Psychiatric uncertainty and the neurobiological buzzword

A few years ago I wrote that uncertainty is inevitable in psychiatry. We literally don’t know the pathogenesis of any psychiatric disorder. Historically, when the etiology of abnormal behavior became known, the disease was no longer considered psychiatric. Thus, neurosyphilis and myxedema went to internal medicine; seizures, multiple sclerosis, Parkinson’s, and many other formerly psychiatric […]

Do patients avoid psychiatrists for fear of legal holds?

Over on the Shrink Rap blog I got caught up in an off-topic debate. The post was on why psychiatrists avoid insurance panels, something I’ve written about myself. But the commentary wandered into exorbitant fees, inadequate mental health services for the poor, income disparity between psychiatrists and patients, a generation that expects something for nothing, […]

Who is mentally ill?

My fellow psychiatrist and blogger Dinah Miller raised this simple yet profound question on Shrink Rap the other day. Who is rightfully labeled mentally ill? Is it anyone with a psychiatric diagnosis, past or present? Anyone with currently active psychiatric symptoms? Anyone receiving psychiatric treatment? Dr. Miller observes that “the mentally ill” is an oft-cited […]

Third-party payment for psychotherapy: (2) Medical necessity

In my last post I outlined some complexities of third party payment for office psychiatry, and especially for psychotherapy. As my example I used Medicare, the only third party payer I bill. Some of the problems include complex billing (i.e., collecting from multiple parties), partial reimbursement, unrealistic documentation requirements, loss of patient confidentiality, and a […]

Third-party payment for psychotherapy: (1) "Do you take Medicare?"

From late 1996 to early 2007 I was medical director of a low-fee mental health clinic where psychiatry residents and psychology interns receive training. Since the clinic accepted Medicare for payment, I did as well. I signed on as a Medicare “preferred provider” and have remained on the panel ever since, even though I left […]

Online commentary: marketplace of ideas or shouting match?

A central disruptive technology of our online world is the breaking down of unidirectional communication. In years past, newspapers and other media published articles without immediate feedback from readers. True, a few readers might telephone the editor’s desk, and the paper might print a select handful of “letters to the editor” in the next issue. […]

The APA annual meeting: a photo essay

As posted previously, last month I attended the American Psychiatric Association’s (APA’s) annual conference. Straying from my usual format, I thought I’d post pictures from the meeting and, of course, offer comments. The meeting took place in Moscone Center, a conference center complex located just south of Market Street in downtown San Francisco. Depicted here […]