Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts

Wednesday, May 12, 2010

Death and Mental Illness

Huffington Post

May 11, 2010

Lloyd I. Sederer, MD

Deadly Consequences: Why We Need to Integrate Health and Mental Health

Dr. Sederer talks about how people with severe mental illnesses die an average of 25 years younger than the general population--
He talks about lifestyles, the lack of a medical home, the contribution of medications to chronic illnesses, nicotine, and the role of prevention and early diagnosis.

Alarming evidence has emerged in recent years, from studies of people treated in the public mental health care system, that adults with serious mental illness die on average 25 years earlier than the general population. For a decade or two before their demise they suffer from early onset diabetes, high blood pressure, heart and lung disease and cancer. Why? Their habits place them at great risk for these conditions. They eat poorly, are sedentary and don't have a primary care doctor -- or if they do they don't go and get preventive and ongoing physical healthcare. They smoke heavily, with more than three out of four being nicotine dependent (see my previous blog on this issue here).

The psychiatric medications many receive for their mental illnesses increase the likelihood of weight gain, diabetes and cardiovascular disease. Mental health professionals have discovered what the Craig family painfully learned: physical disability and early death add to the burden of mental illness for those affected and their families. The burden does not stop there since our health care system, already groaning from the weight of the consequences of American habit disorders, shoulders the extraordinary health costs of this high need population.

What can be done? A lot.

Click here to read the whole article. Well worth reading.
Lloyd I. Sederer, MD

Monday, March 22, 2010

My Three Shrinks Podcast 50: More About Geeks

In this show we continue with our guest Dr. Pat Barta of the Adventures in Telepsychiatry blog.

We talk about electronic health information systems and Clink continues her rant which she started in her post Rage Against The Machine. Roy mentions the Certification Commission for Health Information Technology and the American Recovery and Reinvestment Act which provides funding incentives for doctors who use health information technology. We cover developing standards for behavioral health information technology, including personal health records which allow patients to store their own information voluntarily "in the cloud", on a server. Dr. Pat Barta talks Open source health record systems and information security.

Health Data Rights is an organization that developed a proposed declaration of rights for patient data. Another organization addressing this is SpeakerFlower, of which Roy is the spokesperson.

Dinah talks about her blog postWhat's An Emergency? and wonders how flexible psychiatrists should be when a patient says they need to be seen right away. Which situations are truly emergencies? What should you do if a patient turns down multiple appointments offered for that same day? Should your office voicemail tell people to call 911?

Finally, Dinah wonders what has happened in states with medical marijuana laws. She mentions KevinMD's blog post Medical Marijuana Has Doctors Asking Questions. Should marijuana be prescribed for attention deficit disorder? How do you do clinical research on a controlled substance?

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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

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Send your questions and comments to: mythreeshrinksATgmailDOTcom

Sunday, March 07, 2010

My Three Shrinks Podcast 49: Pixelated Psychiatrists

For today's podcast we have guest psychiatrist Dr. Pat Barta talking about telepsychiatry, telemedicine and all things neuroimaging. We ponder how licensure works for telepsychiatry, whether or not you can get reimbursed for it, what the difference is between a face-to-face evaluation versus a telephone interview and why we don't yet have an iPhone app to diagnose schizophrenia. All of these topics (and more) can be found on Dr. Barta's blog Adventures in Telepsychiatry.

We talk about Pauline Chen's article in the New York Times: "Are Doctors Ready for Virtual Visits?"

Roy, Dinah, Pat and Clink discuss electronic health records and who should have the rights to our personal health information. I'm including a link to the Speak Flower web site, an organization dedicated to promoting patient-controlled health information systems.

We also hear from Dinah's new dog. Please go to iTunes and write a review.

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

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

Sunday, November 08, 2009


The times they are a-changing....

Next year, the new parity laws for mental health will go into effect: health insurance must cover mental disorders the same when it covers other medical illnesses, without limits on visits, or higher co-pays. It remains to be seen how this will play out-- my fear has been that the response might be to simply eliminate mental health benefits from insurance policies. From the American Psychological Association (sorry, it was a pdf file so there is not a direct link) on the Wellstone-Domenici Parity Act of 2008 :

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (The “Wellstone-Domenici Parity Act”) will end health insurance benefits inequity between mental health/substance use disorders and medical/surgical benefits for group health plans with more than 50 employees. Under this new law a group health plan of 50 or more employees that provides both physical and mental health/ substance use benefits must ensure that all financial requirements and treatment limitations applicable to mental health/substance use disorder benefits are no more restrictive than those requirements and limitations placed on physical benefits. This means that equity in coverage will apply to all financial requirements, including lifetime and annual dollar limits, deductibles, copayments, coinsurance, and out-of-pocket expenses, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage and other similar limits.

We don't know yet how this will play out...I hate that little clause "...that provides both physical and mental health/substance use benefits..." because it's left as an option. Would we tolerate a health insurance plan that excluded pneumonia or cancer? And it would be so nice if one could see a psychiatrist without pre-authorization (do you need pre-authorization to go to the doctor for your back pain or headaches or fever?) but my guess is that won't play out, since surgeries require pre-approval in many plans.

The New York Times has an optimistic piece on upcoming parity. Leslie Alderman writes in "In Anxious Times: Help for the Mind as Well as the Body:" Alderman writes:

The law’s changes can be good and not so good. Good, because you might have access to more care. Not so good if there are new requirements, like getting precertification for coverage, that place additional barriers to getting treatment, says Kaye Pestaina, vice president of health care compliance for the Segal Company, a benefits consulting firm.

“Employees should make sure their employer provides information to them about any new medical management rules,” Ms. Pestaina said.

Okay, so the House just passed the President's Health Care Reform bill (all 1,990 pages of it). What might this mean for psychiatry and how will parity play out in a newly-insured American?

Thursday, June 18, 2009

HealthCampMd on Friday

UPDATE Fri 11:22: Watch live streaming at (search for healthcampmd).

Here are the room links:

I'll be leading a discussion on electronic health records and CCHIT at noon, along with Ji, who will be talking about smart devices feeding patient info back in their health records.

HealthCamp is one of these un-conferences (started as a barcamp by Mark Scrimshire) where a bunch of people get together to talk about a subject matter, but they don't figure out who is going to say what until they get there. The presenters are the audience. These all-day conferences are getting held all over the place, and Maryland's turn is on Friday, June 19, at Stevenson University, just north of Baltimore.

I've not gone to one of these before, but I'm going tomorrow. I'll meet folks in person with whom I've only been emailing or twittering over the past few months. I'm thinking something good can come out of it, as there has been this groundswell of pent-up energy and enthusiasm behind the whole health care reform bandwagon. Yes, even a 'call to action', I guess.

You can still attend in person for about 30 bucks. If you cannot attend but want to join in on the action, you can watch the live twittering going on by monitoring the hashtag, #hcmd09. There will probably also be some live streaming via Ustream and BlogTalkRadio. And I'm sure there'll be Flickr pics posted, too.

If I find more links to these 2.0ish things, I'll post them here. So stay tuned.

Tuesday, June 16, 2009

Time for a Change!

The political theme of the moment is health care reform. I thought I'd link to Atul Gawande's article in the The New Yorker, " The Cost Conundrum."

Gawande visits McAllen, Texas, a town where health care costs have escalated to twice the national average (per Medicare) for unclear reasons. He asks questions and hunts for answers, and he compares the medical system there to other systems, including that of the Mayo Clinic where care seems to flow in a more patient-centered, less economically-driven way.

Gawande concludes:

Instead, McAllen and other cities like it have to be weaned away from their untenably fragmented, quantity-driven systems of health care, step by step. And that will mean rewarding doctors and hospitals if they band together to form Grand Junction-like accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers—whether public or private—would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don’t form these organizations.

Monday, June 15, 2009

Health Care & Social Media

The use of social media (eg, blogs, Twitter, Facebook, Youtube, LinkedIn, etc) by doctors and other health care providers is rapidly increasing, just as it is for really everyone else.

The New York Times did a story recently on doctors who twitter.  For the past couple months or so, I have been participating in a weekly twitter chat on the subject of health care (hc) and social media (sm), called #hcsm.  A bunch of folks involved at various levels in health care talk about, well, lots of stuff.

Last night, two health attorneys (Daniel Goldman & David Harlow) talked about various topics, such as whether docs should follow or friend their patients, whether tweets are copyrightable (mostly not), and what hospitals can do about negative comments about them in social media venues.  If you'd like to read a sampling of the conversation, go to HITshrink (guess who).

(Dinah's AFK for the week, so she asked me to keep the lights on around here.)

Sunday, March 15, 2009

The NAMI Mental Health Report Card: Grading the States 2009

The National Alliance on Mentally Ill Mental Illness came out with their report card on how each state is taking care of mental health issues. The national average is a big, fat D. As the kids would say, "epic FAIL!".

Only 6 states scored a B (sorry, no A's): Connecticut, Maine, Maryland, Massachusetts, New York, and Oklahoma. Nice to see in Maryland we moved from a C in 2006 to a B.

What prevents us (all states) from doing better?

Saturday, March 14, 2009

Shrink Rap: Grand Rounds is up at Doc Gurley

Doc Gurley did something pretty cool for this week's Grand Rounds -- a LIVE edition.  Click on the image to go to her post and listen to GR... or you can read it there, as well.

Interesting or shrinky topics: dating site for folks with mental illness; how to tweet your next conference; "what if real life were like health care?" (this one by Doc Rob is pure brilliance); long-term outcomes of deep brain stimulation (Dr Shock); what's the ICD9 code for saving the whales? (Cockroach Catcher); and the ICD-10 code for Insect bite of anus, Initial encounter (S30.867A).

Tuesday, June 24, 2008

Shrink Rap Grand Rounds: The iPhone 3G Edition

[47] . . . [48] . . . [stay tuned for #49 in Dec '09] . . . [All]

Tuesday, June 24, 2008

My Three ShrinksGrand Rounds 2007MediphoneTortureExcellenceAnorexiaRecoveryVideo PainDrink RightThe JointDr NurseTiny ShrinkBreastNot SickPubMedWinnerADD PhonePopcornDroolingWhat's NewWeb PowerEating NemoPillgateExpressRxiPhoneMail1Safari1iPod1My Three ShrinksNSAIDLabelsSexSwaySham PtEnvironmentDevicesMore AppsPainOne HourCuttingPotter HatSpyingReformAntiPhoneDifficultInsuranceDiscrimStragglerDucksiTunesPrivacyPTSDPhone2Mail2Safari2iPod2

[HOVER or CLICK on any of the above icons to go to the post, or to use the functions at the bottom]

Welcome to Grand Rounds, Volume 4, #40 (see future GR schedule). If you missed our first Grand Rounds last year, with our amazing Clicky Brain, then feel free to pause and enjoy.

This year, since the anticipated release of the Apple iPhone 3G is just around the corner (July 11), we asked for submissions to have some connection to the iPhone, no matter how twisted the logic is to make the connection. The medical blogosphere obliged. So we are including, free of charge, our Clicky iPhone, which will let you visually navigate this week's Grand Rounds submissions (yes, the buttons on the phone really work).

Of course, below that is the regular text for you old-schoolers. And if you have low vision or prefer to LISTEN to your Grand Rounds, you can get our PODCAST of it HERE.

We'll start off with the posts which most closely held to our iPhone theme. Why an iPhone theme? Well, besides the fact that Roy is the resident Apple fanboy and Clink the fangirl, the iPhone has a lot of potential as a flexible and easy to use tool for today's health care professional. Sure, Roy wrote a tongue-in-cheek post about using it as a multi-faceted psychiatric tool, the iShrink, complete with breathalyzer and tremor-diagnosing imaging software, but the fact that its standards are open for third-party development means that we will see a tremendous amount of software written for it and available in the App Store. Joshua from Tech Medicine reviews some of the coming medical applications. Oh, and if you're already tired of hearing about the iPhone, you may as well just close your browser window now, because it only gets worse (better?).

EDIT: Yikes! It's already into Wednesday and I found out that I missed two Grand Rounds submissions... just left them off completely. Sorry about that. But here they are right at the top, so please check them out...

1. Social worker Still Dreaming writes about "Why I Don't Care About the New iPhone." I know what you're thinking... I really did just overlook her. (She actually like the iPhone.)

2. Midwife With a Knife has an excellent, scholarly post about restrictions on work hours for residents. Wish there were restrictions on hours for producing Grand Rounds!

Here's the rest...

Jeffrey from Monash Medical Student also points out some other medical applications for the iPhone.

Annie from Home of the Brave writes about a growing body of evidence which demonstrates that nurses, physicians and psychologists have been used by the government as agents of abuse and torture.

JeffreyMD notes that "Apple has long been considered to be a company that strives for excellence in their products." Which brings us to his post on The Pursuit of Excellence on a personal level. [Good reach.]

What if Apple was no longer deemed to be a computer company? Am from the Cockroach Catcher (yum) speculates about what if anorexia nervosa was no longer deemed to be an illness.

David from Mariana's Eye is still recovering from Grand Rounds last week.

In addition to detecting intoxication, doing your laundry, and filling out your clinic paperwork, the iPhone can play videos to reduce your pain, according to How to Cope with Pain.

How do you prevent neck pain from talking on your phone too long? Jolie from Fitness Fixer teaches us how to use your neck correctly.

Does the Joint Commission have standards for iPhone use in hospitals? Kim from Emergiblog has a humorous script for them when they show up unexpectedly. (Scroll down past the part about smoking.)

PCPs, watch out! "The ascendancy and final triumph of the doctor-nurse is as inevitable as that of the iPhone. Except that, unlike the iPhone (which only has Apple and ATT behind it), doctor-nurses have the undying support of the entire federal-industrial-medical complex (not to mention the formidable Mary Mundinger)," so says Dr Rich from Covert Rationing Blog. [Who's Mary Mundinger?]

Tinyshrink from Why Am I Still Here reminds us to heed HIPAA while using our iPhone on the elevator.

Louise from Colorado Health Insurance Insider says that the iPhone 3G will be the most convenient place for doctors to find and display information about the benefits of breastfeeding to women in hospitals or in remote locations.

Hypochondriac? Jenni from Chronic Babe thinks her always-sick relatives would love the internet connectivity of an iPhone.

Second Life on the iPhone? Bertalan from ScienceRoll wonders if it's possible (this is a Medicine 2.0 carnival).

Inspired by the design innovations in Apple's iPhone 3G (see her Open Letter to Steve Jobs), Amy from DiabetesMine ran a design challenge to encourage innovations in diabetes care. The response was amazing: check out the winners. And, you can listen to the winner on out Grand Rounds Podcast.

Should your 7-year old get an iPhone? Will it cause ADD? See what Mother Jones has to say at Nurse Ratched's Place.

Sandy at Junkfood Science notes that a group in Santa Fe fear getting fried by cell phones and wi-fi, so are trying to get these banned from public buildings. Next thing you know they'll be using iPhones to pop popcorn.

Drooling over the iPhone 3G? Tony from Hospital Impact is. It's a doctor's next best thing.

Laurie at A Chronic Dose eschews the new iPhone and other new medical treatments, finding that what's old is new again. (She gets the gold blogging star for sending me her post while waiting to be seen in the ER. Who needs an appendix, anyway?) FYI, Laurie's new book, Life Disrupted, comes out this week.

Using the web (even on an iPhone) to interact with your doctor improves satisfaction of the patient and the provider. Check our Graham's post on Canadian Medicine, where he describes patients who are happy to pay a small fee for the privilege. Listen to Graham on our Grand Rounds Podcast.

Dr Shock reviews the latest Cochrane evidence-based medicine on the use of omega-3 fatty acids for bipolar disorder, noting that the little iPhone clownfish here are one of the highest in omega-3's.

What if, when you got to the front of the line, the Apple guy gave you a Blackberry instead of an I-Phone? After all, they do essentially the same things, right? Henry at InsureBlog has the disturbing story of a pharmacy chain that pulled that trick on its customers.

David from HealthBlawg also writes about the "evil" pharmacy benefit managers, and noted readers of Paul Levy's column chastised Paul for using the term "medication compliance", which has become a bit of an un-PC term to use. David dutifully points out the the iPhone is as "un-PC" as the come.
[un-PC... get it?... lol]


Will that shiny new iPhone help you remember things? Maybe, but don't expect the Motrin to help. Mona from the Tangled Neuron reviews research from our Hopkins colleague, Constantine Lyketsos, showing that NSAIDs don't help with cognition once Alzheimer's dementia begins. Aspirin doesn't help either, but it helps in other areas.

Walter from Highlight Health has seven ways to get in touch with them. I'm sure that all of them can be done from... you guessed it... an iPhone.

Patient chart out of labels? DrCris from AppleQuack snaps a pic with her iPhone. And be sure to check out her excellent post on branding oneself.

Zoe Brain has a long post about cross-gender brain differences. Somehow I doubt she typed all that on her iPhone (yes, I'm getting tired now of the iPhone references). You can also hear Zoe on our Grand Rounds Podcast.

Speaking of brains, why do smart brains make bad decisions (like paying $599 for a phone last summer that is available for $199 now)? Alvaro from Sharp Brains tells us about how our minds get swayed (and is offering 1,000 bonus points!).

Sham patients? The Samurai Radiologist discusses the reasons behind this fake-out trend on Not Totally Rad.

Paul from Medicine for the Outdoors addresses the important issue of why health care providers, and in particular physicians, should understand environmental issues and their impact upon human health.

Finally. Peter from Medical Pastiche has put his thumb on why we doctors like devices like the iPhone so much.

Dr Penna brings us yet another list of medical applications for the iPhone 3G.

Dean from the Back Pain Blog thinks the only excuse for not getting your mitts on a new Apple iPhone 3G would have to be coming down with a severe case of sciatica, which he addresses in Sciatica and Epidural Injections. Steroids anyone?

Give an Hour. DrVal from Dr Val & the Voice of Reason describes on our podcast an effort to get at least 10% of mental health providers to provide one pro bono hour per week helping our returning veterans and their families, because our government won't provide adequate access to treatment for PTSD and traumatic brain injuries.

In case some of you are struggling with violent thoughts against the iPhone lovers in you, Nancy from Teen Health 411 reviews a book about people who intentionally injure themselves.

ZXC, a family doc from Canadian Medical Blogs, thinks that the sorting hat from Harry Potter could be placed on patients with psychiatric complaints and it would tell him their diagnoses. Looks like the DSM-V will have some competition.

This one is a bit different, being a cartoon. Holly sent this one in from Candorville. I think he's not a shrink, but from Homeland Security. (There's a real Canada theme going through these posts; notice that?)

MJ from Interested Participant notes that the many in the US are pointing to the uninsured as reasons to move to a single-payer system, while folks in Canada are using similar rationale to argue for more private pay options. Maybe the grass is always greener.

The Snarky Gerbil is waiting for her anti-iPhone while talking about Biederman's fall from grace and peer review for journal articles.

Barbara from In Sickness and In Health writes about having hard conversations.

Kerri from Six Until Me writes about trying to get coverage for a diabetes device (Dexcom CGM) that insurance companies routinely decline. Also, congrats on the new hubby (how'd you get that one authorized?).

Are you feeling like a second-class citizen without an iPhone G3? Are you wondering if people will treat you the once you're relegated to the land of Nokia? Doc Gurley wades into the treacherous waters of discrimination of all kinds when she looks at a cluster of recent data about whether or not doctors discriminate when treating patients based on their - not phone - but race/ethnicity.

Zagreus from The Physician Executive got this in way late, but we got it into the post (we weren't able to get these last few on to the podcast).

And, that's the end of Grand Rounds for this week folks. Next week's Grand Rounds is hosted by The Covert Rationing Blog. If you'd like a recap of this week's GR, listen to our podcast as Dinah, Clinkshrink, and Roy take a light-hearted dip into this iPhone Edition of GR.

And, a final note of caution by Dr. Pink Freud (which I read on the podcast):
Dear colleagues,

The new Apple iPhone 3G must be stopped! I first recognized the potential dangers of the device whilst perusing Apple's description of the product:

Consider Apples assertions: "(The) iPhone already gives you mobile multitasking. But 3G technology lets you multitask in more places — without connecting via Wi-Fi. Since 3G networks enable simultaneous data and voice, you can talk on the phone while surfing the web, checking email, or using Maps. All from your 3G cellular network."

My appeal is based on the foundation of simple biology. To date, the data from numerous studies supports strong gender difference in the area of multi-tasking, consistently demonstrating that women's brains, though smaller (apparently size doesn't matter here) are inherently better suited for multi-tasking. The Apple iPhone 3G takes multitasking to heretofore unrealized levels! Simply put, the male gender is not cognitively equipped to handle such technology safely. The implications are dire. Overloading of neuronal circuitry could lead, at a minimum to temporary cognitive impairment. Worst case scenario: What if men attempt to drive and use the new iPhone 3G at the same time? Seizure activity might result, leading to increased traffic accidents. The human toll would likely be catastrophic.

Apple should, at the very least conduct research to assess the short-term effects of the iPhone 3G's multi-tasking capacity on the male gender. Until such time as the effects can be determined, in the interim, Apple could market a less dangerous product to men; perhaps, the iPaper-Cups-With-A-String-Between Phone. As mental health professionals, we need to come together on this issue and be heard as one gender-neutral voice. Who know, maybe someday, perhaps with the aid of cognitive enhancing psychotropic medication, men will be able to handle the iPhone 3G. But for now, this may just be a dream.


Christopher Bush, Psy.D.
(A.K.A. Dr. Pink Freud)

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