Defamation Of The Defamed - Resist!

The Facts

I am on a mission.  As a psychiatrist my mission is to push back and resist, any and all attempt to disrespect my patients and their suffering.  A week after the FL high school shooting, the rhetoric surrounding the mental illness has gotten uglier, more cruel and is trickling down from the top.  Never in my wildest imaginations, I thought that the derogatory terms used to describe patients with mental illness, would be thrown around from one of the highest offices of our country.  I have heard words like, "sicko savage", "insane monster", "lunatics", "crazy", "nuts", "wacko", "madman", and the list goes on.

Please put the breaks on!!

This irresponsible and disrespectful course of using derogatory terms about patients, who suffer from mental illness, has to stop.  There is a difference between colloquial use of these terms and actual clinical relevance of such descriptors.  We call ourselves, our friends, and our adversaries, any and all of these words in our heads, out loud, jokingly or sometimes seriously, but with the understanding that these are expressions of frustration, humor or at times, anger.  Never do we use those words, full well knowing about someone who has a truly diagnosed mental suffering.  So why is it okay to vilify a whole specific population, in this manner?

Is it because they are already vilified and easy to target, or is it because the arguments of these patients as the root cause of a massive national problem, i.e. access to guns, are hollow and don't hold much ground, unless they are dragged in the mud?  Mud slinging always emerges from weakness and lack of substance.  It's not like, mentally ill patients aren't already defamed enough.  What is the point of further dehumanization, other than a pathetic spin on a problem that is not of their making?

The defamation of defamed, has to be called out.  We must resist!!!

Mental Health - The new Boogie Man Part 2

Here we go again.  I have lost count of how many times I have written posts like this.  Exhibit 1, Exhibit 2,  and Exhibit 3 . 
Before I start, let me clear the ground for anyone who would want to jump on me, curse me, threaten me and/or call me names.
 - Mass shootings by people with serious mental illness account for < 1% of annual gun related homicides. (1)
- Patients with serious mental illness count for 3% of violent crimes and even less in gun related violence. (1)
- This Epidemiological Research brings to light complex nature of violence and negates the absurdity of "Mental illness" talking point as a cause and effect, simplistic concept in context of the rampant gun violence problem in the United States.(2)
- According to The National Safety Council's report on the leading causes of death in the United States listed are: 1/370 people under the category of assault with a gun, death by a mass shooting 1/15,325, and accidental death with a gun 1/6904.  All these numbers are higher than the chance of dying by an attack from a foreign terrorist and dying by being in a tornado or cataclysmic storms. (3),(4)
I can keep citing and trust me, I have done my research but I am not the one who needs convincing that guns ARE the problem.
Since the start of the year 2018 multiple gun related incidents have happened across the United States in various schools.  Whether you want to quote the numbers with or without counting the number of children dead or not, is up to you.  Take your pick.  How many is too many? What is your threshold?  What are you comfortable with? Please feel free to pick a number.
But I refuse to play this game anymore.  In May 2014, I wrote this blog post that I would now call, De ja Vu after the Santa Barbara shooting.  Since then, every time a shooting has happened, I have gone back and read it.
How many times I have felt that things are finally turning around? ZERO. And how many times I have felt that we are sinking down, deeper and deeper in this hole....100% of the time.
I am sick and tired of thoughts and prayers, because they don't bring back the dead children but only pander to the sold out, cowardly, selfish politics of our country.
I am refusing to be the next casualty of the economics of the gun industry's bottom line.
I do not want to hear another person telling me that guns don't kill.....because THEY DO.  They are weapons made to KILL and to be used by willing humans, to do exactly what they were made to do.
I am not going to give up my right as a human being, as a mother and as a citizen of this country, to have my children go to school in the morning and to have the 100% expectation of them coming home in the afternoon, like they are supposed to.   Or do you want to tell me that the right to bear arms, is somehow more important than a parent's right to not to have to bury a child, after being sprayed with bullets?
I refuse to be labelled as part of the problem because the sold out politicians have decided to trample on the mentally ill and point the finger, as they simultaneously take money from the gun manufacturers through the NRA, while they slash funding for mental health, public education, safety nets and refuse to do anything about enforcing the gun laws.

The two knee jerk responses; mentally ill and/or over medicated, need to STOP!!!!
Which direction do we go as providers? Because don't we full well know that there are millions of people with particularly violent ways of thinking, that has nothing to do with chronic mental illness and they don't come knocking on our doors to get help with changing their way of thinking?
We are losing our voice in this because the talking points are shaping the public perspective in our direction by lumping every angry, unhappy, disturbed and at times racially motivated individual as "mentally ill"?  Before we know it, this will solely be a mental health problem.
It is our job as physicians, parents and mental health providers to speak up and point out that lumping every disturbed, psychopathic, angry, and criminal person, as a mentally ill patient, actually completely bars congress from doing anything at all.  It's a cowardly cover for the incompetence of our political will.
Why do our patients have to suffer even more, when statistically we know that SMI patients are most dangerous to themselves and to those who intimately take care of them, (when acutely sick) and not just random students or mall goers?
Why do we have to keep making amends with every new shooting, only to repeat the heartache until the next "biggest mass shooting in U.S history"?   Isn't every shooting bigger than the last one?
Why do we not talk about the trauma our first responders are subjected to every shooting, when they witness the carnage of these lethal weapons, used by a "law abiding citizen" who legally bought the gun/guns. tactical gear, magazines?
Why do we keep allowing the peripheral trauma to spread from these weapons to our every day life?
Why do I have to be okay with my young children being terrified of active shooter drills and that this is the norm in their education? Why don't we talk about the generation of traumatized children, who are growing up in this culture of people's right to own such weapons? Why do we keep giving up on their right to live their lives and hopes and dreams of future olympians, doctors, scientist, ballet dancers, cops, teachers?

United States doesn't have a monopoly on mental illness but it seems like we definitely are the worst in using mental illness as an scapegoat.  Please help me understand what sort of unique "mental illness" is so prevalent in this country that we have over 30,000 firearm deaths every year and more mass shootings than any other developed country in the world?

I am sorry but you may need to take a vacation from hunting a deer with an AR-15 and use the good old fashioned hunting rifle along with your hunting skills, because we need to figure this out...NOW!!!
As a psychiatrist who treats SMI patients, I refuse to simply take this excuse that somehow the United States has a more seriously mentally ill population than the rest of the world, and by association, hand off the entire responsibility of the mass massacre culture onto my most vulnerable patients. I will not be an accomplice in making our children a walking target of this epidemic of inaction.  This is not on my profession to fix.  This is not on our children to fix, but this is on us to say ENOUGH!!!

I am here to say, mental illness is NOT evil and EVIL is not mental ILLNESS.  Is that loud and clear enough for us to move on to the actual problem????
When will we be ready?????
When will be the time?????
When will we choose our children?????
When do we start saying and voting #NOTME #NOTMYCHILD ?

1- Gun Violence and Mental Health - APA 2016
2- Swanson, J. W., McGinty, E. E., Fazel, S., & Mays, V. M. (2015). Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Annals of Epidemiology, 25(5), 366–376. http://doi.org/10.1016/j.annepidem.2014.03.004
3- Causes of Death in USA
4- http://www.nsc.org/learn/safety-knowledge/Pages/injury-facts-chart.aspx

Hello, I am a physician. Who are you?

Many years ago when I embarked on my journey to become a physician, I didn't anticipate practicing medicine in the United States, one day.  My training in the medical school was pretty straight forward, not only in terms of my role and responsibility as a physician, but also regarding the roles and responsibilities of the ancillary team members.  Now over a decade later while practicing in the United States, I find myself in an uncharted territory.  A territory where I have to justify my place as a physician and actively try to keep the scope of practice boundaries from getting blurred, by a slew of political and economical motives.

The ground rule of practicing medicine, "First do no harm.", seems to have become a mere philosophical inconvenience, for everyone else but the physicians.  As if the onslaught of managed care and the increasing regulation, telling me about how I should practice wasn't enough; now I am to welcome with open arms; warmly and happily, the next best thing, or I will be labeled arrogant, angry and an obstructionist. 

Enter the world of mid level non-physician providers and the expectation of the system, that the physicians would and should assimilate.  All this in the name of access, cost, and teamwork.  The political lobbying and the financial investment in the gradual but surefire, decimation of a physician's unique place in health care; is something that I never expected to have to deal with.  

How does someone deal with the indifference of a whole system towards your own existence?  What does one tell the politicians and lobbyist who don't seem to understand that becoming a physician takes years out of an individuals life and is more than just how many number of hours of clinical training one has vs a mid level provider? Where does one draw the line between collegial and advisory relationship with another profession that also threatens and actively tries to devalue your own profession, by assuming a false equivalence not only in scope of practice but in fundamentally trying to change the definition of your hard earned place as a physician?  How does one start a conversation with the agents of change, when citing facts about glaring discrepancies in basic education and competency are deemed, territorial and unproductive?  

The rising cost of health care in the United States, because of the failed system of managed care and divisive politics, has turned the blame somehow on the physicians.  The current environment is literally putting a target on the backs of a profession that takes more than half of our lives to learn, perfect and practice.  

Practicing as a physician in the United States, isn't a walk in the park.  Just because you are done with residency and/or fellowship, doesn't mean you are done.  There are certifications, MOC, continued CME requirements, ever increasing regulatory pressures that claim to reduce physician burden by the way of MIPS or APM, but rarely do.  Despite all the pressures and demands that a failed and overblown system puts on us as physicians, we are supposedly the problem and not the solution.

The push to let more and more mid level providers ranging from CRNAs, to NP, ARNP, DNP, PA, prescribing psychologists and something called Cathopathic Physicians (yes it is a thing and they are still actually NP) the list goes on and on, practice medicine without having the comparable education, training, testing requirements and frankly ability, to do so, is what a healthy healthcare system wouldn't need to do. 

The false logic of cost containment and improved access, falls right on it's face when organizations actually are replacing physicians with mid level providers at steep salaries and/or exuberant contract rates.  This is where the rubber meets the road because the reality is that that most mid level providers don't go to the rural areas to work but actually end up replacing highly trained and specialized doctors, giving patients no choice in the delivery of their care.  

As a physician in this time of existential threat to my profession, I have learned that if we remain complacent to the trend, we will be part of the problem and eventually be decimated by a monster health care system, that is incapable of reigning itself in and defining boundaries for the sake of the patients it is supposed to serve. 

Elevating mid level providers to the level of a physician by allowing unsupervised independent practice, is not the solution for a sick system but rather a recipe for further sickness, only with a steeper price, i.e. patient safety.  Filling the market with inadequately educated and poorly trained providers from online schools and scarce patient contact hours, is not a healthcare innovation for the future but a ticking time bomb of medical negligence.  

So I wake up every morning and get ready to go do what I do best.  Be a physician!!!  

I make a conscious effort to educate my patients about their choices for their healthcare.  And I am ready to ask every day, to whoever will question or dilute the validity of my place in the system as a physician, "Hi, I am a physician, and I am trained to practice independently.  Who are you?"  

Because if I don't step up to save my profession and be blunt about it, no one else will.