Psychiatric Times Vol 15 No 8

Explaining the Realities of Mental Illnesses. The ongoing campaign against stigma and discrimination attempts to promote an attitudinal shift from misunderstanding and fear to knowledge and compassion. Unfortunately, mental illnesses only grab the public's attention when high-profile tragedies become front-page news.

Recently, in reviewing a particularly complicated case with a representative of a managed care company, I was told that I was the only child psychiatrist in the country who could not come up with a diagnosis in one session.

A traditional medical chart is a varied collection of printed and handwritten notes, forms, letters and laboratory reports. As the chart grows, it becomes more and more difficult to keep track of the information it contains.

A new booklet released in April of this year provides, for the first time in modern medical history, a road map for ending life with physician assistance. Entitled The Oregon Death With Dignity Act: A Guidebook for Health Care Providers, the publication was the product of a two-year project sponsored by the Center for Ethics in Health Care at the Oregon Health Sciences University in Portland.

As her patient leaves the consulting room, Susan Roth, M.D., picks up her computer's microphone and begins dictating. "Wake up. Open template recurrent major depression. Patient identification: Mr. Johnson is a 64-year-old married white male. Chief complaint: difficulty sleeping, loss of appetite and depressed mood with suicidal ideation for the last three weeks."

The fact that the Health Care Financing Administration (HCFA) canceled the July 1 start date for implementation of the much-maligned new evaluation and management (E/M) documentation guidelines does not mean that Medicare is relaxing its efforts to root out erroneous physician billing of Medicare.

In more than two dozen programs throughout the United States, telepsychiatry is ushering in a new way of bringing mental health services to thousands of individuals who, in the past, may have gone without. More often than not, however, they are pilot projects or grant-supported endeavors, meaning that these prototypes of the psychiatrist's office of the future have yet to prove themselves in the medical marketplace.

Uncle Joe - Poetry of the Times

Despite threatening skies on a Sunday afternoon in late May, about 2,000 people gathered in New York City's Bryant Park for the fourth annual picnic given by National Picnic for Parity, a broad-based coalition of mental health providers, consumer groups, legislators and other advocates interested in achieving parity for mental illness.

Psychiatrists would fare considerably worse than anticipated if the Health Care Financing Administration (HCFA) sticks with its recently-announced intention to use a 'top-down' methodology in rearranging new practice expense relative value units (RVUs) for 1999. The new methodology would yield a 4% increase over the four years 1999 to 2003, compared with the 'bottom-up' methodology HCFA had previously chosen, where psychiatrists would have received a 19% increase.

In the first study to compare the efficacy and tolerability of mirtazapine (Remeron) and fluoxetine (Prozac) in patients with major depression, David Wheatley, M.D., of The Royal Masonic Hospital, London, and colleagues from throughout Europe showed mirtazapine and fluoxetine to be similar in tolerability, with mirtazapine significantly superior in efficacy.

By many estimates, the health care industry has been a relative latecomer to awareness of the Y2K problem. Databases may be corrupted or destroyed. Billing records may be voided. Births may be treated as future events. Insurance policies may be canceled. Claims may be denied. Thus, the problem may be especially acute in the health care industry.

The psychiatrists' apparent interest in natural medicinals may be driven by the rising popularity and widespread use of the products among the public. At the annual meeting of the American Psychiatric Association, a symposium considered the hazards and benefits of herbal medicines, and, perhaps for the first time since the 1960s era of psychedelic experimentation, reconsidered the therapeutic and research potential of hallucinogenic substances.

In 1995, I noticed that I was spending more and more time playing solitaire on my computer. I was trying to learn a new computer program and was very frustrated by it.