Dr. Henry Paul, MD

Psychiatrist, Author and Educator

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

A 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

HE DIED OF A HEROIN OVERDOSE!

July 20th, 2015

A growing number of obituaries of people who have died of heroin overdoses refer to their addiction, The New York Times reports. In the past, these obituaries tended to say a person died “unexpectedly” or “at home.” Partnership for Drug-Free Kids “More Obituaries Refer to Addiction as Heroin Overdoses Increase”

Heroin again! I have written blogs about painkiller and heroin addiction for the past year and the need in this country for more awareness. Now I applaud families who are opening up about their loved one’s addiction, particularly in obituaries. In the past, obituaries referred to overdose deaths as an “undisclosed” or “sudden” illness. Now families are candidly disclosing the cause of death as a drug addiction. Families are not trying to scare anyone. On the contrary, they are helping to promote awareness that just may save a life.
“This is part of a trend toward a greater degree of acceptance and destigmatization about issues pertaining to mental illness, including addiction,” said Dr. Jeffrey A. Lieberman, Chairman of Psychiatry at the Columbia University College of Physicians and Surgeons, in the Partnership for Drug-Free Kids article.

He added, “If a family chooses to do this, they can have a cathartic experience that facilitates the grieving process. When the person was alive, they may have been enabling, and they couldn’t acknowledge it. But this allows them to begin that process of coming to terms with the fallibility of the family member and their own limitations in not having been able to deal with it while the person was alive.”

I found a comment posted by “Charlie” to the Partnership for Drug-Free Kids article said it best, “No one plans on being addicted. They think they are stronger than that. Heroin messes up how your brain processes things. It messes up your entire system. These are people that made a bad decision once or maybe twice and the addiction took hold of them.”

The news media is reminding us every day that we have a serious painkiller and heroin epidemic in this country. All teenagers will be exposed to drugs and alcohol at some point. Studies show that about 65 percent of teenagers try marijuana in high school, but for many children drug experimentation begins even earlier, in grade, middle or junior high school. Parents need to understand that alcohol and marijuana are gateway drugs. What I am concerned about is that there are still so many parents and teens that don’t understand the dangers. Teenagers are known for risky behavior. It is part of their development. Many teens don’t think about the cause and effect correlation of drugs and alcohol with the greater likelihood of becoming involved in criminal activity, suffering from suicidal tendencies, or facing other life-threatening dangers such as death from overdose.

We need to work together to do a better job at keeping our at-risk population safe from drug addiction. It really is a matter of life and death. For more information on addiction you can visit:

YOU CAN MAKE A DIFFERENCE IN THE GROWING HEROIN EPIDEMIC

HEROIN AGAIN!

Why heroin is spreading in America’s suburbs — The drug has followed prescription painkillers into new neighborhoods, forcing police and parents to confront an unexpected problem. By Kristina Lindborg, March 2014, cover story.

Nice coalition. Look for coalitions in your area. Powertotheparent.org

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.

HEROIN AGAIN!

March 19th, 2015

“New York City is now the “nation’s most significant” heroin hub,” according to city Special Narcotics Prosecutor Bridget Brennan. NY Post, 3/16/15, NY is now heroin central: narcotics prosecutor

I have been writing about heroin now for over a year in my blog, and the heroin situation just continues to get worse. Heroin is an epidemic that has taken America by storm. I cannot impress enough on parents that they need to educate themselves about the dangers of prescription painkillers and the rising use of heroin. These threats are particularly dangerous to our teenagers and young adults.

Here are some facts on Heroin from the DEA’s Prevention4teens:

Narcotics (such as heroin, morphine, OxyContin, etc.) are used to dull the senses and reduce pain. Narcotics can be made from opium (from the opium poppy) or created in a laboratory (synthetic and semi-synthetic narcotics).”
Heroin is a narcotic which can be injected, smoked or snorted. It comes from the opium poppy grown in Southeast Asia (Thailand, Laos and Myanmar— Burma); Southwest Asia (Afghanistan and Pakistan), Mexico and Colombia. It comes in several forms, the main ones being “black tar” from Mexico (found primarily in the western United States) and white heroin from Colombia (primarily sold on the East Coast). In the past, heroin was mainly injected. Because of the high purity of the Colombian heroin, many users now snort or smoke heroin. All of the methods of use can lead to addiction, and the use of intravenous needles can result in the transmission of HIV.
Heroin Effects: Euphoria, drowsiness, respiratory depression, constricted pupils, and nausea.
- Overdose Effects: Slow and shallow breathing, clammy skin, convulsions, coma, and possible death.
- CSA Schedule: Heroin has no legitimate medical use: Schedule I.
- Street Names: Horse, Smack, Black Tar, Chiva, and Negra (black tar).
Denial Can Make the Problem Worse: Some parents may be afraid to confront the realities of drug use, so they may deny the truth, even to themselves. You may have heard some adults say: “My kid doesn’t use drugs.” “It’s not a problem for our family.” “I used drugs and survived.” “Drug use is a normal part of growing up.” “We’ll never solve the drug problem.” “Alcohol is more dangerous than marijuana.”

I recommend that you attend a forum at your local high school or a community coalition awareness forum to learn more about the substance and heroin abuse in your community. Many local coalitions are forming around the country to educate the public, parents and teens about the dangers of heroin and the painkillers that often are the “gateway” drug to it.

Some of the latest newspaper stories about the heroin epidemic:
Schumer Moves to Reverse President’s Cut in Critical Drug Trafficking Program
Man accused of stashing heroin in daughter’s diaper
4-year-old hands out heroin at daycare
Cops seize $2.5M worth of heroin in Bronx raid
Schumer slams Obama’s proposed cuts to anti-drug program

Disclaimer

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.

POLICE AND SCHOOLS PARTNERING TO BETTER UNDERSTAND MENTAL HEALTH ISSUES

February 9th, 2015

Police and school officials in Fort Wayne, Indiana, are teaming-up to understand the basics of mental illness in young people in an effort to cut back on arrests of children in a mental health crisis. This partnership is inspiring to see because it is through collaborative efforts like this that young people who are at risk will get the best help.

The greatest way to help young people who have mental illness is to get them treatment and not to incarcerate them. The problem is that the symptoms of a mental health crisis are mistaken for delinquent behavior, and that can lead to arrest and possibly jail time.

There has been an ongoing debate in the medical community for years about the link between mental illness and criminal behavior. So why do so many Americans associate mental illness with criminal behavior? Because that is what is in the media and that’s what people remember. Think Sandy Hook. I’m sure what comes to mind for many is that the shooter was on the autism spectrum.

Behavior disorders in young people are often disrupting and bothersome to parents and teachers. It is normal for parents of teens to worry about their behavior, concerned that episodes of “acting up” may be harbingers of future antisocial, sociopathic development, or that their teens are on the road to violent criminality, substance abuse, living on the “edge,” and ending up in jail or prison.

The reality is that most normal teenagers do act up from time-to-time, sometimes in very disturbing and destructive ways. Adolescence is a time of testing limits. In young people who are still developing it remains self-evident that abnormal behaviors are often part of normal developmental progression, and they are temporary. In other instances it can be part of a disruptive behavior disorder, and if that’s the case the most important thing to do is to get the teen the proper treatment.

Young people with disruptive behavior disorders such as ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD), do occasionally break laws, especially those young people with Conduct Disorder. If your teen’s behavioral problems have proven to be intransigent, they may suffer from a behavioral disorder that requires greater attention and more specific help. The upside is that these disorders in young people can more easily be treated than the adult syndrome of “Antisocial Personality” (the Psychopath), which is notoriously resistant to psychiatric intervention. Youth carries with it more hope of intervention and possible change. Thus schools, police and mental health professionals working together offer the most fruitful hope.

Click here to read about the partnership between police and school administrators in Fort Wayne.

PSYCHIATRY HOSPITAL CARE AND INSURANCE COMPANIES

December 30th, 2014

When insurance companies deny treatment for the mentally ill, it can be devastating to patients and difficult for doctors to prescribe treatment. It can also be tragic. CBS 60 Minutes ran a segment in early December that looked precisely at the role that insurance carriers play in the treatment of patients.

Scott Pelley, who did the interview for 60 Minutes, interviewed the mother of 14-year-old Katherine West, who had bulimia that was supposedly rooted in deep depression. Her mother, Nancy West, had said that her daughter had also been a “cutter.” West’s daughter was recommended for a twelve-week hospital program that would cost nearly $50,000. Against the recommendations of her doctor, the insurance company pushed for Katherine West to be released after only six weeks. She came home as an outpatient. She died shortly after arriving home.

“Did it make sense to you that a doctor at the insurance company was making these decisions based on telephone conversations?” Pelley asked in the interview.

“No. No, they didn’t observe my daughter. You’re talking about a psychiatrist, a pediatrician, a therapist who observed my daughter on a daily basis. But some nameless, faceless doctor is making this decision. And I was furious. Because to me he was playing God with my daughter’s life,” said Nancy West to Pelley.

What is frustrating about the Katherine West story is that an insurance company doctor who had never seen her was making the decision on the best course of treatment. As a practicing psychiatrist, I know that insurance companies are dictating hospital admission and discharge. It has become more difficult for me to get people admitted under the policies defined by the insurance companies — policies that lend themselves more and more towards non-hospitalization. When I do get a patient admitted I also find that insurance carriers are shortening the length of stay, just like in the case of Katherine West.

What is at issue here is the overall health and welfare of the patient. I find the decrease in admission to be a folly since patients are often discharged before even the effectiveness of the prescribed medication can even have an effect. These patients are not even in the hospital long enough for deep exploration of the psychological/social circumstances that brought them there in the first place.

Worse, when they are discharged early and without a full course of treatment they are most often sent back to the stressful environment that precipitated the need for admission. Discharging too early makes it difficult for them to recover and can lead to relapse. Discharging a patient too soon also leads to a “revolving door” syndrome of hospital care with quick re-admissions. When a patient is being discharged, the hospital has to make an appointment with an outpatient facility or program in order for the patient to be discharged. In many cases, an outpatient appointment is scheduled even before the hospital and treating psychiatrist have even been able to prepare a status report. In many cases, it is also before remission of the symptoms that led to the admission in the first place.

The solution lies in more collaboration between the insurance carriers and the doctors who are treating the patients. We are talking about peoples’ lives not just statistics. We are talking about loss of life too. Just read some of the news headlines, and you will often find that a tragic psychiatric mistake was made all too often because of an early discharge or the refusal to allow someone to be admitted in the first place.

Click here to watch Scott Pelley’s 60 Minutes interview “Denied”.