WHY I DON'T LET INSURANCE COMPANIES TELL ME HOW MUCH I CAN CHARGE FOR HELPING MY PATIENTS

Almost two years ago I decided to not accept the limitations that insurance companies place on what I charge.  Insurance companies reimburse psychiatrists for a brief "medication check."  This often translates into a 10 minute session during which there is discussion of how the person is doing in general, an evaluation of current symptoms and response to the medication, review of any side-effects to the medication, decisions regarding any dose changes or change to a different medication, and finally a plan for evaluating the response to the medication and possible side-effects.   That is a lot to cover in a short amount of time.  I do not believe that it can be done in 10-15 minutes.  It takes more time to cover all of these areas that are important for anyone taking medications.  I have found that this can not be rushed and that improvement is related to the time spent listening and interacting and coming to joint decisions regarding the treatment. This is true whether it is focused on medication or other forms of treatment.

I have also found that the time spent is important to be able to assess the level of stress each person is experiencing and then develop ways to help that person reduce their stress level.  This is very important to overall improvement and is a major factor in increasing positive responses to medication.

I also have seen the importance of making the treatment fit the individual person. This influences the type of medication that I prescribe and allows for a determination of the optimum dose of medication. One size does not fit all. Even if one can guess that based on statistics with large numbers of people a certain dose range is likely to be helpful for any one person, it still makes a difference to discover a specific dose that is helpful for each person.  

Individualizing treatment for each person is also important when evaluating some laboratory [blood test] results, especially those involving hormones such as the thyroid.

All of the above takes time and I will not compromise this to fit reimbursment limits from insurance companies.  I have found that even though it costs more initially to see me, the positive results and improvement lead to a significantly improved quality of life and is worth the investment.

For more about my philosophy of treatment, please see the "PHILOSOPHY" section of this website.

CHRONIC STRESS---ARE WE ALL VICTIMS?

Recently, I was listening to a "Great Courses" cd on the history of our understanding of evil.  There was a discussion of the repeated experience that people who had participated in doing evil things were often convinced that they were doing their duty and what they should be doing.  They were not acting like they were demoniacally possessed and did not seem to think that what they were doing was evil.  How can this be?  I then thought about the fact that often the people doing evil things had experienced mistreatment earlier in their lives.  A possible example is the way that Germany and the German people were treated after World War I as they were made to suffer economically and in other ways.  The stress of this [abusive?] treatment may have caused many of the German people to cope by dissociating or numbing themselves from feelings and emotional reactions to other people.  They would then have been more easily manipulated by someone like Hitler to see other countries as against Germany and believe that protecting their country was their duty. 

If this dissociating and numbing happens to a lot of people then there is a risk that they can be manipulated into doing evil things.  So, even the people doing evil things may be victims.

This points out the terrible impact that chronic stress can have.  

JUST LIKE ME

Recently I was listening to a cd on "mindfulness practice" from the "Teaching Company" and the lecturer said that when he is frustrated or upset with anyone he tells himself "just like me."  He then is more able to stop being stressed by the person or situation. I started to try this and it was initially confusing as I would be irritated by someone and then say to myself "just like me" and then I would think that it was not just like me because I didn't do what the person was doing.  I kept trying to say "just like me" even though I didn't seem to fit me.  Then one day as I was beginning to get irritated I then as I was about to say "just like me" it occurred to me that just like me might really be a reminder that the person is a human being "just like me."  It may not matter what they are doing but that I need to respect and recognize that they are just like me...another human being. 

Maybe the importance of recognizing the humanity of someone who I am allowing to irritate or frustrate me is that we too easily treat others as less than human or not as worthy as we feel we are.  This makes it easier to rationalize negative thoughts and then negative behavior towards others.  This then is disrepectful to others and to ourselves. 

So, "just like me" might help us to have reverence for other human beings and spread loving kindness around the universe.

EARLY MENARCHE [START OF MENSTRUAL PERIODS] AND DEPRESSION

C. Joinson, Ph.D. et al, report in the June 2013 issue of the Journal of the American Academy of Child and Adolescent Psychiatry on their longitudinal study of the impact of early menarche and the development of depressive symptoms.  They found that early menarche was correlated with increased depressive symptoms in 13 and 14 year old females but not for 16.5, 18 and 19 year old females.  Depressive symptoms increase over the course of adolescence for females but the increase is more rapid in early adolescence and this is two fold [100 %] increase.  They defined early menarche as menstrual periods beginning before menarche represents 15.5% of the sample. 

Unfortunately, earlier menarche seems on the rise. This means that there are more and more adolescent girls who are at risk for having depression at an earlier age and this predicts more depressive episodes, with a significant impact on their lives, including an inceased risk for suicide. 

What to do? Stop using hormones in producing food? Stop exposing pregnant women and young children to endocrine altering chemicals? Early identification and treatment of depressive symptoms?  Your ideas?

BEING BULLIED IN CHILDHOOD AND SELF-HARM BEHAVIOR AS AN ADOLESCENT

Earlier, I wrote about the impact of being bullied and being a bully, ten years later.  One study showed that children who were bullied were at significantly inreased risk for anxiety and depressive disorders while males were also more likely to be suicidal and girls to have agoraphobia [fear of public spaces and crowds]. The bullies had an increased risk of antisocial personality disorder.  I felt that the bullied children were also at increased risk for post traumatic stress disorder.

Another study by S.T. Lereya, Ph.D., et al, in the June, 2013 issue of the Journal of the Academy of Child and Adolescent Psychiatry reported on the impact of being bullied in childhood on adolescent self-harm [cutting and suicidal] behavior. They controlled for a number of other variables that also can lead to self-harm behavior and found that about 20% of the total self-harm behavior was caused by the bullying.  This is a very large effect from the bullying. 

It is a critical problem, especially as children [and adolescents] very often suffer in silence and do not tell their parents or teachers.  They also tend to  hold their feelings in so it is not easy to detect depressive symptoms.  Frequently they will complain of a number of different nonspecific symptoms that include headaches, stomach aches, backaches, dizziness, sleep problems and they may resist going to school and be withdrawn. When they do tell an adult they often feel that it doesn't help as they expect the adult to get the bullies to stop.  It would seem that a focus on helping the victims of bullies to cope with this stress so that they are no longer feeling overwelmed and can ignore the bullies more successfully.  Another focus, of course, would be to stop bullying from occuring in the first place.  Zero tolerance for violence or the threat of violence, so why not zeo tolerance for bullying?  I wonder if educating children and adolescents on the impact of bullying and the different forms it takes and then how to resist being part of bullying, wouldn't help reduce bullying significantly.  I am interested in your thoughts about how to prevent or at least reduce significantly, the bullying of our children and adolescents. 

Of course, it happens with adults, too.