As a result of the decision in Potvin v. Metropolitan Life Insurance Company, physicians will have due process rights to a notice and a hearing before being terminated from health plan panels. As a result, termination without cause provisions in provider contracts will no longer be enforceable, something doctors nationwide have wanted for a long time.
In a long-awaited decision that culminated often anguished public debate and agonizing over moral and ethical concerns, the U.S. Supreme Court in June reversed the opinions handed down by the 2nd and 9th Circuit Courts of Appeal and held unequivocally that there is no constitutional "right to die." The controversy over physician-assisted suicide will now spread, as each of the 50 states becomes a separate battleground. "Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide," said Chief Justice William H. Rehnquist. "Our holding permits this debate to continue, as it should in a democratic society."
In Kansas v. Hendricks, the Supreme Court upheld by a narrow 5-4 margin a Kansas law that permits the civil commitment of individuals who, due to a "mental abnormality" or "personality disorder," are likely to engage in "predatory acts of sexual violence." Justice Clarence Thomas said the Kansas statute "comports with due process requirements and neither runs afoul of double jeopardy principles nor constitutes an exercise in impermissible ex post facto lawmaking."
Annick Hollister has always loved to paint. Her parents, Hal and Patsy, remember that ever since the age of 3, art was a way for her to express herself when she couldn't convey her feelings in words.
How can the simple act of forgetting become the impetus for a psychiatrist to develop his own series of self-administered psychotherapy computer programs? According to John Greist, M.D., it began when he forgot to ask his patients important information during the interview process. He also became aware that the very way he formed the question would lead to different responses from the patient, depending on the person he was speaking with or their frame of mind.
A colleague recently told me that he is actively treating more than 250 patients at three separate locations. "Do you think I need a computer?" he asked. That is a question many psychiatrists are asking as they see more patients and do an increasing amount of paperwork to maintain the same income they earned with far fewer patients just five years ago.
Computer-Assisted Diagnostic Interview (CADI) uses the computer to assist, enhance and improve Traditional Diagnostic Interview (TDI). CADI was first presented at the APA's annual meeting in 1996. CADI modifies both data collection and data processing. It occupies a place between the less-than-reliable TDI and the reliable but time-consuming structured interview like the Structured Clinical Interview for DSM (SCID).
Many of us have heard the horror stories and seen them reported on the national news wire services: publicly known persons or their family members have their medical records published, names of HIV-positive persons are released, clerks are bribed to deliver the names of patients and their diagnoses, physicians are given free software in return for their lists of patients' names and addresses. It is not that these breaches of confidentiality could not and did not take place with hard copy medical records, it is just that they are so much easier to accomplish now, and can be done in great number and from remote locations, anonymously.
Detoxification from alcohol and drugs can be safely accomplished in outpatient settings. Careful selection of appropriate patients and frequent monitoring are key elements of successful detoxification. The success of outpatients withdrawing from alcohol without serious medical complications and continuing in recovery programs is comparable to success rates of inpatients when there is careful selection of patients, a good triage process and good nursing and medical assessments.
In 1962, fewer than 4 million Americans had ever tried illegal drugs. By 1983, that number had risen to 80 million. Drug use peaked in 1985 and dropped until 1992. Since then, use has been increasing steadily, particularly among teenagers. This increase is partially a result of a trend back toward glorification of drug experimentation and legalization, and also because there's a general resurgence of smoking. Whether it's marijuana, tobacco, opiates or cocaine, it's still smoking.
Because alcohol- and drug-dependent patients tend to develop high rates of symptoms usually associated with common psychiatric syndromes, practitioners often fail to diagnose substance dependence and instead jump to treat more familiar disorders. The risk that such circumstances will occur is understandable given statistics that two of every three alcohol- or drug-dependent individuals meet the criteria for psychiatric disorders and one of every three such individuals meets the criteria for anxiety or depressive disorders.
Given that cannabis (marijuana, hashish, ganja, dagga, etc.) is the most widely used illicit substance in the Western world, it behooves us as physicians to understand as much about it as possible. The cannabinoid receptor is a good starting point in such a pursuit. Marijuana is not a single substance, but a collection of substances or compounds which become 2,000 on pyrolysis. Numbered among the 400 constituents of the plant Cannabis sativa are some 60 cannabinoids.
To understand our fascination with drugs in the first place, we need to ask some basic questions, such as "Why do we like to take poison in small quantities?" The truthful answer is always some variation of "To feel better." How does this come about, and why do we have so much trouble with it?
Despite the public's growing acceptance of addiction as a biopsychosocial disease from which recovery is possible, an ideological chasm persists between psychiatry AA.
Is the rising use of psychotropic medication to treat anxiety and mood disorders incompatible with the psychoanalytic approach? As a psychopharmacologist and psychoanalyst who frequently provides consultation to analysts regarding medication for their patients, Steven P. Roose, M.D., has studied this question and presented his findings and opinions in various scientific papers, books and meetings.
During a career that has spanned four decades and taken him around the globe, Ari Kiev, M.D., J.D., has studied everything from folk psychiatry in Haiti to community psychiatry in England.
The guidance answers the most commonly asked questions about how ADA affects persons with psychiatric disabilities, said EEOC chairman Gilbert F. Casellas. "It provides practical instruction to employers and persons with psychiatric disabilities on their respective rights and responsibilities."
As a result of today's competitive and rapidly changing economic arena, an increasing number of physicians outside academic centers are getting into the business of establishing investigator sites in which to conduct clinical trials for new drugs.
Although recent news portrays general violence as on the decline, the Centers for Disease Control still rank health care providers only one notch below convenience store clerks and taxi drivers at risk for homicide. Mental health personnel are exposed to these ultimate threats in emergency rooms, on home visits, walking through lonely hospital corridors or hotel corridors during conventions, as well as on the street and at home.
We believe that TMAP [The Texas Medication Algorithm Project] is the first large-scale use of medication algorithms, Rush said, "certainly in a community mental health setting. A project like this may help to lay the groundwork for improved public mental health treatment here and in other states as well." Medication algorithms, according to the project directors, consist of "a series of treatment steps, each of which is defined in turn by the clinical response of the patient to the preceding step."
While pharmaceutical research in the United States provides for unparalleled high quality of treatment, many drugs already proven effective in other countries may never become available here due to a combination of obstacles.
This two-year study of 341 patients is the largest controlled trial conducted in a population with moderately severe Alzheimer's. The primary end points, assessed quarterly, were the onset of severe dementia (clinical dementia rating of 3); death; institutionalization; and loss of ability to perform at least two of three basic daily activities (eating, grooming and toileting).
Daniel Chaffin, M.D., says he has never been at the top of the physician pay charts. That's why the solo practitioner in San Rafael, Calif., decided long ago to pay close attention to his finances. He dutifully put money in a retirement plan each year, avoided speculations, and focused his attention on growth-oriented stocks and stock mutual funds. The result: A seven-digit retirement account, additional investments on the side and, in short, financial security for himself and his wife as he nears his 70th birthday.
Like most other medical specialties, mental health has its share of unscrupulous providers who choose to break the rules and often end up learning lessons the hard way. The federal False Claims Act, a civil remedy, along with a myriad of other criminal statutes, have evolved into powerful weapons in the hands of federal and state prosecutors who have made health care fraud a national priority.
One type of investment that psychiatrists might find especially intriguing are health care mutual funds-specialized portfolios that invest in medical companies ranging from pharmaceutical manufacturers to biotechnology firms to health maintenance organizations. Although these industry-specific funds should not be held in isolation, they can provide solid long-term growth potential to a well-diversified portfolio. Here's key information on five top funds:
What Z has done is momentarily lift the veil that conceals...another veil. Thrilling because he is doing in public what I do in private. Stripping the professional illusion that psychiatrists are invisible machers, not just real friends and enemies, creditors and debtors, parents and partners, but detached angels. An illusion fostered by a xenophobic profession carefully cultivating the illusion of transcendental social levitation.
Project for Psychiatric Outreach to the Homeless Inc. (PPOH) is an award-winning program through which volunteer psychiatrists help agencies treat the homeless mentally ill started by psychiatrist Katherine Falk, M.D. "Up to this point I could walk by people living in cardboard or over gratings, shrug my shoulders and say 'at least they get taken to Bellevue,'" Falk recalled. "But what I found out is... they weren't taken to Bellevue or anywhere else."
After a decade of diminishing control and exclusion from provider panels, psychiatrists are developing strategies to regain some control of health care. With the help of consultation services like those provided by the American Psychiatric Association, they are learning to survive and prosper in this era of managed care.
A scandal-rocked Medical College of Georgia has announced tightened compliance controls for clinical studies in the wake of a 172-count indictment that charged two former professors with diverting more than $10 million in research funds. Richard L. Borison, M.D., the former chair of MCG's department of psychiatry and health behavior, and Bruce I. Diamond, Ph.D., once a professor in the department, were jailed in February.
Causal Explanations that Suggest How to Change