Monday, July 02, 2007

My Three Shrinks Podcast 27: Shrinks On The Take

[26] . . . [27] . . . [28] . . . [All]
Back in Dinah's back yard today. For our U.S. readers, please have a safe July 4.
And if you live in France, the UK, Canada, Cuba, or Guantanamo Bay, Dinah wants your comments on her post about Michael Moore's Sicko. Okay, okay, citizens of other countries are welcome to comment, too!

July 1, 2007: #27 Shrinks On The Take

Topics include:

  • Doctor Anonymous has new Podcast, where he talks about chatty doctors, nursing home patients, and discovers BlogTalk Radio (similar to TalkShoe).

  • Vermont Shrinks Rolling in Pharma Dough. The New York Times reported on doctors who get money from drug companies, finding that in Vermont the #1 specialty to cash in is Psychiatry. Vermont has a law requiring the reporting of such income, and the story misleading suggests that the average Vermont psychiatrist gets $45,000 from drug companies. Closer reading shows that there were 11 psychiatrists who received an average of $45,000. Still. What are they getting paid for? Here's some insight from a #2 specialty: Endocrinologists. A US Senator has suggested that all such income get reported, just like they have to do (makes sense to me).

  • Zyprexa Class Action Lawsuit for Fraudulent Marketing Zips Ahead. CL Psych informs us that a judge is allowing this suit to go forwards, based on allegations that Lilly engaged in fraudulent marketing of Zyprexa for unapproved uses. See also the March FDA Drugs for an FDA warning against Provigil. We launch into a wider discussion about off-label prescribing and combination medications. Listen to find out the #1 prescribed drug which is FDA-approved for bipolar depression (hint: it's not an SSRI).

  • Doctors Who Talk Too Much. The Archives of Internal Medicine has an article by McDaniel et al., which has been in the news. They sent fake patients into participating physician offices over the course of a year and recorded the interactions, categorizing the utterances in various ways. One-third of the visits contained physician "self-disclosures" (talking about themselves), with 85% of these not being useful. It doesn't seem that they asked the pretend patients how useful these discussions were. I view the study's conclusions with suspicion. I would like to see compliance rates and outcome measures compared between a group of patients whose physicians self-disclose and one whose physicians do not (ideally, assignment would be randomized, and a physician would have patients in both groups).

  • Q&A: Can you have a mental disorder and still become a mental health professional? Listen in as we address this question from a listener.
The song at the end is called "Talk Talk," by the group, Talk Talk. You can get it at iTunes.

Find show notes with links at: The address to send us your Q&A's is there, as well.

This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from
Thank you for listening.


Anonymous said...

I meant to say something about this the last podcast but forgot.

I think you should keep podcasting outside, no reason to waste the beautiful weather.

I just wonder if it's possible (I don't know anything about audio production) to turn down/off whatever is filtering out low-volume noise? There's a lot of background noise and birds, but only when you guys speak. I think it would be less distracting if it was continuous.

Midwife with a Knife said...

I enjoyed the podcast, as usual.

My only problem was that the volume seemed to vary. Roy was very easy to hear, but at times, Dinah and Clink were really hard to hear.

DrivingMissMolly said...

I agree with MWAK, but enjoyed the podcast nevertheless, as well as the birds and Max.

I have to say, my GP doesn't talk at length to me about himself. After over 13 years, I know very little about him.

Right after my mother died (I was on a cruise with hubby and had to fly home from Cozumel to take Mom off life support and to be with the rest of the family), he told me that he got the news his Dad died while he (doc) was at his 40th birthday party at at a restaurant. I found this helpful because it helped me see that these things just happen, irrespective of where and when.

I hope that made sense. I have had trouble expressing myself lately.


sophizo said...

I agree with everyone so far. Outside is nice except when you get sirens and loud animal noises. Also, I had to have my volume on full blast to hear Dinah or Clink which made Roy's voice sound like thunder. Not very fun to hear such a contrast in sound.

I did like the content and your bantering back and forth about these topics (though I still think Dinah doesn't talk nearly as much as Roy and clink!). Keep up the good work and have a safe July 4th!

Sarebear said...

Dinah's gonna be tickled by that last, I think!

Yeah, I had to have Roy booming to hear the two ladies as well.

I was tickled and delighted to hear a fitting use of my bad nose-phone pun! Since all cell phones have cameras these days anyway. Thanks for noticing and remembering, Clink!

It was fun to hear Max's input.

Sarebear said...

Oh, on that one patient/actor - it brings new meaning to "Taking one for the team", or, "he took the news sitting down" (I guess he was laying, butt . . . . .)

That patient was the butt of many jokes, among his fellow actors, I'd guess.

(I kid you not, the word verify here was cmjjkgut)

Midwife with a Knife said...

I did find it hillarious that one of the standarized patients ended up getting a flex sig. I would have 'fessed up long before that!

Anonymous said...

Can one of you comment on this?
OCD can make you feel like a weirdo and so I hid it through most of my treatment b/c it wasn’t to bad, even though I didn’t expect my therapist to judge me for it. When I finally brought it up I was somewhat shocked when my therapist said she too had it, but insisted it was well under control, except in situations she doesn’t encounter much where she’ll sometimes carry out a mental compulsion. She mentioned I should add paxil to my wellbutrin, and I said I thought I heard about alot of paxil withdrawal problems, and she said “yeah I went thru that”. (She rarely talks abour herself, tho I do know her husbands job/personality and they have two young sons. This only came up when she was trying to build common ground-my personality is like her husbands I guess. None of it bothers or distracts me tho).
Though I was shocked and though her main issue was religious obsessions while mine were compulsions I felt really relieved and unselfconsious afterward. I guess even though I know you are trained to not judge, I think ocd is a hard thing to understand unless you have it and have actually felt that repetitive irrational doubt and those maddening urges- even I think supernatural obsessions are hard to understand-but since I knew she knew the feeling and it I think it helped a ton

Still what do you think of mental health professionals who admit to their patients a shared mental illness, or what medications they were on? Does it also depend on the illness?

Roy said...

anon-yes, I find that fuzzy sound in the background when we speak annoying, too. You are right--if I leave it in continuously, the brain will adjust to it and screen it out much better than GarageBand does. I will give it a go.

As for the volumes [sigh] I even had the mic away from me and smack in front of the fairer shrinks, and still no joy. You two are on notice... if you don't sit closer or speak up, we are getting lapel mics! (We'll do a fundraiser... BTW, whomever it was that gave us $10 last month, THANK YOU!)

Ladyk73 said...

Thanks for answering my question regarding the diagnosed mental health provider.

I decided to go from my masters in social work, because I wanted to be an advocate, and a case worker for the hardest to treat.

Last fall, I had a significant attempt to end my life, and I was committed (involuntary) to an inpatient ward for a little over a week. While there...I observed, and "got" what was happening around me. Bored of coloring, I thought alot about what my fellow "inmates"...really needed.

Since then...I have been diagnoised as bipolar II. I am not better yet, and know that this will be lifelong.

I had reservations about doing clinical work. SERIOUS ones. I became close to a psychologist at the Psy center, where I volunteered, who knew my history (I had to confess, as some of my "peers" had since been admitted there). He encouraged me, against my resistance, to do clinical social work.

The degree takes two years (and I have already taken classes non-matriculated). I hope that by the time I graduate, I will be standing on solid emotional ground.

Thanks for your input.

Your Mother said...

I loved the phrase "self-disclosing cardinal."

I'll never listen to birdsong quite the same way again. :-)

Gerbil said...

re: mental health providers with their own history--this is a topic which is near and dear to my own heart. It was much easier for me to come out as lesbian in my training program than to come out as someone with her own "stuff."

I would not have chosen my clinical specialty if not for my personal experience. I couldn't imagine doing professional presentations without self-disclosure; and I've never had anyone react negatively.

However, I don't think any my "stuff" (nearly all of which is truly past history) has ever been a liability for me. In fact, though I can count on one hand the number of times I've overtly self-disclosed the "stuff" to a client, I can't begin to count the number of times a client has said to me, "You know, you're the first therapist I've had who really gets it."

While I was still a heavily-medicated college student, my psychiatrist told me he had designs for me to go to med school instead of grad school. I pointed out that I was barely about to stay awake in class, so I doubted I'd make it through residency. He maintained that I would still make an awesome psychiatrist because of the "been there, done that" factor. (Obviously, I didn't take his advice!)

One final note--I think that the idea that mental health professionals must themselves be mentally healthy is self-perpetuating. If no one self-discloses for fear of being considered unfit to practice (regardless of actual fitness to practice), then nothing will ever change. Three words: Kay Redfield Jamison.