked my damnedest with these folks; and like the company, was eager to be accepted into the addiction community. There was this reception, and they had invited people from every substance abuse program in town. I was there and ready to go to bat as the only physician who had experience with these folks locally. Two people showed up. One was an older, fatherly type. The other was a young sidekick who was presumably learning from him. This older guy said something that rings in my ears now. “You got to earn your sobriety.” Read more on Time to Stop Judging and Start Healing…
Filed under medicine, News, Substance Abuse by on Jan 4th, 2013. Comment.
My husband and I don’t have children – much less “tweens” – but even I know who Hannah Montana is.
Okay. I only have a little idea about what is going on in this specialized world except when some of the women with whom I tend to associate (the mental health field is almost all women) told me that their little daughters loved Hannah Montana. But I would have to be Helen Keller not to see her image on blankets and jewelry and plastic stuff the exact nature of which is unidentifiable to me, and to hear her recordings in public places where they blare so-called “popular” music indiscriminately.
This should be understandable.
I will admit I had to look up the information that Miley Cyrus plays Hannah Montana on a Disney network TV show that has all the tweens twittering or tweeting or whatever. Read more on Hanna Montana Gets High — And Tweens Follow…
Filed under Celebrities by on Dec 21st, 2010. Comment.
My husband told me something that I thought was a joke, but he convinced me it was serious.
During “drive-time” he heard an advertisement for a medical marijuana dispensary on the radio. Among the many conditions it promoted marijuana as helping was eating disorders.
My thoughts went immediately to stoners with the midnight munchies making an emergency run to 7-11 for Cheetos or the late-night drive through at Burger King. Read more on Standardizing and Regulating Medical Marijuana — Who Are We Doing It For?…
Filed under medicine, News, Research, Substance Abuse by on Dec 10th, 2010. Comment.
Okay, I have this vivid memory of sitting with a bunch of colleagues in a doctors’ lounge in Beauvais, France, trying to figure out why we had inflicted upon ourselves the punishment of studying medicine and then practicing it for a living. There were a couple of guys who wanted to be missionaries; really religious folk. Others discussed the exalted status of the doctor in the community, the money that went with it, etc. When it came to a choice of specialty, there was a lot of discussion, even then and even in France, about the difficulty of the studies, of developing a practice, of making a living. Rarely there was a feeling of passion. This was viewed as naive. I remember a woman who wanted to go into oral surgery because she believed that the human spirit was lodged in the teeth (Really). A woman who wanted to be a cancer doctor because her mother had died of cancer far too young. And there was me, the “brain freak,” granted there was a Jewish idea of public service and healing humanity. But my passion for the brain was (and is) real. How it works and what it does to behavior are things I find passionately consuming as well as sacred. Some of the French doctors laughed; others just smiled. I guess they figured I would grow out of it.
As I write this, I am wearing a heart-shaped wristwatch, with a picture of a sagittal section of the human brain. Read more on “Marijuana Doctors”…
Filed under medicine, News by on Nov 10th, 2010. Comment.
He was 50 and he told me right up front, “I need more of the medications the other doctors give me. You can just renew them for me; that is why I am here.”
That’s probably the second most common thing a patient says to me. The most common is, “Why didn’t my other doctors tell me that?” No, I don’t just renew prescriptions, I explained to him. I told him that I need to get to know my patients, so that I can make sure that I give them the correct medications.
“I don’t want you to do that,” he said to me. “All the other doctors just give me renewals.” I told him I didn’t much care, that was not how I worked, and if he wanted renewals he would have to tell me how he was doing. Read more on Self-Medicating On Pot And Booze As A Life Plan…
Filed under Substance Abuse by on Sep 14th, 2010. Comment.
It seems that the first television advertisement for medical marijuana has hit the California airwaves without a whimper. The first TV commercial just ran on a Sacramento station.
Having experience in many clinics from the Oregon border to the Mexican border, I can confirm that in most of California, medical marijuana is commonplace. It does not seem to be tremendously difficult to obtain, and I have attended many patients have valid prescriptions for it.
There is a list of conditions for which it is alleged to help, which is as long as your arm. Hearing about these conditions where cannabis is the preferred treatment usually causes me to smile, and I suspect that the list continues to grow with each new patient who wishes to use this remedy. Read more on Marijuana–The Only Drug Without FDA Approval…
Filed under Alternative Medicine by on Sep 10th, 2010. Comment.