Wednesday, June 29, 2011

Government sanctioned deceit on hold

According to this NY Times article feds have postponed planned deceitful survey of doctors:

Administration Halts Survey of Making Doctor Visits

Let keep up the pressure to abandon the idea completely.

Sunday, June 26, 2011

Government sanctioned liars

New York Times: U.S. Plans Stealth Survey on Access to Doctors

According to the article factitious federal "shoppers" plan to call primary care offices to assess relative availability based on payer, like Medicaid, Medicare, insurance or direct (cash) pay.

Physicians should look at this as an opportunity to send a message to Washington: Starting now or in a "few months" stop accepting Medicaid and Medicare patients. Apparently docs can avoid the calls altogether by not accepting or returning calls from ID-blocked numbers.

Or send them to the ER.

Sunday, June 19, 2011

Go Ahead and Die!

Health care financing: The Lounge Lizards tell it like it is. Do I see the jolly roger coming up over the horizon? (What's the proper spelling of aaaarrrrrgh?)

Shiver me timbers.

Saturday, June 18, 2011


Enough is enough! Stop the me-too drug explosion now.

Ask your doctor.

Did Danny Carlat write this song?

Gotta get me some of this.

Do med schools select for wimps?

I have this pet theory that part of the reason medicine is in such a pathetic state today is the failure of docs to stand up for themselves and their patients. On the wimp spectrum I see psychiatrists at one end and surgeons at the other. To get into medical school you have to comply, comply, comply. Conform. Don't assert. Rebels and mavericks need not apply.

Thursday, June 16, 2011

What If Psychotherapy Required Physician Referral?

I didn't think much of it when my own physician wrote me some kind of order or prescription for 12 sessions of physical therapy a couple months ago, maybe just whether my medical insurance would claims for additional sessions differently. But a few days ago I was surprised to read in a physician forum a discussion of possible ramifications if physical therapists were allowed to treat patients directly, that is without referral from a physician. I had always assumed that patients could self refer to physical therapists in much the same way they can to psychotherapists.

This led me to wonder what it would be like if one could only engage the services of a psychotherapist with an order from the physician, maybe not necessarily even a psychiatrist. Maybe this would only apply to reimbursement. In other words you could self refer at will provided you paid cash, but perhaps there would be reimbursement from healthcare payers only with physician referral. Maybe it already works this way for some carriers.

How would this impact a typical psychotherapy practice? How would physicians determine whether to refer for psychotherapy? Would they get to know better the psychotherapists to whom they referred? It already seems to me that even psychiatrists might find it difficult to find a local psychotherapist who provides the type of psychotherapy best suited to a patient's particular problem. I suspect most physicians lump it all together as psychotherapy or counseling and don't know the difference between psychoanalysis and dialectical behavior therapy or between family system psychotherapy and primal scream. Certainly it would seem that physicians might be inundated with marketing efforts by psychotherapists clamoring for referrals. Maybe physicians would thus learn something about psychotherapy methods. Or would busy physicians just ignore it all and blindly authorize whatever treatment they are patients requested?

Under such a system might there be more communication, real collaboration, between physician and psychotherapist? Would it be easier or more difficult for patients to get treatment? What would be the impact on health care costs overall? Would such a policy solve problems or just create new ones?

Thursday, June 9, 2011

Apps for Psychiatry

Robert Post, MD started publishing paper charts for tracking mood, meds, events and other information relevant to Bipolar Disorder years ago, but Optimism here is the first I have discovered that might handle the task digitally. I hope they come up with an Android app.

I have not tried Optimism or recommended it to patients yet, but I have started tracking my own moods with the T2 Mood Tracker from the National Center for Telehealth and Technology. I find the free Android app easy to use. It produces a graph to track mood, anxiety, PTSD, and head injury related parameters. A patient could show it to his provider during visits, but I would like the capability for providers to view the chart in real time with a browser which would allow more accurate viewing via Skype/Tango. When the app detects out of the ordinary entries, it suggests you make a note, which you can also save in the app for later viewing.

A patient actually introduced me to the idea of an (iPhone) app for monitoring sleep. I downloaded the free Android app Sleep Graph. To use it I must activate it, then leave it on the corner of my bed all night. (I wonder whether it can produce separate graphs for each person and animal on the bed.)

Two apps from Apple appear to allow you to address sleep problems:

ResMed appears to focus on breathing related sleep problems.

Sleep Hygiene seems to record total sleep time and other parameters for overall sleep monitoring.

What other apps have you found useful for addressing psychiatric problems?