Sunday, April 20, 2008

Two Years Of Shrink Rap Tomorrow: Anniversary Post

On April 21st, Shrink Rap will be two years old.

It's no longer ruining my life. I still love having a blog with my two terrific friends, Roy & ClinkShrink. I still love that her blog name is ClinkShrink.

Ducks and chocolate and podcasts with or without prestigious guests,
readers who read and those who comment. Hummus and Cake and Pizza and Beer. And they help me with computer problems and listen to my teenager stories. And people in South Africa and Australia read my random thoughts, they get stirred up or they simply ignore me. What could be better? More chocolate of course, but I don't run like Clink, so I'll watch it (go down....).

So, for lack of anything more brilliant to say: I'm reposting my first blog post. I have to say that Shrink Rap has now become so big and bulky that it's hard for me to find and navigate it. It's not a blog you could really start from the beginning and read through. I found my first post, and two years of psychiatric progress have not outdated it.

The post is called "Plan: Continue Treatment, Return When?"

Our hypothetical patient enters the office; he's never seen a psychiatrist, and he's here because he is overwhelmed with sadness after being laid off from work. He isn't sleeping well, he's lost ten pounds, he's having trouble organizing his job search, he's irritable and arguing with his wife. He is clearly a bright guy, but tells us he's lost jobs before and feels he isn't living up to his potential. He's not psychotic, he's not dangerous. A full evaluation is done and some decisions are made about what type of treatment to begin. So here's my question: When do we have him return for the next visit? Is that a silly question? And do I really want an answer? You want to ask more questions about our patient, talk about how you would treat his depression, or his adjustment disorder, wonder why he repeatedly loses jobs and is there perhaps a personality disorder as well? And no, I don't want an answer, what I want to do is throw out the idea that there probably is no consensus among us about how often patients should be seen. If our patient is seen in a clinic, he may well be started on an antidepressant and told to return in three to four weeks. In a private office, perhaps he'll be told to return in a few days, or maybe not for week or two or three or four. And if there isn't enough disagreement on how often to see patients at the beginning of treatment, what happens if he has a good response to a medication, his symptoms are alleviated, but he still fills the sessions talking-- do we continue to see him daily/weekly/biweekly/monthly if he isn't asking to come less often and if he's paying his bill?

Okay, nostalgic rambling. Come back to Shrink Rap...oh later today or maybe tomorrow.

[Roy here...]  Nostalgia, huh? Okay, here's a link to my first post, which was sort of a Tom-Kat-Scien-tology post called Tom Knows Psychiatry.  We made a very short podcast yesterday (about Virginia Tech, which we podcasted about last year) for the 2-yr blogiversary, but the recording mysteriously disappeared so there will be none this week.  We did take a picture of the carrot cake that Clink got for the occasion, which I've put up top.

And here's Clink's first post on Recertification Exam Fees.