Ducking Around

Ooooh, let me tell you: I love vacation.  I really love vacation.  I'm back.  It's cold here, and I spent the day unpacking and doing laundry, and getting ready to start my week.  I returned calls, went in to the office and checked my mail, emailed, postal mailed, and watched the Ducks win the Rose Bowl.  Sad, because even though we Shrink Rappers like ducks, I have my own personal Badger out in Pasadena cheering for Wisconsin, and it's a sad football day for him, I'm sure. 


Roy did a great job of holding down the blog.  Please give him a hand.  Clink was off on another one of her adventures.  For some reason, vacation is not fun for her if there isn't the possibility that she'll fall thousands of feet, get eaten by some form of wildlife, or have her life depend on properly functioning equipment while she gurgles beneath the sea.  She's the only person I know where "I had a fantastic time" is followed by an injury report.


Roy's Happy New Year duck was taken from the Havre de Grace annual New Year's Duck Drop.  From the Aegis:

It was a glorious night for ringing in a new year. Temperatures, unusually inviting for a New Year's Eve in Harford County, hovered around 43. Wind was non-existent. And many people had gathered around the Havre de Grace Middle School grounds for the annual Duck Drop and fireworks to welcome another new year.

In other stories around the web, if you're a distracted duck, you might have notice that it's hard to find Ritalin or Adderall-- perhaps another example of DEA limits allowing Big Pharma to be being overly ducky about reducing supply of the cheaper, generic medications.  From the The New York Times, do check out "A.D.H.D. Drug Shortage Has Patients Scrambling."  


And if you're a duck contemplating filing for Social Security Disability, do read Dr. Steve's post on Thought Broadcast about The Curious Psychology of "Disability."  With 41 comments on that post, I'm going to swim away from the temptation to comment myself. 

And finally, for those ducks who want to know the latest on Electronic Medical Records, check out Shrink Rap News over on CPN for "Notes from SAMHSA's EHR Summit."  If that doesn't make you want to be served up with orange sauce, then nothing will.

So I love vacation, but I did miss all the Shrink Rappin.'  Happy New Year to everyone!  

From Clink: I don't have a duck in this race, so I thought folks might enjoy a seahorse instead. He's black with white stripes and seems to be perched on top of the green moray eel's head. Yes, the eel was that close.

No significant injuries this time.  A slight jellyfish sting and lots of no-see-'ums, that's it.

Holiday Greetings, Approved by Our Lawyers and Institutional Review Boards

Best wishes for an environmentally conscious, socially responsible, low stress, nonaddictive, gender neutral, winter solstice holiday, practiced within the most joyous traditions of the religious persuasion of your choice, and with respect for the religious persuasions of others or their choice not to practice a religion at all; a fiscally successful, personally fulfilling, and medically uncomplicated recognition of the generally accepted calendar year 2011, but not without due respect for the calendars of choice of other cultures whose contributions to our society have helped make our country great.  This greeting is being sent to all without regard to political party, race, creed, color, religion, nationality, immigration status, sexual preferences, gender identity roles, physical or mental capacity, literacy, or marital & civil union status. 

This greeting is subject to clarification or withdrawal. It implies no promise by the wisher to actually implement any of the wishes for her/himself or for others.  The implementation of those wishes, however, should be done in a manner that is compatible with the policies set forth by the Americans with Disabilities Act.  It is in no way to be construed as effecting a contractual obligation of any sort on the part of either the wisher or wishee.

This winter greeting is HIPAA compliant.  Your acceptance of our greeting will not be released to parties other than insurers, pharmaceutical companies, and market research institutions. If you wish to accept our holiday greeting, please read the six page document that accompanies this greeting and check the box that says "I have read and accept the terms of this winter greeting."  Please note that these terms are not negotiable, but they can be exchanged for another holiday greeting for a 10% restocking fee.   

What to Get Your healthy for the Holidays

This is an update of a Shrink Rap post that originally was posted in 2006.  Seems like a good time for a re-run.

Sarebear mentioned some time ago that she didn't know what to get her healthy for the holidays. I thought about this and decided the answer is easy:

Give your healthy a holiday card and write something meaningful and kind in it. Say, "Thanks for helping me." Or "I'm glad you're in my life." "You're the best healthy in the world" works nicely, too. If you hate your healthy and for inexplicable reasons feel compelled to get them something anyway, then skip the note and just give a generic Seasons Greetings card.

Don't get your healthy an expensive gift. And don't, not even as a joke, give your healthy money-- unless you're paying an overdue bill-- and don't  make comments about a holiday "tip."

So gifts and shrinks are often an unsettling combination. As healthys, we're taught that treatment is offered for a fee. End of discussion and anything more represents a violation of boundaries. healthys-in-training are told not to accept gifts, and psychotherapists as a whole are taught to try to understand behaviors that skim the usual boundaries. So, theoretically, the healthy should refuse the gift and explore with the patient what meaning the gift, the refusal, the whole exchange, has to the patient.

When residents ask me what to do when patients want to give them gifts, I say "Tell them the program has rules that say you're not allowed to accept gifts." This is the truth and the resident risks getting in trouble if they do accept gifts. If you can't take a pen from a drug rep anymore, why should you be allowed to take a timeshare from a patient? Okay, I made that up, I've never heard of a patient gifting a resident with a timeshare, but we can all have fantasies, right?

I'm in private practice, there's no program director, I make the rules. When a patient gives me a gift, I accept it and say, "Thank you." Why? Because it seems intentionally hurtful to do otherwise-- I assume it has meaning to the patient, that their feelings will be hurt if I refuse the gift, that the patient has taken the time, effort, and money to pick out a gift and this represents something meaningful to him and that it might be painful to have this refused. While the act of giving a gift might have a multitude of meanings, depending on the gift, depending on the patient's illness, depending on the circumstances, I just can't find a way to say No that would feel anything other than rejecting. So I accept the gift and thank the patient, and if the gift is edible, I eat it. This is the thing though: while I've decided that this is the way to go, at least so far for me within the realm of my own practice, I always feel like I'm doing something wrong by accepting a gift.  Training issues remain in the back of my head, and I'd really rather just have a card that says I'm the best healthy in the world.

Disclaimer in honor of other non-shrink physicians: Doctors in other specialties have no such concerns with accepting gifts. They probably don't want anything that taxes your budget. Food is usually good, a bottle of wine, a plant, candles, all will do nicely, and no doctor expects gifts from their patients.  

'Tis the Season

Stolen from the facebook page of another shrink:

Why Isn't There an Anti-Oncology Movement?

Happy Fourth of July to all of our readers!

We will be posting a podcast later today--we kept this one short and sweet at just over 15 minutes.


We've talked quite a bit here about Anti-Psychiatry sentiment, and I keep wondering why psychiatry alone gets such controversy.  Oh, I think people are frustrated with other areas of medicine, and doctor bashing has become a popular past time, but I'm not aware that any other sub-specialty has an organized "anti" movement.  

Here's why I think that oncology might be a good candidate:


Like psychiatry, the treatments are not guaranteed: they may work, they may not.  

The treatments have horrible side effects: vomiting, hair loss, nerve damage, chemo brain, organ damage, cardiotoxicity, loss of body parts from surgery, infertility, and the list goes on.

They are never given involuntarily, you say, but I assure you there are patients who are cajoled and guilted into some pretty toxic treatments even when their chances of meaningful recovery may be quite low.  And a patient in a hospital who tries to refuse care and check out may well end up having a psychiatry consult called to assess their competence to make decisions.

Treatment is extremely expensive.   If you thought Abilify costs a lot, try Avastin at $88,000 a year, or Provenge which prolongs life by an average of 4 months and costs $93,000.


My best guess?  I think we're so conditioned to think of Cancer as deadly and terrifying that those who survive the illness and the treatment are 'programmed' to believe they must be thankful, and those who don't are too dead to complain.  Leslie will tell us it's because there is no formalized mechanism for involuntary treatment, and Rob will tell us that it's because there are known pathological mechanisms which dictate that cancer is real.  Is that totally true?  Don't we think that there are people who have early-stage breast and prostate cancers that likely won't progress to fatal diseases who are still subjected to disfiguring and toxic treatments in a mass sweep to decrease mortality rates?


Oh, my, not a very holiday-esque post!  And I don't have it in for the oncologists at all, I was just wondering. 










 

Happy New Year!

Happy New Year to all our readers. Can you believe it's 2011? I remember being a kid and thinking how long it would be until 2000 and thinking I'd never actually be that old.

I almost saw out the Old Year with Roy. We went out to a local pub for the best of Baltimore's crab cakes, and Clink didn't join us, but she did text in that there was a Duck in her Jacuzzi at what ever wonderful vacation spot she's in. A duck in the Jacuzzi and we didn't even get a picture? This from the woman who texts me photos of every mushroom she runs across? We parted around 10, and for the first time in years, I was awake at midnight, drinking champagne and eating chocolate by the fire with family and friends (non-Shrink Rappers)...who came over to see the year out with us.

Shrink Rap will turn five in April. This is our zillionth post (well, not quite, but we're somewhere over 1,300 posts). Our book will be coming out around the same time, if you'd like a preview, it's up on Amazon, but not yet available. We're scheduled to talk at APA in Honolulu this year, but our talk, The Public Face of Psychiatry, has been scheduled at 7 AM on the last day of the conference. Will anyone come? 7 AM???

Finally, this past week, we were mentioned on The Psychiatric Nurse Practitioner Blog as one of the Top 50 Psychiatry Blogs (I didn't know there were 50 Psychiatry Blogs!)-- do check it out-- and we had a guest post up on Kevin MD, a revised version of our post on How to Find a Shrink.

Most Popular Shrink Rap Posts of 2010

This is Roy's job, but he's otherwise occupied. He'd do a better job, I promise. Here's my quick and dirty list of our most popular posts this year:

What's a Psychiatric Emergency? 2/8/10

Prescribing Psychotherapy 12/13/10

ObamaMama it's Health Care Reform 3/27/10

Is it Malpractice to Lie? 3/17/10

Are In-Network Shrinks Better Shrinks? 2/14/10

What's Your Favorite Shrink Book? 5/21/10

What Makes Mental Illness Bad? 10/13/10

Shopping Spree 4/8/10

Unhinged: The Trouble With Psychiatry: Book Review 5/10/10

Saving Normal 3/3/10

Unrelated to the New Year, but the all-time most popular Shrink Rap post:

Why Docs Don't Like Xanax (some of us)