Shoutout question to my Psychiatry bloggers Shrinkette and Maria (okay, my dad too):

Is there a name for the laugh that one makes when talking about a patient who it just totally psychotic or manic or out there ? Because if there’s isn’t, there should be. I propose the “slaugh” (that’s sad because the patient is so sick + laugh) or the “DeMlaugh” (short for Defense Mechanism + laugh). I’ll use it in a sentence:

My resident showed me a picture a patient drew of her, labeled “Space Devil.” The Space Devil’s body was a playing card, featuring a heart, diamond, clover, and lightning bolt, featured the words “smoke” and “sex” around the waste, and had a long, blue-highlighter-colored tube (a colon?) pooping out Zodiac signs. It was so bizarre, my only possible reaction was to slaugh .

4 Comments »

Being on psych this month, learning and reviewing all the psych diagnoses, you can’t help but fearfully self-inspect for psychosis, personality disorders and the like. Look what I learned in school today: I’m a schizoid narcissist with passive-aggressive tendencies and a history of anxiety problems!

I’m really enjoying psych, and I wonder if it’s because I can relate to some degree. I think most of my classmates enjoy it, but some just don’t, and perhaps it’s because they’re just not neurotic enough, or don’t have a good sense of how challenging life can be with mental health problems.

Just a thought.

6 Comments »

Donorcycle brings up organ donor policy , and reminds me of the Spanish model of organ donation: if you want an organ, you have to be willing to donate one when you die. You have the right to opt-out, but this automatically places you at the bottom of the donor list.

18 people die each day waiting for an organ, and countless others spend months and years on waiting lists with incomplete lives.

I have to admit, the Spanish idea sounds appealing, but maybe a little too punitive. We could probably save all those people if we just had an opt-out rule, where you’d put a sticker on your driver’s license if you didn’t want to donate.

And by the way, the sticker isn’t proof, people. Discuss your organ donation status with your family, because ultimately they decide.

8 Comments »

Not anymore, at least. 40% of businesses do not offer health insurance to their workers, and that’s up from 31% in 2000. How can people possibly think this is working?

• More than one-third (34%) of adults ages 19 to 64 (both insured and uninsured) either had medical bill problems in the past year or were paying off accrued medical debt.
• The $10,880 average annual premium for a family of four in 2005 surpassed the yearly gross earnings of $10, 712 for a full-time minimum-wage worker.
• Forty-one percent of adults with incomes between $20,000 and $40,000 a year did not have health insurance for at least part of 2005.
• 51% of women without health coverage have not had a mammogram in the past two years, compared to just 9.2% of women with coverage.

What an utter disaster. We should be ashamed of this level of care.

5 Comments »

An attending told us today in our first psych lecture, “Medicine is not about stamping out disease, it’s about helping people.”

Boy have the days of medical school applications passed.

No longer do I try to figure out how to rephrase “I want to help people,” and fit it into a 500-word essay. But along with it went the whole initial notion of medicine–that is, a profession built on helping people, improving lives, easing suffering. Now for me it’s about turning a patient’s story, signs, and symptoms into a diagnosis, and then figuring out what to do for that diagnosis. Sure, often the goals overlap–but in the end, I’m not out to relieve suffering, I’m out to cure disease.

I expect (or hope?) that this will come back to me once I get the whole “diagnosing and treating” thing down pat–hell, a large part of the reason I write this blog is to remind me and others of the important stuff, because it’s just so damn easy to forget.

12 Comments »

Part of the reason I decided to study social policy in college was the fact that I knew that as a doctor, I’d primarily being trying to improve the health of individuals, but I saw far too many individuals for any one me to help. So when I read about the legal aid services for children, and the fact that it’s going national , I couldn’t have been happier.

It turns out that doctors tend to work in a pretty specific realm (the medical one, surprise surprise). But health tends to be affected by multiple realms. Doctors are great advocates for their patients for their medical health–giving medications, for example–but when it comes to more systemic, structural problems, I’d give doctors as a whole an F. That’s why we work with social workers, child life specialists, home health nurses–these people have better footing in the non-medical health arena.

What the Boston legal team has been addressing is another level of advocacy–administrative and regulatory advocacy. This entails ensuring that laws are enforced and people are held responsible for their responsibilities–for example, ensuring that a landlord keeps his apartments’ habitable. Lawyers know how to push the right buttons (and have the time to do so) that often doctors don’t.

It’s possible that these lawyers are having a greater impact on health than the doctors with whom they work.

3 Comments »