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. 
The psychological ability to adjust to chronic medical illness is an area where there has been very little study. Lately, I find myself working mostly with this population of people. I’m noticing that some adjust very well and some do it very poorly. It depends on a lot of factors.
The situation is clearest when the illness we’re talking about is back or neck pain. Back pain, more than neck pain, has been clearly correlated to the presence of major depression. If a person walks into the office crying and says they’re having trouble controlling what’s going on, it’s a pretty sure bet we’re dealing with depression.
Most back pain patients aren’t prepared for the kinds of life adjustments they are required to make. Generally, many will need to switch from a job that has involved lifting or other physical work to a job that is more sedentary. Quite honestly, most back pain patients are in no way prepared to do this. Mostly, this is because anything that is sedentary is going to require a higher level of education. Most of the folks I’m seeing are not highly educated, so the back pain leads to incapacity. Read more on Adjusting to Medical Illness…
Filed under depression, Diagnosis, Disease, Doctors, medicine, Mental Illness by on Nov 5th, 2012. Comment.
I enjoy having friends, like just about everyone does. But that’s not why I’m in this business. When a patient needs help, I will do my best for them every single time. And if a few colleagues get bruised egos along the way, so be it.
She was a 53-year-old woman, but I don’t think she even would have liked to hear me to refer to her as a woman. We’re talking about someone who was short and stout and wore the kind of cap one would expect to see on a newsboy during World War I. She wore a very male looking zipper jacket, and told me she had the name of the other woman to whom she had dedicated her life tattooed on the back of her neck.
Regardless of all this, her face was red and she was crying. She told me she was chronically suicidal and never thought about anything else. Despite being medicated, her depression seemed to have gotten worse. Read more on What is there to Treat?…
Filed under Diagnosis, Disease, Doctors, medicine, News, Psychiatrists, Psychotherapy by on Oct 2nd, 2012. Comment.
All right — I am married to a man I love and I dearly love my profession. So how could a “boy she has it all” woman like me possibly get depressed?
Mine didn’t look exactly like the criteria laid out in the DSM-IV. I mean, I am not going to sit around for two weeks feeling this way just so I can meet criteria. But other than the two-week bit — I was depressed. I did not want to do much of anything except cry. I could not believe the negative thoughts creeping into my consciousness and I was having a hell of a time pushing them out. I felt sleepy, listless, the whole nine yards.
I did not prescribe myself an antidepressant. I do not think that anybody really believes at this point that a congenital lack of antidepressant has made anybody depressed — ever. Read more on Things to Consider Before Reaching for Antidepressants…
Filed under depression by on Jun 14th, 2012. Comment.
Wouldn’t it be fun to just sit in front of the TV all day and watch your favorite shows?
Actually, it’s pretty darn depressing. Anyway, that’s what I have noticed, and now it’s official.
I cannot begin to guess the number of people I have diagnosed as depressed who watch television all day. I’ve noticed it for a long time, and part of my standard examination is to find out what people do with their daily lives.
Short answer – couch potato.
Most of the time these folks aren’t actually trying to change their lives or get better. This isn’t just a simple, “Oh, I gotta catch Jerry Springer!” or “Oprah is supposed to be good today!” Read more on TV And Depression…
Filed under depression, News by on Nov 25th, 2011. Comment.
Down the hall she came making sounds of distress and physical effort. When she got to my door, it didn’t get any easier. She had to push her way through the narrow doorway, one of those doors designed for thinner people of years past.
I saw a wildly obese 23 year old, with suicidal ideation, who told me her life was worthless. Doctors had found a rare uterine cancer and done a total hysterectomy. She was told that she could have no hormone replacement. So she was dealing with some symptomatic treatments of hot flashes that weren’t doing very much.
I was pretty much impressed by the doctors who had made a rare save. She seemed to be cancer-free now, although she was not “crazy” about the abdominal wall hernia repair that had been necessary to hold her stomach together. Also, she was not enthusiastic about the bimonthly pap smears. But she was alive, and granted, she could not have hormone replacement. She sat in front of me telling me all about how the doctors had taken care of her.
She was crying and depressed. It was not hard to figure out why.
“I will never have children. I will never be a mommy.” Read more on What Can You Do With Your Life?…
Filed under Self-esteem by on Nov 8th, 2011. Comment.
Number 5 in the USA Today catalog of medical changes in the past 25 years is (imagine a drum roll playing – and CYMBAL CRASH!) — antidepressants are the most popular drugs. Read more on Antidepressants Are Popular — And Dangerous…
Filed under medicine, News, prescription drugs by on Sep 9th, 2011. Comment.
The next person to see me made a dramatic entrance. First, she had gotten a head start on her crying in the waiting room. But more than the sound of her crying and sobbing, she could barely make it through the waiting room door. I am no good at guessing someone’s weight. She later admitted to being 380 pounds. I took her word, as our clinic’s scale only went to 300. Her general appearance was that she was swollen with water – a human sponge. The edema bloated every part of her body, and her crying eyes were nearly swollen shut. I started by asking her when her problems began. She was now 42, and said she had thought everything was okay until age 15, when she had been raped by a “friend of the family.” This man was not really a friend, he was a person who went to the same church. Moreover, he was a Sunday school teacher. You would think that by now everyone would know that being a Sunday school teacher does not make someone a saint. But this family had not yet figured it out. In many such cases, this type of person is shielded by the religious community, and even the victim’s parents are often in denial. This woman was lucky. Her parents told her that they were going to prosecute this sinner to the extent of the law.
There was a trial, and she had testified. She thought everything had turned out great, and so did her parents. The rapist was convicted and sent to jail. Again, those who are experienced in these things know that this type of trauma is never over quite so easily. The woman went on with her life and ended up in a really abusive relationship — the kind where someone locks you up and won’t let you leave the house and beats you if you look out the window. By the time she got the courage to escape this living hell and seek a shelter, had a peck of kids. They lived in this shelter for over a year before she found that she had what it takes to start over. She went to school, gained some clerical skills, and started over. She was actually doing pretty well until something happened that triggered a demon she didn’t know had possessed her. She was called for jury duty and went, with pride, wanting to do her civic duty. She couldn’t. She had a panic attack as soon as she entered the courtroom. She ran to the ladies’ room, threw up, and tried to enter the courtroom again – and it was even worse. People thought she was having a heart attack, and they sent an ambulance for her. I do not recommend this means of getting out of jury duty, although it sure worked for her. Read more on Murphy’s Law Of Medicine At Work…
Filed under depression, Diagnosis, Doctors, prescription drugs by on Aug 17th, 2011. Comment.
I had a patient once, long ago and far away, who was the worst “Caffeine Fiend” – properly known as “caffeinism” in medical lingo — I had ever heard of.
He was only 27 but depression and obesity added ten or fifteen years to his appearance. He was single and did not have much of a social life, but he did not much care. He was one of the earlier generation of people to build himself a career doing something with computers, with some sort of techie abilities which I could not understand at all. That enabled him to work from home at least part of the time, and only occasionally would he have to make a mad run to and from his employers’ office. This was in rural northern California, somewhat removed from the Silicon Valley mainstream of this type of activity.
The “from” part was important, as he did not much like to hang around with other humans, much preferring the company of his computer. Read more on Tale Of A Caffeine Fiend…
Filed under depression, Diagnosis, eating disorders, Stimulants, weight by on Jun 16th, 2011. Comment.
Although I had been offered some academic scholarships after a pretty distinguished high school career, my parents had a great ritual. After formally declining them, I had to save and overlap (and trim) all of the letters and put them in a frame for the living room wall.
The idea of actually accepting one of them — they were all pretty far from the greater Boston area where we lived — never even came up. As a precocious over-achiever, I had skipped a couple of grades and was only 15. They told me I was too young to even think about such fantasies as going to a university.
I’m glad that I had parents that loved me so much and worried about my well-being. But gee whiz – I don’t think Doogie Houser had over-protective parents.
Anyway, it was two against one, and I was still a minor and financially dependent upon them. There was a non-negligible scholarship, a work study program, and numerous considerations from one of Boston’s fine local universities. My mother dropped me off at classes and picked me up, since student parking was both expensive and difficult to get.
Of course I never really “felt” like a freshman. I managed, with some difficulty, to convince my mother to either drop me off early or pick me up late. I needed to meet colleagues. All I really cared about academically were the necessary prerequisites for medical school, in terms of courses or grades, but I knew I was in the middle of a rich, seething subculture of the youthful.
There were some activities I would never be a part of, like dating the football team or being a member of a sorority. Types like me did not do those things. But I was so fascinated by large number of people whose age was somewhere near mine. I walked up to them and shook hands and said “hello,” whether they sat on the stoop in front of the chemistry building or in the television lounge at the Student Union. Read more on Student Stresses Are Mental As Well As Financial…
Filed under Stress by on Apr 14th, 2011. Comment.