Happy Mother's Day to All

A Cry for Help

When Roy and I were on Talk of the Nation this past week, a called phoned in to ask about her sister. The question was about care in the Emergency Room/Department, so it was a perfect Roy question and he fielded it. I've been playing with it since, and wanted to talk more about this particular scenario, because the scenario was very common, and the question was more complicated than it seems.

From the transcript of the show:

ANN (Caller): Hi, thank you very much. I would like to ask Dr. Roy (oh, I gave him his blog name here) a question: My sister was admitted to emergency when she cut her wrists, and the doctor on call pulled me aside and said, do you think she was trying to kill herself?

And I said - because my sister is very intelligent - I said, if my sister really wanted to kill herself, she would have done it. I think she's asking for help.

And so he said - and so he had her see the psychiatrist who was on call, or on duty. And she spoke with him for a while. And he sent her home, saying: Well, if you need me, I'm here.

What I would like to ask Dr. Roy is, what protocol was going on there? Why did they allow that to happen? And what would you change, if you could?

----
Roy did a great job touching on issues of voluntary versus involuntary hospitalization and the importance of hooking someone who is looking for help in to outpatient care.

If this were more of a two-way conversation, I'd want to ask more questions. What did the caller think should have happened? Was the sister given a referral for outpatient care? Was she asked if she wanted one? Was she already in treatment? My sense --and I could easily be wrong-- was that the caller thought the patient should be admitted to the hospital. She was desperate and ready now for help. The doctor asked the sister if she thought the patient wanted to commit suicide; hopefully the patient was asked that as well.

So if the caller thought her sister should have been hospitalized, there are things about the 'system' she isn't aware of. Hospital inpatient units are a place that people go to be kept safe. In many ways, they are a holding place and the goals there do not include treatment back to wellness, but treatment back to safety. It's a very low bar, and it ends up that only those who are imminently dangerous, or so disorganized as to be at risk, get admitted from an ER. There are some exceptions: if the ER doc doesn't believe a patient who says he's not suicidal/homicidal, he may err on the side of safety and admit the patient, or if the patient's behavior seems unpredictable, he may get admitted. At a community hospital, a typical length of stay is only a few days, very little actual psychotherapy occurs in the hospital, and while medications may be started, people are generally discharged before those medications can take effect or even be brought to steady-state levels. Gone are the days of long-term hospitalizations. And because of the acuity of illness in those people who are admitted to the hospital, psychiatric inpatient units are often not very restful places. If you want peace and quiet, you're better off in a hotel where you can order room service, have a massage, sleep peacefully, and it costs a whole lot less.

Sometimes people are admitted to specialty units where more intensive treatment does take place which may take longer and may have a goal that goes beyond imminent safety. There are special mood disorder units, eating disorder services, pain units, trauma disorder services, or inpatient stays for ECT...but one doesn't typically get admitted to these from the Emergency Room and often issues of payment limit who can be admitted and for how long. Of course, there is Clink's favorite place, The Retreat, where you can get help in a very pleasant environment, and I imagine they would be happy to have the sister of the caller from the radio, but that is self-pay.

"Getting help" usually means going to an outpatient therapist/psychiatrist and it's not something that necessarily gets started while the moment is ripe. If there is a clinic associated with the hospital, they may have emergency slots for the ER to offer fast appointments, but other times, it can take many weeks to get a first appointment. Private practice varies a good deal-- I know shrinks who can get you in within the week, and others with a 6 week wait, and many who are simply too booked to take new patients.

I didn't write these rules, I'm just letting you know what they are. How do you think it should all work?

Our Book That Was...Then Wasn't....

The official "pub date" on our Shrink Rap book is June 1st. It's a nice date. It's been moved back a couple of times....there was that incident where Roy's hard drive exploded with the index on it that threw things off just a little. Then there's the timing about how it takes about a month from the time the books come in to the warehouse until they get to the store shelves. I guess Harry Potter gets a more precise "pub moment." Amazon, we were told, has it's own release date, based on when the books get to them.

On Friday, we were excited to see that Amazon listed the book as "in stock" with a May 4th delivery date! If you ordered then, it went, no "wait...wait...wait." This was exciting as it meant we could tell people the book was "out." The copy I ordered back in January arrived on Tuesday. So last night, I take a look at Amazon, and the after days of 'only 3 left in stock'..."only 20 left in stock"...up and down with no rhyme or reason-- they are now sold out. Not available now, ships in 1 to 3 weeks. Two days and they sold out? I wonder if they sold one to the person who went on after our NPR interview and gave the book a one-star review on May 4th because it "Sounds like more drug promotion" with no indication that he ever read it. And you wonder why I'm tired of being dissed.

Okay, so Barnes and Noble online still has Shrink Rap, same low price of $12.92.

Here's what the publisher and editorial reviewers have to say about our book. Please note that the "hugely popular" designation was not ours!

Editorial Reviews

Review

One of the most useful books I've read about mental illnesses -- and as the father of a son with a severe mental disorder, I've read just about all of them. It demystifies our complicated medical and legal system, explaining everything from 'chemical imbalances' to involuntary commitment procedures to the most recent advances in brain mapping. If you have a mental disorder, love someone who has one, or are a doctor, therapist, social worker, lawyer, judge, or criminal justice professional, you need to read this book.

(Pete Earley, New York Times bestselling author of CRAZY: A Father's Search through America's Mental Health Madness )

In the too-often confusing and fractured world of mental health services, Shrink Rap is a ready resource for patients and their families looking for more insight into the range of services available and how they are delivered.

(Keith Ablow, M.D., psychiatrist, Fox News contributor, and coauthor of The 7: Seven Wonders to Change Your Life )

Product Description

Finally, a book that explains everything you ever wanted to know about psychiatry!

In Shrink Rap, three psychiatrists from different specialties provide frank answers to questions such as:

• What is psychotherapy, how does it work, and why don't all psychiatrists do it?• When are medications helpful?• What happens on a psychiatric unit?• Can Prozac make people suicidal?• Why do many doctors not like Xanax?• Why do we have an insanity defense?• Why do people confess to crimes they didn't commit?

Based on the authors' hugely popular blog and podcast series, this book is for patients and everyone else who is curious about how psychiatrists work. Using compelling patient vignettes, Shrink Rap explains how psychiatrists think about and address the problems they encounter, from the mundane (how much to charge) to the controversial (involuntary hospitalization). The authors face the field's shortcomings head-on, revealing what other doctors may not admit about practicing psychiatry.

Candid and humorous, Shrink Rap gives a closeup view of psychiatry, peering into technology, treatments, and the business of the field. If you've ever wondered how psychiatry really works, let the Shrink Rappers explain.

Our Fifteen Minutes of Fame!

Can I tell you about our interview on NPR?

If you'd like to read about it on NPR's website or listen to the interview: Click HERE

So the story starts before today. We're shrinks, bloggers, not seasoned media folks, and so it was pretty exciting a couple of months ago when Kathy, the wonder publicist at the Hopkins Press told us that Talk of the Nation wanted to have us on! Only not ClinkShrink because the call in format doesn't allow for more than two guests, and they could use her at another time for a forensic story. Roy and I chatted, Clink chimed in with all sorts of good suggestions from her years of testifying in court and teaching newbie forensics folk to testify, and Kathy wanted to meet to give us some pointers. There were approximately 243 emails involved. And when we met with Kathy last week, she did let us know that if we messed this up, our book-related interviews were finish. Not that I was feeling any pressure, which always mixes well with that pre-interview anxiety.

I picked Roy up at his hospital. I did this because it was on the way and there was no other way to be sure that Roy would make it on time and that I wouldn't have a heart attack if he didn't show up. We got to Washington early and obsessed about where to park, finally opting to park in the NPR building. There were all these people lined up outside waiting for Popsicles from a truck, which we later learned was in honor of the 40th anniversary of All Things Considered. There were no Shrink Rap Popsicles involved, but in the car, I did hand Roy a 'good luck duck.' I have a whole box of them, in case you ever need any.

So we sign in and we're meeted-and-greeted and escorted to a room where we can listen to the radio, wait, and be nervous. We talk about the characters in our book---we'd been warned they might want to mention them, and I had skimmed the book because these people aren't real, they were just vehicles to make all the facts more palatable. Everyone had hated them but me, but even I had forgotten who was who and who did what, and I'm not sure that Roy ever really knew.

Another gentleman joined us. He looked famous, but what do I know. I asked him his name. Peter Bergen. He looked at me like I'd just popped out of a cave and I figured he was famous so I mumbled about how I'm missing a pop culture gene. What are you here to talk about, I asked. I guess that was a really dumb question, because in the last two days, Roy and I may have been the only people in the world on the radio not talking about this. "Osama bin Laden," he said. Right. He asked us why we were there and we told him we'd written about psychiatry. What's it about? We both tripped over our words and had no real clue what our book was about. Funny, but when I got home tonight, my husband was watching that same Peter guy on CNN! Amazing.

So Mr. Bergen goes off to meet Neal Conan, we listen to him on the radio, and we scramble to figure out what we say if we're asked what our book is about. Roy thinks I wrote it in an email once and he searches old documents. I start from scratch: "People don't understand what psychiatry is all about and they make all sorts of assumptions. Shrink Rap explains the nuances and logistics of the practice of psychiatry without all the jargon." Sounds good. Of course, no one else asked what our book was about.

We meet Neal Conan. I'm excited. Roy is oh-so-cool. I ramble because I'm nervous. We sit down and Neal says something about the green button. "I press the green button every time I talk?" I ask. No No No, he'd said, "Press the green button if you have to cough." It's the mute button. Right. Got it. I don't have to cough. Stay away from the green button.

It's like a podcast, and the show itself was a lot of fun. We weren't nervous once we started just talking. I did not faint. I did not vomit. Roy can say the same!

On the way out, I felt like a balloon that had been blown up a little too full and then a pin prick was letting the air seep out. I told Roy that for once he talked more than I did. He said I talked more than he did. We laughed. I let him drive back because my driving makes him seasick.

I check emails. Some nice messages from Sarebear who tried to call in (Thank you!) and Carrie. Barb said we sounded good. One review on Amazon--one star-- and they clearly hadn't read the book. The NPR site already had comments about toxic psychiatric drugs and how psychiatrists don't listen to their patients. Oy, but hey, I've come to expect it. My rant on the subject will be re-posted momentarily .

Kathy called to say we sounded good. Yes!
Thank you for letting me talk about this for way too long!

The Shrink Rappers With Neal Conan on NPR's Talk of the Nation

On Tuesday, May 3rd at 3 PM Eastern time, tune in to NPR for Talk of the Nation with Roy and Dinah as guests (and Clink in spirit). It's a call-in show, and we'd love to hear from you. (Listen to the the 31 minute segment on NPR)

And while we're at it:

Shrink Rap: Three Psychiatrists Explain Their Work
is now available on Amazon at
http://amzn.to/shrinkrap.







If that's not enough:

Please click here to take our short survey on Attitudes Towards Psychiatry.

NPR listeners are invited to take the survey, no mental health experience needed.

To find Talk of the Nation on your radio, click HERE. Please note that some stations do not air both hours of the show (ours is during the second hour). We will post the Internet link after the program airs!
Guidelines for NPR callers can be found by clicking HERE.

Shrink Rap Survey on Attitudes Towards Psychiatry

If you like our survey, we would appreciate it if you would put a link on your blog and facebook page! And, of course, please check back soon for the results!
The link to this post is:
http://bit.ly/shrinkrapsurvey

Podcast #58: I Need a New Drug and Happy Five Years of Shrink Rap and Still Blogging

(Belated) Happy Blogiversary to Us!

Five Years and Still Blogging

Shrink Rap quietly turned Five on April 21st. We chatter about this while we podcast. We kept it short again and talked about some new medications. Roy mentioned a new antidepressant, Viibryd that's a bit like a combo of an SSRI + buspirone. Dinah talked about a conference she went to on psychopharm update and she read some of the slides that were presented by Dr. Neil Sandson. This led us to talk about some other new medications, including long-acting antipsychotic medications that are administered by injection.

We then talked about Silenor, a sleep medication which is the re-packaging of an older medication, Doxepin, in a lower dose. A phone call to the pharmacy revealed some interesting information about the cost of these medications, but you'll have to listen, or call the pharmacy yourself, if you want the answer.

This all led us to a discussion of the combination medication for the treatment of obesity, Contrave, that did not get FDA approval, and Steve's post on his psychiatry blog, Thought Broadcast, on Contrave compared to Swiffer floor cleaning system. Huh? Oh, listen and maybe we make sense.


Thank you for listening.
We invite you to go to iTunes and write a review.

And our Shrink Rap book should be available in the next few weeks: our review copies have arrived. Our next line will be "Go To Amazon and write a review!"

****************************

This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening. Send your questions and comments to: mythreeshrinks@gmail.com.

Can I Hit Back?

Sideways Shrink posed a great question recently in a comment on my post "When A Thick Skin Helps." The question was whether or not physicians are allowed to hit a patient who tries to assault them.

Certainly, physical assaults on patients are not the standard of practice in psychiatry or any other medical specialty. Psychiatrists do undergo some training about physical management of violent patients: I remember in residency we had to get trained in "take down" and restraint procedures. As a group we practiced applying pressure point joint locks on each other in order to make a patient break a grip on us, and to do two person restraints to hold someone immobile until security could arrive. None of this involved any "Crouching Tiger, Hidden Dragon"-type kung fu moves, there was no kicking or hitting or loud kiai karate yells. There was a lot of talk about the importance of being as least forceful as possible. Frankly, I'm not sure how much of that I would have remembered if I had ever been in a position to have to use it. The few times when I was actually assaulted by patients the incidents happened so fast there really wasn't anything I could have done. (OK, so the little manic lady who hit me with a stuffed dog really couldn't count as an assault, and she was already restrained in a geri-chair to begin with.)

But the real question is: will a doctor get into trouble for defending him or herself?

In situations like this it's always best, as one of my friends and mentors regularly states, to think clinically before thinking legally. Safety first, then legalisms. Do what you must do to protect yourself. Learn the security procedures for your hospital or clinic or school or correctional facility, and know them so well you don't have to even think to act on them. If no one orients you to security procedures on your new job, make a point of asking. (Free society employers are particularly bad about this, particularly in an outpatient setting.) Even when you follow the "right" procedures though, it takes some time to get help. By "time", I mean several seconds to minutes, and in that short time a lot of damage can happen. Yes, doctors can and should defend themselves from attack.

What are the potential legal consequences? (Disclaimer: I'm not a lawyer, anything I say can and might be wrong from a legal standpoint, when in doubt call your hospital counsel or malpractice risk management office.)

The consequences could be civil or criminal. An assault or battery charge could be filed by a patient, or a general tort (injury) civil suit could be filed against a physician. A malpractice claim could be made (I doubt anyone could claim that a physician assault against a patient would be a standard part of psychiatric treatment!) however in states that allow contributory negligence (a limitation on damages when an injury is caused in part by patient behavior) the physician's liability would be limited. Finally, the patient could file a board complaint against the physician. So even in the absence of a criminal or civil case the physician could end up on the wrong end of a long, drawn out and painful licensure investigation.

There are factors that could lead to a greater risk of legal consequences if they suggest that more force was used than necessary: if the patient dies or has a serious permanent injury, or if the physician has a chance to escape but chooses to stay and fight instead. And yes, gender discrimination may play a role. If the physician is a young twenty-something, male, six foot four inch tall physician weighing 200 pounds and the patient-attacker is a five foot, 125 pound grey-haired old lady, you could be in trouble.

Off the top of my head I'm not aware of any cases where this has been an issue, and in the heat (or rather terror) of the moment I doubt any doctor is going to stop and weigh out all the potential consequences. And even when the doctor has a legitimate need to defend himself there could still be legal consequences, which are not fun even if the doctor ends up cleared of all allegations.

If I come across any relevant cases or references I'll put them up, but that's what I think off the top of my head.

Hate A Shrink: They Ask For It, After All

Okay, KevinMD today was the final straw. I am so sick Shrink-bashing. We're insensitive, drug-pushers who don't talk to our patients, don't listen to our patients, don't care about our patients. We're in it for the quick buck and "Tell-me-about-your-mother" has been replaced by "Here's your script, NEXT!"

First there was the NY Times article about how shrinks now see 40 patients a day, and the story was about a shrink who tells his patients it's inappropriate for them to tell him their problems. Oy. Shrink Rap commentary HERE.

Next there's MovieDoc who calls shrinks of my ilk who see patients for meds and therapy "sporkiatrists." Jacks of all trades, masters of none, as if one person can't possibly do two things well. You know, I walk and chew gum at the very same time (oy, I'm snarky today).

Oh, and there's the commenter on our Psychology Today blog, Shrink Rap Today, who writes:

'Shrink''Antipsychotics' ('neuroleptics') have been proven to SHRINK the human brain... the frontal cortex, for instance... by about 1 percent loss of brain matter per year... There is horrific fallout from these drugs -So, 'SHRINK' is certainly appropriate.'Rap'Psychiatry, along with its partner in crime, Pharma has a RAP sheet a mile long, particulary in the areas of clinical research, done by psychiatrists... the "off-label" marketing of psychiatric drugs to children, Medicaid fraud... the 'RAP' sheet is quite long.

Thanks for stopping by. Do come again.

And so now KevinMD has a post by a psychiatrist, no less, who writes about how to get heard by your psychiatrist and suggests doing homework and bringing notebooks to those 15 minute med checks. Good we have pointers here because of course we'd assume that no psychiatrist would listen. Dr. Raina writes:

• Many psychiatrists diagnose a patient’s illness after a 45-50 minute interview, without doing any tests to rule out potential medical causes of psychiatric symptoms and without obtaining history from corroborating sources, as recommended by diagnostic experts.
• They see patients in follow up for 15 minutes or less.
• In those 15 minutes all they care about is that the patient says he is better. Once again, they don’t use rating scales or obtain corroborating history to confirm the degree of improvement.
• In general, patients who take still unfortunately difficult step of seeing a psychiatrist want to believe that they are getting better even when they are not.
• For a patient, telling a psychiatrist they are not feeling heard might feel too risky – the psychiatrist might get upset at them and might not like them as a patient any more.
• You could just change psychiatrists. But it’s not easy. You have to reveal the workings of your mind to yet another stranger.

Please, give me a break. What is it with this 15 minute visit stuff? We polled the shrinks in our state. A few see a lot of patients. The most common answer for how many patients do you see on your busiest day of the week? 8-11. Very few see more than 20 patients a day (and these may be 12 hour days?). Many see 1-2 patients/hour. Yes, it's very hard to find a psychiatrist to see you for weekly psychotherapy in-network---insurance just doesn't want to pay for this service. But there is the out-of-network option. On some insurances, it pays 80%. On others, it pays for your parking for the hour.

But we're not all callous jerks waiting to ream patients out if they say they don't feel heard. And what's this bit about how patients want to believe they are better --presumably they are too stupid to know?-- and that's all the doc wants to hear? From a psychiatrist, no less! Dr. Raina, I know a wonderful psychiatrist in Chicago you might like to meet, and I'm sure he'd love to listen to you.

So Clink works in corrections, she sees a lot of patients/inmates, as many as 3 an hour. And her focus is on med management, as is the case in most clinics and institutional settings. Do we think she's callous and uncaring? Ah, I know Clink--she's not. She's brilliant and mild-mannered and while we disagree about some things (about which I'm right), she has principals and she's a devoted and caring advocate for her patients.

I'm tired of being dissed. Thank you for listening.

National Strategy to Reduce Prescription Drug Abuse

Nearly 500 people have taken our Attitudes about Psychiatry survey so far. If you haven't yet, [please do.]

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The White House released its plan last week entitled "Epidemic: Responding to America's Prescription Drug Abuse Crisis" [LINK to pdf of this 10-page plan]. Below are some of the elements in this plan that is part of the National Drug Control Strategy (like that has worked so well :-/).

The areas of this plan involve education of prescribers and users, monitoring programs, making it easy to dispose of controlled dangerous substances (CDS for short), and enhancing enforcement. The plan establishes thirteen goals for the next five years, and also creates a coordinating body, the Federal Council on Prescription Drug Abuse, to oversee and coordinate it all.

If any of our readers have comments on specific items (I've numbered them for ease of reference), including unintended (or even intended) consequences, please chime in.

1. EDUCATION
1. require training on responsible opiate prescribing
2. require Pharma to develop education materials for providers and patients
3. require professional schools and organizations to include instruction on balancing use of opiates for pain while reducing abuse
4. require state licensing boards to include relevant ongoing education in their licensure requirements
5. help ACEP develop guidelines for opiate prescribing in the Emergency Department [this should be a big help]
6. increased use of written patient-provider agreements
7. facilitate public education campaigns, especially targeting parents
8. encourage research on low-abuse potential treatments, epidemiology of substance abuse, and abuse-deterrent formulations
   
2. TRACKING AND MONITORING
1. encourage effective PDMP (Prescription Drug Monitoring Programs) in every state, including use of HIEs and connecting with federal health care systems (VA, DOD, IHS, DOJ), and expanding interstate operability of PDMPs
2. support reauthorization of NASPER, which funds PDMPs
3. explore provider insurance reimbursement for checking the PDMP database before writing CDS prescriptions [interesting...might work]
4. reduce "doctor shopping"
5. issue Final Rule on electronic CDS prescribing [finally!]
6. increase use of SBIRT programs, including via EHRs (Electronic Health Records)
   
3. DISPOSAL
1. expand on "take-back" programs (eg, allowing pharmacies to accept unwanted pills for disposal)
2. develop DEA regs on CDS disposal and educate public on it
3. get Pharma involved
   
4. ENFORCEMENT
1. increase training for law enforcement personnel and prosecutors
2. aggressive action against "pill mills" and inappropriate prescribers
3. establish a Model Pain Clinic Regulation Law for states to use
4. increase surveillance of prescription drug trafficking
5. use PDMP data to identify "doctor shoppers" and do something about it

This is long enough, so I won't list the plan's thirteen goals; these begin on page 9.

While I am concerned that the enforcement aspects will continue to criminalize actions against people with addictions (which should be viewed more as a health problem rather than a criminal problem, IMO), the increased use of Prescription Drug Monitoring Programs to increase identification of and assistance for people with prescription drug abuse problems should be helpful. Recent articles about the diversion of opiates, even by elderly folks who are supplementing their fixed income by selling their Percocets to neighbors, make it clear how deep this problem is. Some of these interventions have a decidedly Big Brother feel to them. But people are dying, so something must be done.

More Happiness, More Suicide?

On Tara Parker-Pope's NY Time Well Blog, she tells us that in places where people are the happiest, for example Denmark & Sweden, for example, have the highest happiness ranks, and the highest suicide rates. This is perplexing.

And apparently, the various United States are also ranked. New Jersey, where I grew up, is the 47th happiest state-- surprising given Full Serve gasoline, good pizza, and beaches. You were looking for something more out of life? Also it has the 47th suicide rate, so the miserable apparently tough it out.

Ms. Parker-Pope writes:

After analyzing the data, the researchers found a relationship between overall happiness and risk of suicide. In general, states with high levels of life satisfaction had higher suicide rates, according to the report, which has been accepted for publication in The Journal of Economic Behavior and Organization.
“Perhaps for those at the bottom end, in a way their situation may seem worse in relative terms, when compared with people who are close to them or their neighbors,’’ said Stephen Wu, associate professor of economics at Hamilton College. “For someone who is quite unhappy, the relative comparison may lead to more unhappiness and depression.”
Dr. Wu noted that other studies have found that people react differently to low income or unemployment depending on how common it is in their community. “If a lot more other people around them are unemployed, it doesn’t seem so devastating,’’ he said.

I'm not sure one idea leads to another. Could there be another factor here? How do suicide rates correlate with the availability of mental health professionals, for example? Or with the price of chocolate in a give region? And how happy is my state?

If you haven't taken our Shrink Rap survey on Attitudes Towards Psychiatry, Please do -- you can get to it by clicking HERE

Dr. Melfi: Live! at APA

From the APA, an announcement that my favorite TV psychiatrist will be speaking at APA. I'm there! CONVERSATIONS Tuesday, May 17, 2011 ; 3:00 p.m. – 4:00 p.m. Kalakaua Ballroom, Level 4, Hawai’i Convention Center, Honolulu, HI Join us for our 10th annual Conversations event! This year’s very special guest is actress Lorraine Bracco. Famous, in part, for playing the role of psychiatrist Dr. Jennifer Melfi on the HBO television series, The Sopranos, Bracco has faced depression in her life. In 2006, Bracco began sharing her story of depression by including her experiences in her book, On the Couch. During the hour long interview, she will share her personal story of her fight, and success over, mental illness. Conversations is free to all APA Annual Meeting attendees

The Shrink Rappers Rap With Dr. Mike Sevilla on Family Medicine Rocks!

In case you missed it, we were on Dr. A's BlogTalkRadio show last night-- Family Medicine Rocks hosted by Dr. Mike Sevilla. Sarebear and Crazy Girl called in-- it was fun! And we got to ramble about our book and what went on behind the scenes, with a shout out or two to our oh-so-tolerant editor, Jackie.

If you missed it, don't worry, it's preserved for all time on the internet and here's the link to the Family Medicine Rocks website/blog with all the info. Mike writes:

We had a great conversation about the origins of the book, the process of editing/finalizing the book, and how they didn't kill each other during this process - Hehe.

The setup for the book is interesting that they wrote fictional characters to explain how psychiatric patients are taken care of. For example, since Roy takes care of hospital based patients, his section talked about that. Clink is a forensic psychiatrist and she tacked questions like "What's it like in a prison setting?" And, Dinah is in private practice and she talked about issues like "What it's like inside the walls of a psychiatrist office during an appointment."

Oh, but I cheated just a little and changed Roy and Clink back to Roy and Clink, just for our Shrink Rap blog (they've long ago outed themselves...).

PT: Psychotherapy "Alive and Talking"

This month's Psychiatric Times continues the discussion [registration required :-( ] about the NY Times article on psychotherapy that Dinah and readers discussed on April 9. This time, our colleague, Ron Pies MD, authored this article which deconstructs the myths perpetrated in the NYT article, which interviewed a med check doctor who found it "sad" that his patients found him to be important to them in their lives (read the article for the full flavor).

I'm glad that Ron pointed out (as we have) that the 2008 Mojtabai and Olfson article -- which implied that only 11% of US outpatient psychiatrists provide psychotherapy -- was a misleading statistic. Why? Because they did not consider brief psychotherapy sessions (30 minutes or less) to be classified as "psychotherapy" for their session. Thus, a 90807 (45-50 min) is considered psychotherapy, but a 90805 (20-30 min) would not be considered so, even though the AMA's CPT manual defines it as psychotherapy. Also, brief and supportive forms of psychotherapy are often given even when only a "med check" is billed. Nonetheless, the sound bite from that article has been: "Only 11% of psychiatrists do psychotherapy". It just ain't true. As Mark Twain said, "There are three kinds of lies: lies, damned lies and statistics."

Thursday Apr 14 7pmET: Shrink Rappers to be LIVE on BlogTalkRadio

You all remember Doctor Anonymous, right?  He's the family medicine doc medical blogger who we've known since Al Gore invented the internet.  Well, he's not so Anonymous anymore, writing a blog called Family Medicine Rocks under his other name, Mike Sevilla, MD.

Mike is interviewing us about our upcoming book (expected to hit the shelves now at the end of May) on BlogTalkRadio. Mike interviewed us before, which we put out as a podcast (#36a), I think.  He'll be asking us questions about the book and the process, which will help us prepare for our Talk of the Nation interview on NPR on May 3.  And we'll be asking him what he's been up to.  I want to find out his experience treating psychiatric illness as a family medicine doc, referring to mental health providers, and such.

So, tune in Thursday (tomorrow) at 7pm Eastern. You'll be able to call in and join us in the conversation.  The link is HERE.  (Note that it says 11pm, but I'm sure we agreed to 7 so he'll probably fix it soon.)