Dr. Henry Paul, MD

Psychiatrist, Author and Educator

YOU’VE GOT IT ALL WRONG!

January 26th, 2016

“Most American parents are completely confused and going utterly in the wrong direction,” Dr. Leonard Sax

A new book out this month by family physician, psychologist, and author, Leonard Sax says that parents have this parenting thing all wrong! “The Collapse of Parenting: How We Hurt our Kids when We Treat Them Like Grown-Ups” looks at the major shift that has occurred over the past 30 years in American culture: the transfer of authority from parents to children.

8930168_sLike Sax, I too, have been in practice for many years. I agree with Sax that we have become an obsessively child-focused society; the children today are running the show!

Sax talks about how parents ask their children to let the doctor look in their (the child’s) throat. The parent then offers to reward the child afterward if they “open up” and let the doctor look in their throat to see if they’re sick!

Another interesting parenting trend, check-out “Spoiled Rotten” in the July issue of Boston Magazine where parents are paying their kids for scoring goals and grades. The rationale behind the thinking of the parents is fascinating. It is also wrong!

Parents today give their children unwarranted praise, try to be their child’s best friend, and give them whatever they ask for. The ability for parents to see clearly when it comes to their children has gotten skewed. Families go into debt trying to give their kids things they shouldn’t. Does Johnny need the most expensive sneakers? Does Emily need an upgrade to her IPhone that is working perfectly fine? Should children receive a trophy just because they were on the team?

Children are used by parents to fill parental needs and thus have their self-realization derailed. Worst of all, this parental indulgence sends the message to kids that they are the center of everyone else’s universe. As a result, some kids grow up without a sense of limits and with a high degree of entitlement and a lack of compassion and with little empathy.

Parents need to assume the responsibility for the fact that today’s kids lack a sense of limits, humility and a decent respect for authority. Kids believe that the end justifies the means, and that process means nothing. Society models and exploits this behavior on television and Internet programs targeting children and teens. It is the parents and society that are allowing this to happen and they need to make changes. Kids didn’t get this way all on their own.

LINKS
The Collapse of Parenting
Spoiled Rotten

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

 

KEEPING THE MIND OF COLLEGE ATHLETES HEALTHY

January 21st, 2016

The National Collegiate Athletic Association released last week new guidelines7537117_s on dealing with the mental health of college athletes, an issue that remains a top concern for the association’s chief medical officer, Brian Hainline.

“Concussions may be the elephant in the room, but mental health is really, I think, going to be a game changer for the NCAA,” he said. “My hope is that mental health is going to become as accessible to every student-athlete as an ankle sprain, and the NCAA is going to take a leadership role in telling the rest of the United States of America how to move away from the pathetic way it handles mental health. And it is pathetic.”

Hainline spoke on Thursday at the NCAA’s annual meeting where he emphasized the importance of mental health. Earlier this month, the NCAA’s Sports Science Institute released a new set of guidelines directing institutions on how to manage the mental health issues surrounding college athletics. Behavior on and off the field are all part of the overall well-being of an athlete.

The new guidelines outline four best practices for the mental health care for college athletes and 24 different mental health agencies weighed in and helped to create the strategies.

The guidelines suggest that colleges implement procedures and clear action plans for dealing with mental health issues including a push for annual mental health screenings for athletes, evaluation of athletes by licensed practitioners and education that will help athletes to recognize symptoms of mental health disorders. The guidelines also address substance abuse and aggressive and risky behaviors that according to a study by the American College Health Association’s National College Health Assessment, says that athletes demonstrate more aggressive behavior and risky behavior than non-athletes.
I think the study and the new guidelines are a vital step in the right direction.

LINKS
Mental Health of College Athletes

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

BURIED PORNOGRAPHY? BIZARRE TWIST IN SEXUAL ASSAULT CASES

January 18th, 2016

“This is the third lawsuit filed by Ponvert in recent months against prestigious Connecticut boarding schools. Ponvert has filed two similar lawsuits against the Indian Mountain School, also located in Lakeville, alleging similar instances of sexual assault and rape of young schoolboys by faculty members dating back to the 1980s.” Hartford Courant

26209317_sSince 2014, three lawsuits have been filed against Connecticut private schools; two at Indian Mountain and one at the prestigious Hotchkiss School, both in Lakeville, CT. Last week one of the cases took a bizarre turn when a judge ordered a dig on the school grounds to look for buried pornography. The Hartford Courant is reporting that a “federal judge has agreed to allow attorneys suing the Indian Mountain School in Salisbury over alleged student sex abuse to dig for evidence of child pornography claimed to be buried on school grounds.”

In the case of Indian Mountain School, former students told the Republican-American newspaper that the school failed to secure their safety from “sexual predators who had unfettered access to the school because they were teachers and even administrators.”

A Federal report in 2014 said, “The failure of U.S. schools to protect students from sexual abuse by school personnel is a story of district cover-ups, lack of training, incomplete teacher background checks and little guidance from the U.S. Department of Education.”

Many of the victims of sexual abuse are left to deal with a lifetime of anxiety, nightmares, panic, terror and other psychological issues. They struggle with sexual orientation and have trouble establishing healthy relationships. So how does this happen and why does it take so long, in many cases, for victims to come forward?

I think that a combination of denial by society and the authorities combined with devious sociopathic traits of the predators make it very hard to track these individuals. Plus, the very liberal court system that is very busy protecting predators in the name of fair and non-discriminatory treatment plus the charm and leadership roles and charisma of the perpetrators. But now there is a coming out of the victims broadly publicized which gives courage to the victim to tell what happened. Let’s hope in the end justice is served.

LINKS
Former Student Sues Hotchkiss School Over Alleged Sexual Abuse
Judge Allows Dig In Search Of Child Porn Buried At Private Connecticut School
Private school faces third suit
Federal Agencies Can Better Support State Efforts to Prevent and Respond to Sexual Abuse by School Personnel

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

PHYSICIAN BURNOUT

January 15th, 2016

“The number of U.S. physicians who say they are suffering “burnout” has jumped to more than half of doctors as the practice of medicine becomes more complicated and millions more Americans gain health coverage under the Affordable Care Act.” FORBES, 12/23/15

16410146_sA disturbing trend is facing the medical community as we kick-off 2016. A recent report by the MAYO Clinic says, “doctor’s work life balancing is worsening”. The new study says the percentage of physicians who say they are suffering burnout rose to 54% in 2014 from 45% in 2011.

The report doesn’t specifically address the Affordable Care Act as the problem, but it does attribute the situation to more people getting healthcare and more paperwork involved with the new healthcare regulations. Where we were seeing a doctor shortage before the Affordable Care Act, this is only going to make that situation worse.

I wrote in October about the shortage of psychiatrists and how the profession was experimenting with telepsychiatry. Long before there was a national shortage of psychiatrists, there was a dire shortage of psychiatrists in rural areas of the country. That trend led the profession to experiment with new ways to treat patients. Hence online sessions with patients. But that has raised its concerns particularly with HIPAA, which requires the protection and confidential handling of protected health information.

Now, the trend we have seen in the psychiatric profession is bleeding over to the entire medical profession as a whole. In March 2015, The Washington Post reported by 2025 the doctor shortage in the United States could be as high as 90,000.

In a statement to Reuters News Service, lead author Dr. Tait Shanafelt, of the Mayo Clinic in Rochester, Minnesota said, “Things are unfortunately getting worse for physicians.”

“Of the 6,880 doctors who responded to the 2014 survey, about 47 percent reported high emotional exhaustion, about 35 percent felt depersonalized or saw less value in their work and about 16 percent felt a low level of personal accomplishment,” Reuters reported on the study.

What is scary about the shortage is that it will create a critical need for specialists to treat an aging population that will increasingly live with chronic disease. According to The Washington Post, the report by the Association of American Medical Colleges says, “the greatest shortfall, on a percentage basis, will be in the demand for surgeons — especially those who treat diseases more common to older people, such as cancer.”

“An increasingly older, sicker population, as well as people living longer with chronic diseases, such as cancer, is the reason for the increased demand,” Darrell G. Kirch, the AAMC’s president and chief executive, told reporters during a telephone news briefing.

So what does this mean for the future of medicine? It will create longer wait times to get appointments, and most likely you will be traveling farther to see a specialist. More patients will be seeing physician assistants, too. For psychiatry, as well as many other medical professions there will be an increased use of concierge medicine, and you will have to get used to telemedicine for diagnosing and treatment.

LINKS
The Doctor Can See You Now – On Your Computer!
U.S. faces 90,000 doctor shortage by 2025, medical school association warns
The Complexities of Physician Supply and Demand: Projections from 2013 to 2025

STOP THE DELAY! RELEASE NEW PAINKILLER PRESCRIPTION GUIDELINES

January 1st, 2016

“In 2013, health care providers wrote 207 million prescriptions for opioid painkillers, almost quadruple the number written in 1999.” Senator Joe Manchin, Beckley (WV)Register-Herald

Yesterday in my blog I talked about the need for the Affordable Care Act, also known as Obamacare, to include medication-assisted drugs to help those in treatment for opioid addiction. There is a movement afoot to make this happen, and I support it. Today, I want to talk about the letter that Senator Joe Manchin (D-WV) sent this month to HHS Secretary Sylvia Burwell urging her to support the release of the CDC’s guidelines for prescribing opioids.

24026286_sAccording to Manchin, this report has been delayed due to pressure from outside groups and objections from the Food and Drug Administration (FDA). Manchin told the Beckley (WV) Register-Herald, “At a recent meeting, the FDA’s Director of the Division of Anesthesia, Analgesia and Addiction Products, Sharon Hertz, was one of the strongest voices against the guidelines,” Manchin wrote, adding, “While the President of the United States, the Department of Health and Human Services, and every other agency of the federal government has been actively working to save lives and stop this epidemic, the FDA is working against these efforts and further endangering the public.”

Opioids are prescribed for pain management, but they are dangerous. Opioid addiction is a medical condition characterized by the overuse and abuse of opioids (i.e. morphine, heroin, codeine, oxycodone, hydrocodone, etc.). When abused, all of these classes of drugs directly or indirectly cause a pleasurable increase of dopamine in the brain’s reward pathway. Addiction happens when a person seeks to experience repeatedly that rewarding or “high” feeling.

34841088_sThe over-prescribing of opioids is the main problem. Many of these drugs are given for longer than 30 days – the time it takes to become addicted. Also, these drugs are often prescribed to teenagers recovering from sports injuries. Painkillers are the beginning of the addiction that leads to heroin. Why? Because heroin is cheaper. According to the CDC, in 2013, 207 million prescriptions were written for prescription opioid pain medications. Those are a lot of prescriptions. With the misleading information presented early on to doctors, there has been a lot of confusion and second-guessing about the use of these drugs and the potential risks.

I join Senator Manchin in urging Burwell “to stand behind the CDC in pushing for the strongest possible set of recommendations to help end prescription opioid abuse and overdose deaths.” It’s true that the horse is already out of the gate and that the epidemic is in full swing, but we can turn this around, and we have to start somewhere. These new guidelines regulating opioid prescribing, along with the medication-assisted drugs are good first steps.

LINKS
The Neurobiology of Opioid Dependence: Implications for Treatment
DrugFacts: Prescription and Over-the-Counter Medications
Manchin decries delay of CDC guidelines for prescribing opioids
The Monster of Accidental Opioid Addiction

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.