so what have you learned in 30 years?


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Yep, it was 30 years ago this week I started medical school, and boy, if I knew then what I know now, would I have finished?  Hindsight is 20/20, but, foresight is infinite, when it is on the money.  Over at, the author there continues to rail away about Paxil and the infamous Study 329 and how SmithKlineBeecham suckered everyone in sight getting Paxil approved for use in C & A patients.

First a little explanation, as best by Wikipedia,

The best summation?  “Led by Martin Keller, then professor of psychiatry at Brown University, study 329 became controversial because the article that reported the trial results – in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) in 2001 – was ghostwritten by a PR firm hired by the drug company and downplayed the trial’s negative findings.[3]

The study had failed to show efficacy for paroxetine in adolescent depression, something SmithKline Beecham acknowledged internally in 1998.[n 1] In addition there had been more examples of suicidal thinking and behaviour in the group taking paroxetine.[n 2] Although the article included these negative results, it did not account for them in its conclusion. On the contrary, it concluded that paroxetine is “generally well tolerated and effective for major depression in adolescents.”[7] The company relied on the article to promote paroxetine for off-label use in teenagers.[n 3] “

The latest from 1BOM about it:

Yes, I commented in the thread, and I ended it as the author closed the thread after me, and here is what I wrote:

August 22, 2015 | 5:20 PM

The problem is, you have nice guys like Dr. Nardo who try to be completely civil and respectful, and then you have people like me. I’ve been practicing 23 years now, & I have no problem calling it the way it is. A lot of Psychiatry ,even if it is under 50 percent, is composed of whores and cowards. And that’s what is a shame, because too many physicians who adhere to this fraternity mindset, can’t call their colleagues on what they really are.

So, you can debate this paxil issue and other failed studies, and Big Pharma agendas per alleged studies that are just out to make a buck, but, it’s important to pay attention to the fact that psychiatric illness is a biopsychosocial phenomenon.

What should bother people, that bothers me greatly, stop paying attention to the few idiots who will take advantage of the public as all these cretins want to do is make a buck and/or glorify their name eternally, but, pay attention to these moronic defenders and apologists who seem to be much greater in number, who want to just further this disgusting cause of selling drugs!

As I’ve been staying here and elsewhere to some level, its not that we have Hillary Clinton and Donald Trump as candidates, but, we haven’t entrenched 20 to 30 percent of the public on either side of this polarized equation of politics that support these narcissistic / antisocial cretins.

The analogy here is, we have the polarized people of anti Psychiatry against pure biological driven psychiatry supporting each other’s causes to the ends of the earth.

So, you as readers, if you really are concerned about the welfare of this country and the healthcare system, need to stop trying to make sense of these selfish idiots who are just out to screw everybody else for the needs of the few. And, I don’t care how harsh or inappropriate this comment is, I find the moronic and disgusting lack of attention to concern and details to what the public welfare should be gets lost in all these, in my opinion, trivial and off base debates.

That’s the point I keep trying to make and yet we all want to get lost on nosology, statistical values, and other distractions that take away from the viewpoint that it’s about getting rid of these bad people and not trying to at least come up with inadvertent ways to make sense of them! or even worse, coming up with creative ways to tolerate them!?

Just my imperfect opinion…

Hey, it is what it is, any regular reader here know that, I would hope.  Anyway, I decided to write this post tonight, Saturday at 10PM although Word Press goes 5 hours ahead so the date here is Sunday the 23rd, as I read the most recent issue of The Week magazine and found it to be just a rehash of endless examples of personality disorder run amok in America and even internationally, but, the talking points page (pg14) had something just pathetic to read.

Titled “College:  A threat to mental health”, it was a summation of how students are being hijacked by not only the colleges who are just looking to profit on these students 4, 5, even 6 year tracks to get just a Bachelor’s degree, but, students even being hijacked by themselves.  The summation starts with Greg Lukianoff and Jonathan Haidt’s piece in The Atlantic:

I like the end of the first paragraph in The Week about the article:  “What’s at stake here is not only academic freedom but also college students’ “mental health”.  You think, when some students think their sole opinions trump those of the majority student body?  Seems eerily familiar with what some of these Presidential candidates are spewing daily??  And to think these students can vote…

Anyway, next paragraph talks of one professor’s point about trying to worry about having to provide trigger warnings to not upset his students.  Gee, how nice.

Last paragraph of the review, you can google Daniel Drezner in the Washington Post to read the point about what colleges are getting away with their inflated tuition rates.  Anyone reading here about to put a child into college, well, I just finished my two rounds, so I feel your pain…

Where is the relation of the failures of Big Pharma to students’ low threshold for pain?  Ironic it is, what I see with some regularity these days, some adult patients coming in for instant relief of their depression or anxiety, and having zero tolerance for not feeling better in a few weeks.  You see, part of why the Paxil study got away with the lies and misleading conclusions started with the parents, who wanted their kids on meds and I would bet that a lot of these teens did not participate in much psychotherapy in that study, but, I didn’t read the full methods section, so my bad if I was wrong on that assumption.  Fast forward to now, and what do we have, more kids expecting everything and not having to endure any pain or discomfort.

Like, their parents as well?

Anyway, back to the top, I don’t get what is to be resolved by beating this dead horse of Study 329, but, that is someone else’s blog, and I hope it gets the resolution the author and regular commenters pine away with every post about it.  Me, I want bad things to happen to the bad guys, and frankly, pleasant and respectful discussion only feeds into the characterologically disordered cretins that continue to get away with bad things.  And I know, what will I accomplish with this paltry blog?

Well, I’ll leave any interested reader with this observation about character.  Pay attention to those around you and see if people you respect and admire do the following three simple things with regularity:

Use a blinker when they change lanes on the road?

Open a door for someone behind them who is in need?

Let someone with just 1 or 2 items go in front when in line for a purchase?

My guess is over 2/3s of politicians never do the above, most psychiatrists with a profit motive also are inattentive to these intrinsic respects, and, in general, most personality disordered people in the communities we live, well, they read the above and might actually say outloud, “who cares” or “what’s your point?”

The whole point of this post comes down to character, and boy, do we lack it as a culture these days.  What is the real shame are the people who come into the office who do know better and intrinsically have decent character, and see they are becoming obsolete in their communities.  Yeah, that is sad and creates some sense of doom in those who are trying to make sense of the senseless.

Like, trying to litigate Study 329 these days.  Hey physician colleagues, would you have gone to Medical School if you knew then what you know now?

Watch that coming 2 X 4 at your head in seeking hindsight…

Summer is almost over, what will Fall bring?  Should I ask?

clueless doctor

This 90 day supply of meds is going to be the death of a lot of people, and I hope insurers are included!



Once again today, I had to call a pharmacy and tell the pharmacist I am NOT writing for a 90 day supply of meds for someone I have seen twice and just settling in on the dose with an expectation to follow up in 4 weeks.  These insurers who have deemed patients get 90 day supplies of meds simply because a script is a maintenance dose is beyond ludicrous, it is the link that a smart and committed lawyer can and should use to get culpability by the insurers for setting a policy that has clinical implications.

But, unfortunately, it will take an idiot psychiatrist to do the bidding, an unfortunate patient to fill the script and then have a negative outcome, and then an outraged family who wants blood.  And the scenario will play out, over and over most likely.

I saw someone recently who OD’d on Wellbutrin and Klonopin from a prior provider and ended up needing heart surgery to repair an iatrogenic caused arrythmia most likely due to the Wellbutrin OD, and the patient was vague if it was a 30 or 90 day supply.  My point to that example:  it may not be an overtly toxic med that winds up being the culprit to a negative outcome.  More than 60 days of some meds can be toxic and not have to kill to be malpractice, and in psychiatry, who do you know, as a provider, you can guarantee can handle having a 90 day supply of psychotropics?

Think about it, colleagues!  I guarantee not only are some patients thinking about it, but, I hope this post has some lawyers sitting back and saying “Hmm, this could be a good opportunity…”

Average Americans do NOT root for the underdog!



First, this study;

Several sources did a fair job summarizing it, this one from the WaPo I will link for readers who might find the actual study a bit of a tedious read:

from there, ““The bullies come out on top,” said Jennifer Wong, the study’s lead researcher. Her surveys, conducted on 135 Vancouver high school students, indicate that bullying is biological, as kids who have dominating tendencies and a desire to rise to the top of social hierarchies often victimize others in order to get there.”

And, “One solution could be to offer high school students more avenues for competition, so that bullies can satisfy their thirst for supremacy in less harmful ways. Another possibility is changing the culture in schools to create a social stigma against bullying.”

Yeah, how’s that going for people who try to be responsible, fair, and just?  Just look at the leading candidates for President, all fairly much bullies and get the glorification for it from the entrenched 25% + equally from both ends of that polluted aisle of Republocrats.

By the way, as I wrote last night in a comment at another blog, this “Black Lives Matter” campaign, no, it is not about “lives” mattering, but, “lies”.  The “V” just stands for vindictive, vicious, and validating of antisocial agendas that these folks scream the loudest for their alleged martyrs in Ferguson, Baltimore, and other incidents where while the police over reacted and killed people.  These citizens who were killed were almost always not pillars of the community, and certainly did NOT cooperate with the police at moment one of the interaction that lead to their deaths.  Resisting police orders, that really is going to result in happy endings.

But, as I also noted in that comment last night, the defenses of the personality disordered are not mature and respectful, but, immature and pathological.  You step back and look at it for yourselves.

Bullies are winning, and the public is just clueless, complicit, and probably more corrupt than the average American wants to admit.

Hot August nights ahead in the East, enjoy those Perseid Meteor Showers while you can, if you feel safe to be outdoors at night where you live…

Addendum Aug 15 PM:  think this says it better than I can regarding the Black Li(v)es Matter campaign:

“The #blacklivesmatter protesters don’t care about abortion, they don’t care about the out-of-wedlock birth rate and they don’t care about reducing the number of black men killing each other.

In fact, if the #blacklivesmatter nutbags get their way, the number of black men dying WILL INCREASE.”

then, “What good is a job in, let’s say, a convenience store if there aren’t any police officers around to protect you from thugs like Mike Brown? What good is more housing when you’re afraid to walk outside because there aren’t any cops to protect you from the gangbangers and drug dealers on the corner? How much does more money for schools matter when you fear for your child’s life every day because his school is like the Wild, Wild West?”

The ending of the article is perfect, so I end the addendum with it and ask readers, how is this a public campaign?:

“However, if these ignoramuses want to scream at random people, try to take over political rallies, block traffic and live in a world where cops aren’t allowed to defend themselves from people trying to kill them, then let them create their own society without police and go live in it. Nobody will miss them. The rest of us appreciate the difficulty of the job the police are doing, like having them around and will support them to the hilt as long as they do their job and obey the law.”

Amen, you want a lawless antisocial group running the show, or, cops who have some accountability and a lot more of them have responsible boundaries and ethical standards?  You figure it out!


Wow, I appreciate validation.


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I have been railing about what I perceive as the frank antisocial component in the Democrat party, but, up to now all I have really used as support is my own anecdotal opinion from what I hear and read from the most outward leadership in the party.

But, I hope readers read this column from John Goodman at

Some of the highlights, or really what are flagrant lowlights he points out en masse with references:

“A study by American Enterprise Institute president Arthur Brooks finds that conservatives are consistently more charitable than liberals. Asone reviewer put it:

Brooks finds that households with a conservative at the helm gave an average of 30 percent more money to charity in 2000 than liberal households (a difference of $1,600 to $1,227). The difference isn’t explained by income differential—in fact, liberal households make about 6 percent more per year. Poor, rich, and middle class conservatives all gave more than their liberal counterparts.

And it wasn’t just money. The conservatives gave more time, more blood, etc.”

Then this gem, “These findings are consistent with my own anecdotal experience. For many years I was an attentive viewer of C-Span’s morning show – where callers could call in on a “Democratic” or “Republican” line. Sometimes lines were labeled “liberal” or “conservative.” What I found striking was how rarely anyone on the Democratic or liberal line advocated a position I regarded as unambiguously liberal. I don’t recall a single caller saying we should all (including the caller) pay higher taxes so that we could have universal pre-school or universal long term care or so we could pay for some other government spending project. Instead, I heard teachers arguing for more pay for teachers, seniors wanting more out of Social Security and Medicare, union members wanting trade protection, blacks wanting more for blacks, etc. In other words, what I heard a lot of was selfishness. The Democratic line attracted a lot of people who want government to intervene for their benefit at everyone else’s expense.”

Well, perhaps to many readers, they can point to the end when Mr Goodman notes both Republicans and Democrats fail their constituencies with either parties self interests at heart.  But, if Obama really is the leader of the Democrat Party, and more than 50% will rally to any and all his “causes” without any hesitation or pause for some concern the agenda is not so helpful and hopeful for the MAJORITY of the public, well, maybe people need to ask themselves what differentiates a narcissistic agenda from an antisocial one.

While narcissists certainly have little remorse for their behaviors, use charm and wit to manipulate, and fail to learn from their repeated poor choices, I think readers might agree the level of:

Lying, outward disregard for harm or other negative consequences, unnecessary risk taking or dangerous behaviors, and repeated violating the rights of others seen universally in antisocials really do differentiate the two personality disorders at the end of the day.

And while I agree with Mr Goodman, both parties have shameless and harmful cretins who put the public at risk without much hesitation, I think the Democrats as a larger majority do it with glee, zeal, and no effort to even contemplate an apology when shown to be flagrantly wrong.

The point to his post is the most disturbing at the end of the day for me:

Matt Vespa, writing at Townhall, quotes New York Times analyst Nate Cohn as saying:

The majority of Democrats and Democratic primary voters are self-described moderates or even conservatives, according to an Upshot analysis of Pew survey data from 2014 and exit polls from the 2008 Democratic primary.Some of these self-described moderates hold fairly liberal views. But the “mostly liberal” Democrats barely outnumber Democrats with “mixed” or conservative policy views, according to the Pew data, which classified respondents based on how consistently they agreed with Democratic policy positions. Only about a quarter of Democratic-leaners hold the consistently liberal views that would potentially put them to the left of Mrs. Clinton.

and the alleged majority of the party allow this dysfunction minority to hijack the alleged intent of helping the people.  Again, being clueless and naive is not a defense or justification for allowing poor judgment to pervade, these folks might as well be overtly complicit at the end of the day.

I leave you with this group of what composes the Democrat leadership:

U.S. President Barack Obama applauds his audience during an event held in observance of World AIDS Day at the White House in Washington December 2, 2013.  REUTERS/Kevin Lamarque  (UNITED STATES - Tags: POLITICS HEALTH) - RTX161CS

Defense Secretary Donald H. Rumsfeld  delivers remarks to students at the Air University at Maxwell Air Force Base in Montgomery, Ala., Wednesday, Oct. 18, 2006. At right is Air Force Lt. Gen. Stephen Lorenz. (AP Photo/Rob Carr)

OH, and how does this relate to a mental health blog?  The fact that most psychiatrists, even if 50.01% of us, are not supportive or tolerant of the lame, selfish, and destructive agendas of the leadership and key opinion leaders of the profession, well, those out there exhibiting continued silence and lack of outward rejection of this failed example of what defines psychiatry makes us complicit, eh?

End of line…

well, there is an addendum (Aug 9 11AM) that again seems to validate my point about the portion of the electorate behind the Trumps and Clintons in this society, and said well by Stephen Hayes:

“The true Trump apologists are way too far in now. They’ve invested too much to bail on him. So his defenders will become increasingly desperate to convince people that this is all part of the establishment’s failure to understand their anger and the media’s failure to appreciate Trump’s appeal.”

then a second paragraph later, “Those who still remain Trump supporters seem to be beyond shame. It doesn’t matter that they’re angry about the incompetence in Washington. Turning to Trump to solve the problems in Washington is like turning to an ape to fix a broken refrigerator. It’s embarrassing, but rather than embarrassment, the Trump followers will feel more anger and their pose will shift from self-righteousness to victimhood. And many of them will dig in further.”

Comes back to what I have written about over and over, when do people realize it is principle that drives healthy and functional behaviors and choices, NOT partisan agenda.  And that is what both sides of the Republocrats have to offer, partisan agenda that has no real benefit for the public.

Maybe there is some principle to these Trump and Clinton supporters, but, does it really branch out for the general public to gain?  I don’t think so, and once again, polarized behaviors by entrenched personality disordered people drives those who are either desperate, or just lazy to work on change.

But, a growing part of the electorate, hmm?

By the way, catch Trump’s comments on both NBC and CBS’s Sunday shows, wow, the man has no clue to when to even try to half heartedly apologize…

Maybe it’s time to use the MMPI in American elections…



The Minnesota Multiphasic Personality Inventory, or MMPI, is a fairly reliable source for making Personality Disorder assessments, and while not perfect, well, what can you say about some of the candidates masquerading as possible representatives, or perhaps better worded, rulers of the people?

What is the MMPI?

“The Minnesota Multiphasic Personality Inventory (MMPI) is the most widely used and researched standardized psychometric test of adult personality andpsychopathology.[1] Psychologists and other mental health professionals use various versions of the MMPI to help develop treatment plans; assist with differential diagnosis; help answer legal questions (forensic psychology); screen job candidates during the personnel selection process; or as part of a therapeutic assessmentprocedure.[2]

In my opinion as a citizen first and psychiatrist second, Donald Trump is a narcissist without much peer, and his performance yesterday, note NOT Thursday night at the debate, speaks volumes why this man should never be in the White House, not even as a White House tour guest as one commentator joked the other day.  And what continues to bother me even more than these faux candidates for public office is this entrenched percentage of an alleged electorate who passionately, but moreso, pathetically support folks like Trump, and Hillary Clinton who I completely accept as a veiled sociopath.

Anyway, I can opine away for paragraphs or even multiple posts on what I think of candidates, but the point of this post is simply this, why can’t we ask people running for office to take the MMPI?  I don’t know who should be privy to the results, be it the party committees, like DNC or RNC, or just some hopefully unbiased and objective third party group, um, if something like that could even possibly exist(?), but, letting some of the people we have come to learn are just completely inappropriate for public office needs to be challenged.

But, I guess that goes back to my earlier comment here, do we have to look at the electorate as well, because why are people like Trump and Clinton having the traction they maintain in the first place?  Just thought an idea worth considering, I know I would like to know who is trying to “lead” us as a society…

pretend psychiatrist

The War on Drugs, Physician burn out, and tonight’s Republican debate, how they all relate.


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Let’s look at each one first:

The War on Drugs, well, what did George Will write about it today:

In there were a couple of interesting comment:

“Some U.S. emergency room physicians are, Winslow says, glad that Mexicans, using precursor drugs from China, have taken over most manufacturing of methamphetamines because this has “standardized the product,” making it easier for physicians to standardize treatment protocols.”


“He [Don Winslow] favors drug legalization because interdiction “is a broom sweeping back the ocean” and because legalization would financially cripple the cartels. But less bloodshed in Mexico would mean more social regression in the United States: Today’s levels of addiction are nowhere near the levels that probably would be reached under legalization, even without assuming the marketing measures that probably would be legal.”

Interesting how physicians are now drawn into this debate, because, quite frankly, physicians are now leading players to addiction, and why in a recent prior post I wrote we now read of states starting to make doctors accountable for this role in prescription addiction.  Which is already playing out as legalization anyway, depending how you frame the issue.

Next, physician burn out, and yours truly seeing this personally with all the flagrant drug seeking by what I think is at least 10% of patients coming into my offices these days, if not even higher in what I had to endure as a Locums doc these past 2 years alone:

In there this:

really, psychiatry and mental health at the bottom at 38%?  I don’t see that as realistic, but then again, with what I have seen as a Locums and had to follow, a lot of these colleagues seem to have no soul in the first place with how they have prescribed in the last few years.

then this graph:

The article says this:  “Of even more concern, among internists and family physicians who responded to the Medscape survey, burnout rates rose from about 43% in 2013 to 50% in both groups, an absolute increase of 7% but a 16% rise in incidence in just 2 years. In last year’s Medscape Physician Compensation Report, family physicians and internists were two of the specialties most likely to say they would choose medicine again—but also two of the specialties most likely to say they would not choose their own specialty again.”

Amazing, when you step back and absorb that FPs and internists would equally say they would choose medicine again or say, basically, “F— it”!

Then this other link,

“Frequent use patients tend to have problems that can’t be managed well in an emergency department,” he said. “Some lack insurance, and so they have problems that need to be addressed but can’t set themselves up with a continuity doctor because they can’t afford it. Others have chronic pain problems and come in looking for relief, and often have developed a dependence on pain medication, particularly narcotics. And this makes ER doctors particularly crazy and frustrated. Which is understandable.”

And, in my opinion, this now includes writing for benzos and even stimulants, and then these ER docs knowingly dump this on office docs, like me.  Thank. You. Not . Much!

So, these drug seeking people who falsely rationalize that being on prescription drugs legitimizes their addiction/dependency, well, just adds to the burn out for those like me who are just being used.

Finally, tonight’s Republican debates starting with Fox News.  By the way, the way they, the network, have shamelessly used themselves as the story equal to the debate itself, well, just watch how Megyn Kelly has made herself the story in every night this week on her show, just pathetic.  Anyway, this debate, what is the point of listening to 17 people pontificate about issues and expect even an attentive and interested audience wade through all the BS going on stage.

How does this all relate in this post?  The War on Drugs has been a waste of time, money, and energy, and cost lives and ruined families.  Burn out in physicians also has been a waste of time, money, and energy and cost lives and ruined families, and addiction both by patients, and by physicians for that matter, has added to those ruins.  And the Repugnocant debate, well, again, waste of time, money and energy to listen to 17 different people tell you each one of them is the best person to be President, when the party has tolerated 17 people, if not even more, running for office and giving them all some platform to mouth off.

War on Drugs, on physicians, the public?  What the hell is going on out there in society?  Idiocy, dependency, and low frustration tolerance.  Welcome to the real world of what America really has deteriorated into these last years.

Got a pill for that?

How is abortion related to mental health?


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I think many Americans are very disturbed about what is being revealed about Planned Parenthood these past few weeks, with the selling of fetal organs and body parts as exposed in the ongoing video releases by The Center for Medical Progress (a surname I really don’t get, but, the partisan agendas seem to like to hide behind such things, eh?).  While there are countless links to this story, the CNN one seems to have other links as well, so readers can surf away, just watch for the rip currents…(didn’t have to deal with them on my trip last week):

Anyway, why do I talk about such a polarizing issue at a mental health site?  I think I broached this topic a few months ago with a post, but I surmise I ended up deleting it when I was worried some of my political posts could have fallout for some Locum jobs I was pursuing, so, while some readers might feel this a bit of an echo, well…

My relating to the two topics winds up being fairly simple to me at the end of the day:  being callous and indifferent to the use of fetuses for the guise of medical research and benefit to living children and adults, well, let’s start with this link to show some less than savory analogies:

“Yes, although he knew he was using the brains of human beings slaughtered in cold blood by his Nazi coworkers (the mentally infirm and the handicapped, many of them children), he explained during the Nuremberg Trials that “those brains offered wonderful material, of mentally poor, deformities and early children’s diseases. Of course I accepted the brains. It really wasn’t my concern where they came from and how they were brought to me.”

Really? That was his justification? To paraphrase: “Even if innocent human beings were being murdered” – the very ones society should protect, seeing that they are the weakest and most vulnerable – “their brains were used for a good cause.”

Does this sound like Planned Parenthood? And is anyone more innocent, vulnerable, and dependent than a baby in its mother’s womb?

To paraphrase their pathetic excuses, “Oh, we’re doing the compassionate thing, using this fetal tissue to advance medical research and save lives. And the companies obtaining the tissue from us are doing a real service to humanity.”

At least Hallervorden was honest.”

Well, I could advise readers to read other links to “Nazi use of body parts and Planned Parenthood”, some of them a bit extreme if not downright rude, but, people forget one little thing about what the Nazis did when going after those who were seen as imperfect:  they went after the mentally ill fairly early on in their “cleansing” of their culture.

My point here?  Tolerating the callous, indifferent, and insensitive commentary of Planned Parenthood defenders and apologists have eerie similarities to what was tolerated and defended by the German people who were not even full Nazi sympathizers.  Because today we listen to those who say basically “no big deal” to allow Planned Parenthood to get away with what they are doing, but I advise any and all readers who are advocates and defenders of those with mental illness, I don’t see the Planned Parenthood crowd probably very supportive of mental health issues, god forbid they have one moment of transparency and candor to what they espouse as alleged needs and wants for our culture.

Abortion is a gray issue, I have no polarized opinion about Pro Choice, or Right To Life, but, I do find people who seem to prey on those who are overwhelmed and fragile, which most women contemplating abortion seem to show, are probably more willing to open the doors to even more heinous opportunities down the road.

And who else is more overwhelmed and fragile, than at least the chronically mentally ill?  You think about it.

I’ll end with this recent news story, remember this guy from Philadelphia?


If not, here is a Wikipedia link to aid your recall:

Not pretty, but, why the Lame Stream Media continues to under report these stories, if not ignore them all together, well, maybe Google “Nazi Propaganda efforts” and see if there are similarities to then, and now.

I doubt readers will like what they might find…!

Why are Clinton and Trump dominating the Republocrat Party?



Like minds dislike alike

I titled this picture “Like minds dislike alike”, as it is what it is, the extremes of personality disordered folk who have nothing but disdain for the general public wind up being the representation for the public.  Really, 25% of Republicans are behind Trump, and at least 45% or more of Democrats are behind Hillary?

What does that say about the expectorate, er, electorate of this country?

Makes one wonder how much of America is entrenched narcissists and antisocials.  More than what the DSM reports as a prevalence, eh?

Again, time for a third party, I think it best called the Purple Party, from all the bruising from the Left and Right that currently rule us.  Yeah, they rule us, they don’t represent us, and in fact resent that they have to put on a show every 2-4 years to get re-elected to their rule.

purple opening

Can this finally make insurers liable for malpractice?



The new BS going on in health care are these mandatory 90 day prescriptions being demanded by many patients, and note in mental health care, NOT a standard of care for over half of them at the very least.  90 day supplies of medication are for stable and maintenance situations, and that does not apply for psychiatry as a whole, at least the first 3-6 months of care.

SO, where does the liability fall here?  Frankly, the way I am handling it, I will not agree to this until patients meet some conditions, like being seen a few times first, no changes in meds foreseen for some period of time, and no history of suicidality or recent inpatient care, at least for the past year if not further.  Some other conditions too, but, not going to detail it here.

And yet, I once met a colleague several years ago who was sued for providing a 90 day supply of meds to a stable patient, who then a few weeks later this patient had a major stressor occur that led to abrupt decompensating and then an impulsive suicidal act of overdose of multiple meds that resulted in the patient’s death.  As this culture is so well known for doing, there had to be a scapegoat, and that was this psychiatrist, who thankfully documented well and in the course of discovery during the lawsuit proceedings, was dropped from the suit.

The family insisted there was no reason for a 90 day supply, but, this patient had no history of suicidal attempts, was not suicidal before or at the time of the last visit, insisted she get a 90 day supply to save a substantial amount of money, and the doctor well documented his displeasure and concern with deviation of standards of care before reluctantly providing it.

Oh, and he also documented he may not continue this practice in further visits per changes in presentation.  Also, he was not happy with the situation as it was dictating the course of follow up visit scheduling, although he was seeing her every three months for the prior 2 visits, but, he didn’t like the idea of any patient having a 90 day supply of ANY MEDICATION in psychiatry.

At the end of our conversation, he noted he was NEVER going to provide 90 day supplies of psychiatric meds ever again, and that was about 5 years ago at least, I don’t know if he is still practicing but with this new mandate, hmm…

So, my reason for this post is twofold:

1.  Providers have to start wondering what is the liability here, but more appropriately who is liable for this 90 day mandate for all medications being paid for by an insurer, and

2.  Will this mess up standards of care for follow up expectations, as patients will almost always assume 90 days of meds at a time, even if not realistically intended for a three month span between visits, that they don’t have to return to the office for 3 months.

Obamacare is screwing up so many aspects of health care, it is amazing that the public by in large remains so silent and complicit with these disruptions, intrusions, and administrative determinations of standards of care.  Amazing isn’t the right word when you step back and reappraise the situation, no, absurd and outrageous are more fitting.

see ya in 90 daze?

obamacare lies

So, who is responsible for all these prescription addicts?



A regular reader, RB, forwarded this link a couple of weeks ago, wasn’t really ready to tackle it until now, but, here it is:

Why this is starting in West Virginia first?  At the end:

“According to a federal report released last year, doctors in West Virginia wrote the third-highest number of prescriptions behind Alabama and Tennessee.”

A lot of opiate addiction is at hand there, and, well, what is the real lesson from this story at the end of the day?  Letting the justice system manage medical issues, well, the real winners are just the lawyers and judges, the losers, the rest of us.  Really, addicts are given yet another bail out for their poor choices alone?

Codependency now has a new name:  complicit physicians.  Once again, no good deed goes unpunished in this society these days, eh?!  Yes, there are idiots and shameless prescribers who just want to collect visit payments whether it be from insurers or conniving cash patients.  But, punishing as many physicians as possible, who really winds up with justice?

When you figure it out, let me know…

'And what if I did doctor the documents? I'm a doctor.'


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