Optimal Performance Without Killing Yourself

My book was released a couple of weeks ago and the feedback so far has been very positive. The book has not yet hit the New York Times Bestseller list yet, although Christmas is still a few weeks away. I want people to realize the book is available just before the season of giving, and the gift to me is a purchase of my book. Go to Authorhouse.com or Amazon.com to purchase.

My hope is that the book is successful for many reasons, although mostly for one. To help people that are entitled to it. People with mental health problems. As I have mentioned before, these are the finest people in our society. They are not to be ignored, segregated or stigmatized. Consider mental health questions and answers by myself at 'Ask the Psychiatrist"along with a further discussion of this issue at obad.ca (the self help group devoted to bipolar patients).

90% of people with mental health problems are hard working, conscientious and performance oriented (see their value in what they can achieve). My publisher is AuthorHouse.com and they were quite helpful in getting my book to market. I primarily owe the completion of the book to my wife, my literary agent Ariela Wilcox and my marketing agent David Davis at MCD.com. I should also mention the people with mental health concerns that have helped me understand life better and the inspiration to write the book in the first place. I cannot neglect mentioning people out there who have no understanding of mental health problems also. My book is designed to invite them into a life of less prejudice and better understanding, which will provide testimony to education being a key to freedom and less fear.

For all the people that don't realize we are more than apes and that there is more to mental health problems than abnormal chemistry, strange parenting and not trying hard enough in life. All of these issues are important, and there are more. Yet, because of the complexity of life, everything adds to everything else. People with problems don't need chastising, they need understanding and compassion.

Oprah, America's biggest advocate for talking about issues deserves mention. Even she has struggled with assuming things that are not true. On a recent show, according to one of my patients, Oprah interviewed Dr. Kay Jamison. Dr. Jamison is a world authority of Bipolar disorder and someone I have had the pleasure of meeting. Apparently Oprah told her that she at one time thought that Bipolar disorder was an excuse. This is from a sophisticated, intelligent person that has done more for the mental health of Americans than anyone else has in the last twenty years.

Thankfully, Oprah now feels that Bipolar disorder is real and not an excuse. Oprah's interview of Dr. Jamison highlights how far we have to go, to inform people of the reality of mental health issues and their importance in terms of health care. Check out Oprah at Oprah.com

If you want to be better informed regarding mental heath issues and also to see that people with these problems are our best citizens, read my book. It costs $12.95 online and it might change your life. It will certainly help mine. Peace and happy holidays.

San Diego Fires 2007

The Santa Ana winds created significant havoc in the early part of fire season this year. Greater than 1000 homes destroyed, 2 deaths, many injuries and hundreds of thousands of evacuations. Living 8 blocks from the ocean I felt fairly secure, although we do live next to a lagoon and the authorities asked us to leave on Monday AM because of the potential for fire spread. My colleague Dr. Eric Drimmer was at greater risk as he lives more inland than I do. I pray that his home is alright as he and everyone else don't deserve to lose their homes.

A reporter asked me my thoughts about the effect of the fire and upheaval on people's mental health. I did my best to answer cogently. It is interesting that the idea of stress was first noted by a Canadian researcher named Hans Selye in 1936. It is hard to imagine that his original idea of stress affecting our physical health was originally met with skepticism. Anyway, the first effect on people is to feel anxious or tense with increased heart rate and rapid breathing. The desire to escape is significant which serves to protect us and is helped by these physiological changes. If the stress does not abate, exhaustion follows. Exhaustion is a politically correct term for depression.

What people need immediately after a life threatening stress is shelter, food and a secure place to recover with lot's of human contact. Anger, sadness and fear are common feelings and should not be denied. At the same time, acting out anger al;ways makes things worse. Walking off that feeling off is always the best approach. Any injuries or medical problems need to be addressed quickly also.

The feeling of loss of control after an out of the ordinary event is significant also. My feeling is to ask people what they would like so that the feeling of some control is returned. Making decisions is a form of control. Reassurance that they are safe and every effort will be made to help them is important. The mayor of San Diego (Larry Sanders) and Governor Arnold Schwarzenegger did an excellent job of mobilizing help and also providing for people's basic needs.

Representative Duncan Hunter was very informative in his description of being more prepared next time. The reassurance of dong more next time is important in helping others feel more safe living here. He described hitting the next fire hard initially, so that things don't get out of control. Considering the military presence and capacity in San Diego, Mr. Hunter talked about being more prepared with helicopters, fixed wing water bombers and overcoming the bureaucracy which can slow things down.

Speaking of bureaucracy, one of my patients called me in the middle of this disaster to say that her pharmacy would not refill her prescription that she has taken for at least a year, without a written doctors prescription. It is another example of how a mental health problem is always treated as less important than medical problems. Would they have been so difficult with this woman if she needed her insulin or hypertension medication? I can't tell you which pharmacy it was, as I would need to hear their side of the story. Still, it sounded officious, unhelpful and bureaucratic to me. I would assume the pharmacist would be aware that we were in an emergency situation in the county.

Duncan Hunter went on to say that Governor Schwarzenegger was an example of a hands on leader and someone who insists on getting things done quickly. I have loved Arnold since his earliest career as a weight lifter and he seems to get better with age. One person that he spoke to said she was mostly struck by how much he cared. It's too bad that more of our politicians aren't like him and Duncan Hunter.

Children should be reassured and kept close. Constant re-exposre to the trauma by watching TV is not a good idea for children and adults. Especially when they show the same pictures and tell the same story over and over. I must say that I was more impressed by the local TV than the national coverage. Keeping family and friends close, apart from providing for basic needs, is really the best we can do to help. As time goes by, the need for more mental health help is probably wise, depending on each and every case. Early trauma counseling probably does more harm than good according to studies after 9-11. Still the risk of emerging Post Traumatic Stress disorder or depression is not insignificant. Getting enough sleep, starting to rebuild and recognizing that the worst off people lost family, friends or pets is a good start. Houses can be rebuilt, people can't.

This is my view at least. In general, I was impressed by how much help was made available. As Dr. Selye remarked years ago, helping others is very good for both your physical and mental health. I try to never forget that one of the best exercises for the heart is to reach down and help someone up. Let me know what you think and take care.

Living in America

I moved to America to live and work in the most productive country in the world. My grandfather was a coal miner from Pennsylvania, my wife was born in northern California and it was exciting to move here from Canada. My intent was to live in an environment where the finest minds in Psychiatry existed. The University of California, San Diego has numerous thought leaders in mental health and their presence inspires me. I had not yet experienced interacting with health care insurance companies where doctors are assumed to be either stupid or fraudulent, although that is another story.

A woman named Dr. Georgiana Rodiger lives and works in Pasadena California and last week I went to visit her. She is not a famous academic at a famous university, although I had heard much about her from my partner Dr. Pam Laidlaw. The office I practice in with Dr. Laidlaw was originally Dr. Rodiger's. Before meeting Dr. Rodiger I read her book, "The Miracle Cure." In Pasadena I had the chance to observe Dr. Rodiger supervise her colleagues as they brought forward people that were struggling in psychotherapy (talking therapy) that they treated. Dr. Rodiger's comments were a combination of both kindness and insight that can only be found in experienced experts. The comments she made were direct and easy to appreciate for seasoned colleagues. After the supervision, Dr. Rodiger spoke to me about my son and a number of other issues. She mentioned casually that she has made a a study of numerous saints as Dr. Rodiger is also a religious and spiritual person.

Driving back to San Diego I could not stop thinking about the morning's experience. That night I had trouble sleeping, which is uncommon for me unless I am excited or worried. Since we met, when I think of Dr. Rodiger's wisdom and generosity, I think she may be a saint herself. In my career I have met many extraordinary individuals that work in mental health. Dr. Rodiger exceeds all of these individuals in my opinion. I spoke to Dr. Laidlaw about my impression and she agreed with me as do most of the people that Dr. Rodiger works with. America is privileged to have people like Dr. Rodiger caring for and teaching others how to help people with mental health conditions. It makes me proud to be a psychiatrist knowing I have colleagues like Dr. Rodiger.

At the same time there are disturbing things in America. It seems the higher one goes, the greater potential for the depths. In the November 2007 Vanity Fair, I read about issues that shocked me. According to one article, some military contractors appear to be committing fraud, stealing money from American taxpayers at an amazing rate. Some estimates are that billions have been over charged, making a small group of these thieves wealthy. Until the cases are heard everyone is innocent, although apparently the justice department is reluctant to go after contractors like Halliburton and it's subsidiary KBR.

While congress debates cutbacks for mental health care, it seems ironic. The thought of cutting millions that help people get better and/or even return them to becoming taxpayers themselves, while neglecting the prosecution of people charged with stealing billions seems wrong to me. If hte stolen money could be recovered it could be put toward a good cause with moneyh to spare. There would probably be enough for some of my patients to even buy a bike which tey fantasize about. Can you imagine getting around San Diego on foot, let alone a bike? Please read the article on page 212 of Vanity Fair November 2007 edition titled "The People vs. The Profiteers" by David Rose. See if you find it as disturbing as I did, considering all the other needs in America that require those stolen funds. In fairness, maybe there was no intent to defraud, it was just an honest mistake. Maybe the tooth fairy is real also.

Two weeks ago I was on the deck of the Midway, an aircraft carrier docked in San Diego. The description of landing and leaving the deck of this great ship by brave airmen left me with goosebumps. What the people of America have been able to accomplish in so many settings is inspiring. From the mental health practitioners to the brave people of their military, American's have much to be proud of. The problems will be solved and my hope is to make a contribution to this great country and the great people I have met. If someone has stolen from these people, they should be ashamed of themselves. No matter how rich they became though their greed.

Access to care

A very serious illness called Schizophrenia is not being treated adequately because of access to care. This illness has had a number of new medications introduced over the last 15 years to treat it. Unfortunately, many of these medications are not effective enough. Some of them have side effects that are very serious like weight gain, diabetes and elevated lipid levels. Clearly the side effects are not more significant than the illness, in terms of disability. Unfortunately, because of the lawyers wanting a piece of the health care pie, the side effect issue is often augmented and used as an opportunity to make some people rich (not the people with the problem, those that represent them). Even though medications are necessary for this illness, they are usually available, even if it is at a very high price. Maybe the price wouldn't be so high if the companies making the medications could worry less about litigation.

The treatment where access is denied by many insurers and even some governments is talking therapy and rehabilitation. Did you know that if you don't have medi-care and medi-cal coverage in California, there are many rehabilitation programs you can't attend. These programs are the only way many patients can learn to cope better, care for themselves and maybe in some instances even work. The combination of our current medications with rehabilitation programs is the only way to get better. It would be called optimal treatment, what you would want for your loved one's or yourself. Medications managed by doctors that care enough to optimize treatment and reduce side effects, along with talking therapy that helps patient fear less. Many psychiatrists I have worked with fit this bill. To assist the patient with schizophrenia get to a point where their self-esteem will recover to some extent. To deny access to this kind of care that can be provided at not a great expense, is a crime.

Schizophrenia is a condition where people feel that others might want to hurt them. In an excellent outpatient program like Palomar Intensive Outpatient program, people have a chance to be their best with a devastating disease. The staff at this program are dedicated, caring, empathic and devoted to helping people with severe mental illnesses achieve their goals. I have seen families break down and cry when they discuss their loved ones suffering and how the staff at Palomar helped them. Nothing is more rewarding to a health care provider than to see someone face their illness and fears, get the assistance they require and watch the person smile again.

Karen, Teri, Mona, Victoria, Jackie, Judith and Angelica are the people in our program that save lives and then assist our patients to embrace the idea that their lives matter. That they matter. Working with the people I work with makes me feel like there couldn't be a better branch of medicine than psychiatry. To think that if you get the diagnosis of schizophrenia after the age of 18 years and not be able to get medicare so you can get the rehabilitation necessary, is arbitrary and cruel.

Maybe a congressman, senator or President needs to have a loved one go through this illness, not have rich parents, and need a program like ours that they can't get into before things change. I don't care how things need to change so that people with a difficult illness get the help they need, just that they get it. Thanks again to the staff and patients at Palomar Intensive Outpatient Program.

I should mention our administrators Sheila and Susan for helping us make it happen also. Their friendly and professional attitude makes a difference when advocating for mental health care. If you agree or think otherwise about any of these thoughts, leave a comment for all of us who care to ponder.

60 Minutes

60 Minutes is perhaps the best news show ever. It is a staple of American life, or at least my life. The courage of reporting and trying to show both sides of a story seems to be the policy. Last Sunday, Katie Couric exposed a serious issue for people that visit psychiatrist's.

Apparently, a young girl (age 3 I believe) was behaving in an odd way according to her parents and they sought psychiatric help. The psychiatrist seemed like a nice person that was trying to help them. A diagnosis of Bipolar disorder was made in the child and medications were prescribed. According to the story, the parents gave more medication than the doctor recommended and the child died. Nothing for a parent could be worse than losing a child. Still, the parent or parents were charged with murder and the mom is now behind bars. The details are no doubt greater than what was in the show.

Katie interviewed the mom and a psychiatrist in Boston who has done a tremendous amount of research into Bipolar disorder in children. He is a well known doctor in child psychiatry circles and is clearly an authority. In terms of moving knowledge forward, he is doing his best. A psychiatrist in Oregon was interviewed also. His contribution to the story was his experience with children in his practice that take numerous medications for Bipolar disorder. Some of these children had their diagnosis changed and were prescribed fewer medications with good outcomes. Bipolar disorder may occur in children although it is probably infrequent. Options other than medications might be reasonable considering the lack of study using medications in children this young. I am assuming that talking or behavior therapy were not offered although I may be incorrect.

The whole story is important as another example of "who's to blame." Psychiatrists that prescribe medications not approved for children are taking a big risk with their patients. Still, as the expert from Boston argued, something needs to be done now and not always when all the data is in. I would argue that as long as patients can appreciate the risks and controversy, they can at least make informed decisions. If the doctor feels that he would proceed with the treatment in his/her own children, it is a viable option. All of the options take time to explain however, and not everyone can understand things quickly.

My position is to wait after explaining my perspective for up to a week until the parents or patient can digest the discussion and return to ask further questions. The risk of treatment must be less than the risk of the condition at least. All of this takes time, and many doctors are asked to see patients quickly to cut costs and see more patients, encouraged by the insurance companies so they can make more money or control care. Most insurers will pay for 15 minutes of a psychiatrists time and make the doctor jump through lots of hoops if he or she would like more time to talk to the patient. It is the principle reason I have gone into a practice where the shortest visit is 30 minutes and I usually recommend 1 hour. I don't call my sessions medication management either. The sessions are to discuss psychiatric management, talking therapy and other options. Not just medications. Medications are an important aspect of treatment when it is necessary, although it can't be the only approach to consider.

It was not emphasized in the show, although hurrying lends itself to making mistakes in psychiatry and other branches of medicine. This perspective may not be a factor in this tragedy, although I would be surprised if it didn't play some role. With more time to talk to the parents, consider other approaches and diagnoses, maybe this tragedy might have been averted. It is not to blame anyone, just to offer another explanation for what happened to a little girl, that is now not with us anymore. Too much emphasis on using medications and not enough time to assess patients. Like all tragedies, there are many factors that must come together for it to occur. Let me know what you think as I don't intend to blame anyone.

Grief and Divorce

Grief occurs with every divorce, although grief can promote divorce in a contented couple. Grief is caused by loss, and the loss most frequently thought of, is that of a loved one. Nothing is more difficult than to lose a child. For years there has been recognition by health care providers that often marriages are another casualty of losing a child. Many relationships end in divorce some time after.

It seemed odd to me that when we need each other the most is at times of tragedy, and yet as mentioned previously, there are many relationship terminations. Recently I heard something that may explain this behavior. After a major loss, the parents are in such pain that it is overwhelming. The feeling of not carrying is frequent. Anyone with children can relate to this pain and anguish, although experiencing it first hand must be more intense than intellectual speculation.

This reason for relationship breakdown is as follows. In many parents grieving the loss of children, when the parents or remaining children come together, the pain comes to the surface and the psychological trauma is re-ignited. This pain is understandably avoided. Also, grief is unique for different people and certainly males coping mechanisms differ from females. These different experiences of grief, varying coping styles and pain production in survivors that get close may be the reason people split up. It is terrible to experience another loss in the midst of grieving, yet it is common.

Another factor in loss is anger and even blaming. Both are destructive to relationships although emotions trump logic every time. If we could share a loss by avoiding blame as best we can, accept our feelings (no matter how intense and painful), see others as handling things in their way with respect and understanding, respect the need for separateness, we might regain peace in our lives again. We never get over a loss of this magnitude, although if we did the spirit of the person lost might disappear. Keeping the spirit alive with feelings, memories and any other means, including conversation with the deceased is all worthwhile.

I hope this helps people after their terrible loss and perhaps one more case in family court might be avoided. Tell me what you think as these are just my thoughts.

Fix Health Care With Simplicity

This is a very important and difficult question. My opinion is that the least insurance companies are part of the solution the better. Certainly catastrophic insurance is necessary, although it seems that health care that might be more affordable if the non-catostrophic health insurance was eliminated. I provide halth care for free as does every doctor I know as part of their regular practice. With escalating premiums and shrinking incomes for nurses, other health care professionals and doctors, no wonder people are starting to question the role of health insurance companies.

According to Time magazine, doctor's incomes have gone down every year for the last 15 years. If nurses aren't exceeding inflation, where is the money going that everyone says is increasing health care costs each year? The only people in a position to judge what is necessary are informed health care providers and the subsequently informed people or patients they serve. Of course there are health care professionals that are more interested in money than helping people. I have not met these health care professional yet and I would then assume they are a small minority. This small group is no reason to assume that most health care professionals need supervision from an insurance company that is trying to hold onto your premiums and make it difficult for you to obtain the care you need. Maybe if the insurance companies were not participating other than for catastrophic care, health care costs might not outstrip inflation.

Years ago I saw experts interviewed about the new direction in restaurants. One expert from Manhattan suggested that people are going to demand better food and better service so that higher priced restaurants was the way to go. The second guest owned pizza restaurant's in Southern California and he felt that people were moving toward high quality food in casual environments that were clean and yet not fancy. The last guest owned steak restaurants in Chicago. His perspective made the most sense to me. He said that if any business treated their employees right, then the employees would treat the customers well and make sure they got what they came for. With this simple approach, customers would come back, making for a profitable business that served the community.

If the solution to solve health care in America doesn't include health care professionals being treated with respect and a fair wage for their work, then health care problems will continue. It is a simple yet important idea that I think is right. Let me know what you think, because I care, and I need feedback.

Oprah and Mental Health

Oprah has done more for the mental health of Americans than any other person in the last twenty years. Her shows focus is on what people do, think and feel. This perspective is the exact same as mental health practitioners. Oprah herself is a kind, friendly and empathic person (the ideal of a mental health professional). You do not need to be famous to be on her show, just someone that has a new idea, a new experience or a way of helping people. A major difference with other people interest shows is the lack of ridicule by Oprah. Making fun of people is not something that Oprah does. When Oprah asks questions, she is sincerely interested in the answer, as all excellent mental health care providers are. Her coverage of mental health issues, understanding of people's successes and trials, along with a sense of humor and humility about her own life, enable people to share and talk. When I was a young man studying psychiatry, the advice was to conduct yourself as Judd Hirsch portrayed in the movie "Ordinary People," and you would definitely pass the oral part of the final exam. Years later that advice still holds. Most are more familiar with how Oprah behaves at this time and the same advice applies. Be like Oprah and you will pass your exams in psychology, social work and psychiatry. I am glad to be a psychiatrist in an age when public figures are able to suggest that mental health care is necessary and that it has more to do with growth than anything else. I should not neglect to mention Brooke Shields, Owen Wilson, Robin Williams, Mike Wallace and all the other famous people with the courage to let people know that they aren't perfect and if they need assistance, they go and get it. Oprah is a great American and she should be proud. If you agree or disagree with any of these thoughts, let me know.

Band Wagons or "the latest treatment"

It is reasonable to fear psychiatrists that just prescribe medications and those that won't. Patients deserve to be treated for what works best rather than a psychiatrists therapeutic preference. A recent article in the American Journal of Psychiatry talked about Benjamin Rush, the father of American psychiatry. Dr. Rush was the only physician to sign the declaration of Independence and also the Constitution. He was a great doctor and a great American. During the Yellow Fever epidemic in Philadelphia, Dr. Rush stayed behind to save people's lives. Unfortunately, his primary treatment was a common one of that time called blood-letting. Even though this treatment was ultimately ineffective, Dr. Rush prescribed it even for himself. He survived thankfully although it reinforced his conviction. The point of this story is that after WWII, psychiatry believed that psychoanalysis was the treatment for everything. In the 1950's, we started to prescribe effective medications for many psychiatric maladies. The biological psychiatry revolution has been truly helpful for many patients. Unfortunately, many medications are only effective with some kind of talking therapy. At present, many neuro-scientists are using Freudian insights to guide their biological and genetic investigations. As one of my insightful psychiatry colleagues has admonished, "for all the psychiatrists who proudly proclaim they don't so psychotherapy, shame on you. For all the psychiatrists that proudly proclaim they only do psychotherapy and never prescribe pills, shame on you." Thankfully, most of us do both psychotherapy and medication management or at least insist that patients on medication need the addition of psychotherapy. Band-wagons could be a reasonable perspective for researchers as they need to focus and pursue their ideas with passion. Clinicians need to provide the people who are desperate for help the best treatments available, not what they have the most training in, or their "favorite approach." I get excited about new treatments and always hope they'll work. The ideal care however, is guided by science and at the same time open minded. That is certainly the case in psychiatry and psychology when all the answers are still not in. We know a tremendous amount when it comes to people, although we still have lots to learn, as in every branch of medicine. If you think otherwise or agree, let us know.

Private Practice

Recently I decided to go into private practice. Working for my patients is something I have always enjoyed. Unfortunately in America, you can end up beholden to some insurance company that always wants more information about the people we serve and also to dictate practice. The basic paradigm is that psychiatrists can perform medication follow-ups in 15 minutes or less. This is probably applicable to a group of patients we serve, although it is not enough time for many patients. Rushing people through their care just seems anti-therapeutic to me. I respect all the practitioners that can do it and still have satisfied patients. Unfortunately, I just couldn't seem to rush people through the description of their troubles and not feel like I was being disrespectful. You can ask to see and be paid by an insurance company for more time. Unfortunately the process of obtaining approval is so cumbersome, most practitioners don't even attempt it. I would rather see my patients for the time they need, bill them fairly and not feel like my care always had to be providing the cheapest alternative. I will continue to see severely ill people in a different setting. The great folks at Palomar Medical Center support my ability to help people with little money and yet great need. I felt someone needed to explain the appeal of private practice. It's about some insurance companies policies.
Telling doctors what is appropriate medical care without even having seen the patient is analogous to a back seat driver with a taser. At least it seemed that way to me.

Fear of Psychiatry

I was talking to my new tennis partner and great friend Alan yesterday about my idea of people seeing a mental health professional once yearly for a mental health check up. A preventive helath care idea. Alan told me that people are afraid of mental health practitioners because in part they don't want to be analysed. There are other reasons of course, although I wanted to address this specifically.

The fear is even greater of psychiatrist's as we can hospitalize against one's will and medicate also. All of these perspectives are the same fear and I hope these comments help. It is my opinion think that to be "analysed" is to be judged. This is something we as mental health professionals try to avoid in fact. Our job is mostly to understand, which as a technical term is to be "analysed" after Freud's psychoanalysis treatment. We do judge behavior that is harmful to anyone however. If I was in a session with a patient, and they informed me their young child had been left in the car, I would immediately stop the session and insist they attend to their child. That is judgement of one's parenting skills and necessary for a childs safety. It is rare in our business for this to occur (it has never happened to me) as the overwhelming majority of people we see, are especially careful and cautious. We are often trying to promote some fun in life and being less harsh in one's views as a frequent intervention. First and foremost, we want to treat people with respect and consideration, invite them to share their thoughts and feelings in a safe place where there won't be an automatic response of censure or disapproval.

Most of the people I have seen in my career have been treated as people that matter, people with courage to carry on in the face of adversity. Of course we judge, although it is rarely necessary. Almost without exception, judging is ultimately appreciated by the person we are serving if judgement is required, as it can involve saving their lives. I know that people have been treated harshly by mental health professionals in the past and I only hope that was not the intention, as it has certainly never been mine. Thanks for the insight Alan. I hope this helps and let me know what you think.

Health Insurance

My new practice does not take health care insurance. I have spent the last two years taking health care insurance and in a word it has been mostly demoralizing. The expectation by insurance providers (or maybe a better word is demand) is for psychiatrists to see patients for subsequent visits in 15 minutes or less. This is a unrealistic and apart from saving insurance companies money for services needed, it is ridiculous. I have prided myself in spending as little time with patients as necessary for their care to reduce costs. It has almost never been less than 15 minutes unless rare circumstances occur. Years ago while doing research into Seasonal Affective Disorder, our rating scales to assess progress or not in patients, took at least 20 minutes. Our research was to measure receiving a specific intervention for the condition or not. I did my best to not provide talking therapy in those studies so the patient didn't receive two interventions at the same time, confounding the results. Unfortunately, it became abundantly clear to me that physicians with expertise and patients with problems that went beyond medication or light therapy in this example, would still receive it. Confronted by a person who's dog had just died, needed the support required and I did my best to help the person first, even though it confounded the research to some extent. It is impossible to just provide medication or surgery without the talking therapy, even for health care professionals that don't realize how helpful their comments are. The same is true of psychiatrists writing prescriptions for patients with mental health problems that are also being seen by a talking therapist or not. Something comes up in the persons life since the last visit and it can't be ignored by the doctor. When it's ignored or referred elsewhere, it is seen by the patient as insensitivity or lack of caring. Neither augments the doctor patient, the foundation of all interventions. Research is clear, the more a person seeing the doctor trusts and likes the doctor, the more likely they will comply with other interventions like taking medication. 15 minutes is simply not enough time for a therapeutic exchange to occur and that is why I don't work with insurance companies in my new office in Rancho Santa Fe. Some people may have to pay more up front, although the more effective treatment is worth it in the long run. A small increase in time with a person in need, provides more comprehensive care and ultimately costs less in the long run. If you think otherwise or agree, let me know by posting a comment. Thanks.

Optimalpsychguy origin

Why did I pick Optimalpsychguy as my address? Because Optimal Performance People is mostly what I have seen in my 22 years in practice as a psychiatrist (the psych part of the address). My book Optimal Performance, Without Killing Yourself, The 6 4/4 Steps describe my alternate view of who we see struggling with depression and anxiety conditions. A very close friend of mine, who has been as much a brother to me as one could ask for, started calling me psychguy years ago. It is a good description of me. I am a psychiatrist with a sense of humor and humility. In many ways, just another guy though. I created this blog to complement my interest in human behavior and perspectives. My patients have taught me a tremendous amount in my career and I hope this blog will be an opportunity to share ideas and critique my view. Please share your thoughts with each blog I write. Thanks.