When “a picture is worth a thousand words” becomes “a picture is worth many endless turds”.



RX endless turds


This picture is run in many psych periodicals of late, and when you look at it, doesn’t it just offend the hell out of anyone who reads into the intent!?

The patient is uneasy and distant, the clinician is intruding and looking either suspicious or at least not outwardly supportive, and who the hell is this chemist in the back of the room???

Better living through chemistry, eh?  Nah, not to me.  “Patient inspired” is the logo for the company, well, as long as the patient don’t expire, keep on selling them drugs, folks.  Here is the better picture for the message, you decide:

drug dealing


It is what it is these days, “Mother’s little helper” redux from the Stones, and boy, we still don’t get it, do we?

Another lame post as copying one from earlier.


infinity mirrors


I have always been fascinated by mirror to mirror image, as close to infinity you will ever be able to grasp tangibly.  Anyway, this post I wrote a while ago is still fitting, so you can read and digest.


The post as written:


The title of this picture is “a bitter pill to swallow”, and that is not only fitting, but the metaphor of what mental health care has been simplified and trivialized into these past 10 years.  Let’s have a brutal and candid moment of honesty and reality folks, patients aren’t interested in expending the time, money, and energy to truly problem solve their mental health issues and needs any more.  No, they want and demand the quick fix, the simple solution, the easy out.  And I say give it to them!

So, I advise every state in this country that runs mental health clinics to let go of 50% of the therapists at the state clinics by the end of the year and just have psychiatrists treat about 80% of the patients alone, and allow the doctors to provide some amount of therapy along with the predominate medication management visits that go on now for at least 50% of the billable care provided anyway.

Why do I suggest this today?  Come on, we all know that the majority of therapists aren’t providing real psychotherapy at Community Mental Health Clinics these days, no, they are just holding hands, writing treatment plans, and trying to be psychiatrists without the training nor expertise.  What happened yesterday to motivate this post?

First, the patient who has enough psychosocial crap going on that could keep the patient busy for at least every week visits for honest and dedicated therapy care, if not even 2 a week attendance, but after not showing up for a therapy visit for almost 4 months, the patient shows up for a visit and just after 15 freakin’ minutes in the office, the therapist is at my door asking me to change the meds I started 10 DAMN DAYS AGO!!!  Yeah, thanks for that effort, COLLEAGUE!

Then, about 2 hours later, a patient who is a bit complicated with probably both mood and psychotic issues, comes in after a therapy visit just prior to meeting with me, and tells me what meds the patient needs as the therapist spent much of the therapy visit discussing the meds this patient needs to think about changing to in order to be stable.  Yeah, that homelessness and lack of support in the community will really dissipate quickly with a med change.  At least the patient admitted it was ridiculous for the therapist to be suggesting medication changes without any specifics nor knowledge of side effects or risks in changing the current meds.

THIS IS WHAT IS GOING ON IN THERAPY OFFICES THESE DAYS AT LEAST 50% OF THE FREAKIN’ TIME, BOTH IN CMHC AND EVEN IN PRIVATE PRACTICE OFFICES THESE DAYS, PEOPLE!  Therapists by in large aren’t interested in providing appropriate therapy interventions, they have bought and sold the biochemical model, and if the patient is in any way difficult or not invested, then the therapists want the patient drugged and out the door.

So, to all those bureaucracies out there trying to save money and maximize health care interventions, unload those non MD staff as much as able, and let those who are invested and trained to provide care the way it is intended to be the providers.  And this is not sarcasm or a joke, this is what mental health care is today.

To all those “therapists” out there who want to collect a pay check and do the least you can do, don’t let the door hit you on the ass when you are escorted out.  Frankly, if some of these patients could get appropriate legal representation, suing some providers would reinforce the message to administrations out there who want to avoid the publicity in the first place!

And when the quick fix fails, as it will as many psychiatrists will do just 15 minute med checks onwards anyway, maybe some of these joker asshole MDs will also face some malpractice consequences as well.  Hey, time to touch the stove, folks.

Me, I am ready to provide the compliment of care I was trained to do in residency.  This god damn compartmentalization by insurers and administrators and false equivalent non psychiatrists, well, good luck with your agendas as currently in place!

Oh, there will be more about this matter in days to come, COUNT ON IT!!!



So there you have it, nothing new, but well said in my opinion.

Oh yeah, that is my opinion.  Kinda like that mirror at the top…

What else has to happen that Obama will ignore or trivialize before you all get it?!



The way the CDC and Obama have screwed up managing the Ebola crisis is just a combination of ridiculous, stunning, and sheer idiocy.  And, once again, how do you rationalize shutting down travel to Israel under the hypothesis that planes could be shot down by Hamas, and not just level that f—-g hell hole next to Israel, and then tell us we have to allow people to travel from Western Africa so their economy won’t possibly collapse?  If that is not the worst textbook example of twisted, sick, and perverse logic, well, then readers here can explain what frightens me even more than Obama and his sick agenda:  how do we have a pervasive 35% of Americans who say in poll after poll that Obama is doing a good job, his policies are helping America, and, he is a good leader?

That scares the shit out of me, not that there is a fixed partisan and antisocial gathering that is out to mess with the healthy public, but, responsible and focused people don’t get in these idiots and scum bag faces and let them know that ignorance, apathy, misguided blind loyalty, and sheer self destuctiveness will NOT be tolerated.

But, those who care and are willing to fight for what is right and needed are fewer in number every damn day of late.  Hell, I see this mentality in mental health every job I take these last few years.

The meek will inherit the earth?  Nah, just cockroaches and weeds, we will snuff ourselves out, letting the hideous and clueless rule until death pervades.  Hope you liked the post!

Addendum October 17:

Watch the video and think!


People want to reduce their anxiety significantly? Vote in 3 weeks, with your heads, not your rears!!



I see more and more people come and say “I have anxiety”, “I am overwhelmed”, or “I am anxious about everything”.  Well, hey, ISIS, Ebola, the IRS, more police shootings and random violence by officers, and let’s not forget health care insurance, so, what is this miraculous drug they are all seeking?

Please be sure to get back to me with the answer, and make sure it is cheap and available in large quantities.

Give me a damn break, pay attention to who controls you in your state and federal representations and decide if you want another 2-6 years of their rule.

Oh, and the voting booths should not be in the school bathrooms!!!woman screaming

A painful read, but, a necessary one too.



hope and freedom


You won’t be very comfortable after reading this link, but, it reminded me of one of my most painful moments as a resident, first the link:


In there was this from the author, Ms Maynard:

“I would not tell anyone else that he or she should choose death with dignity. My question is: Who has the right to tell me that I don’t deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?”

Without going into detail again, as I think I wrote about the situation in a post last year, I faced an older woman, about in her late 60s, and she was dying of metastatic breast cancer, having been hospitalized for severe pain and complications of chronic opiate use.  She wanted staff to give her a lethal dose of meds so she could die, as she believed if she took her own life it would have consequences of her afterlife options.  The physicians who admitted her wanted me to psychiatrically hospitalize her as “she is crazy and suicidal”.  Well, at the end of the consult, I felt she was exhausted and wanted to end life on her terms, with her family around her and at home.  I said “No” to admitting her to a psych unit, and advised she be discharged home once medically acceptable.

The physician did not take well to my consult eval and recommendations (yeah, the one time you’ll read PC commentary here!), but thank god the attending psychiatrist over me supported me and was quite unusually very heated at the nursing station in telling the physician “transfer the patient to another colleague and get out of my face”, agreeing with me we as doctors can’t save everyone and certainly can’t avoid their deaths, especially not on our terms sometimes.

I found out a couple weeks later the patient was discharged a day or two after I saw her and died at home about a week later, and between the lines it was inferred she had “assistance”.  Good for her.

That is why the paragraph above from the link hit home for me this morning.  Who the hell are we as doctors to supersede other people’s choices when it is obvious that life has been spent, that quality of life is not going to be what others would accept if in those shoes of the terminally ill?  One thing the woman I spent an hour and a half with in that hospital room 22 years ago said to me that still comes back to be heard to this day is simply this:

“Why can’t people accept that fact that I want to die, that I have lived, and I don’t want to end my last days in a cold, sterile place like this!?”

I don’t know about afterlife options, I have my theories and hopes, but one I will throw out is this:  if there is an afterlife we all share that is for those who did more good than bad, I bet the woman above is there and well received and supported by her peers.

I just hope there is a separate place for those who are more bad than good, and their peers deserve each other for a despicable eternity.  Why we can’t get some validation this plays out to give some pause and reflection while alive, well, I guess your spirituality has to give you that hope and faith.

I’ll end with my favorite picture found on the web:

road to paradise

It is endless what the President does to do nothing!



Fridays I go to read Charles Krauthammer’s column at the Post, and today, well, you read it and weep, which you would if you honestly cared about America:


in there was this:

“Obama has committed the United States to war on the Islamic State. To then allow within a month an allied enclave to be overrun — and perhaps annihilated — would be a major blow.

Guerrilla war is a test of wills. Obama’s actual objectives — rollback in Iraq, containment in Syria — are not unreasonable. But they require commitment and determination. In other words, will. You can’t just make one speech declaring war, then disappear and go fundraising.

The indecisiveness and ambivalence so devastatingly described by both of Obama’s previous secretaries of defense, Leon Panetta and Bob Gates, are already beginning to characterize the Syria campaign.”

Again, I know I am an echo chamber, but, when do you call someone on cluelessness without concern, or, have the right to conclude inaction is to create covert action by others to fill the void?

If facts do come forward that show Obama is out to ruin this country, what are all of you going to do if that happens?  The typical, “oh, I can’t believe this is true.”? Nah, you are all focused on how to avoid Ebola.  Hmm, another lack of action ploy there as well???

Sad, scary, and stunning, all in one sentence.  Have a nice weekend.

Addendum 2 hours later:

Wow, this is beyond worth the read:


I won’t even try to highlight comments, the whole thing has to be digested, especially page three, and boy, is it ugly to read.  But, it is complete.

If you are going to a Community Mental Health Clinic and the doctors keep changing, BEWARE!

I’ll write more when I get home, but, it is more than obvious to me that clinics that keep using locum docs and going thru 3 or more in a year are making a loud statement to their patients.

I’ll leave you with this picture, this is what I lug to my office through a locked door over 40 feet away from the front desk every day, and today’s stack weighed 40 pounds.  the cup is there to give perspective, it is 6 inches high.


Crazy stuff going on where I am at now, and oh, they want me to see new evals up to the last day I am there, but, will not leave me slots to schedule for follow ups and can’t guarantee the next doc will be available for much of November.  Incredible what administration does to screw up care!

Not a smidgen of corruption by the IRS, right, Barry?


Oh man, you gotta love what the jerk Republicans are doing, as far as the corrupt Democrats see this investigation against the IRS.  Read this beauty, NOT about the Tea Party here, but, the consistency this agency is doing to hide their corrupt and disruptive efforts is beyond incredible, it almost redefines what antisocial agendas can try to accomplish, with the leader in the White House in charge:


Yeah, you all keep rationalizing, minimizing, denying, and deflecting how serious the IRS investigation is about.  Oh, and pay attention to the lap dog of Elijah Cummings who is the “Senior” Democrat on the committee.  Notice that he reads almost 90% of his comments and alleged spontaneous outrage rebuttals, because the jerk is scripted, from beginning to end.

It is nothing less than disgusting he is one of the Maryland Derelict-gation that goes beyond kissing Barry’s butt day in and out.  And next month, ALL of them who have been in power will stay there for another 20, er I guess just 2 years is the term.  But, Maryland does get the resent-ation, oh, again, representation it deserves by voting with this lever:

voting booth lever


Can’t wait for the electorate to take another dump, EH!?

Don’t ask, Don’t tell takes on new meaning with our “President”





I have read some disturbing and uncomfortable stories about his guy above, but this one should really make anyone who is even a bit unsure what Barack Obama is doing in the White House even more perplexed, if not downright frightened, allegedly still believing he is representing and protecting the people of the U.S.A.  Read and ponder:


“This is not the first time questions have been raised about Obama’s lack of engagement and interest in receiving in-person daily intelligence briefings. On September 10, 2012, the GAI released a similar report showing that Obama had attended less than half (43.8%) of his daily intelligence briefings up to that point. When Washington Post columnist Marc Thiessen mentioned the GAI’s findings in his column, then-White House Press SecretaryJay Carney dubbed the findings “hilarious.” The very next day, U.S. Libyan Ambassador Chris Stevens and three American staff members were murdered in Benghazi. As Breitbart News reported at the time, the White House’s very own presidential calendar revealed Obama had not received his daily intel briefing in the five consecutive days leading up to the Benghazi attacks.”

Sure, the usual spin by the apologists and defenders is either this information daily is not essential to get it in person, or the president really is not so invested in the day to day operations, which is inappropriate, but hey, he is president, he can do what he wants.

Then there are the dissenters who say the president is just clueless and wanting to be a rock star and his narcissism is unchecked.

Then there is me, and my take is still simply this:  he will continue to chip away at the basic fabric of this society until we are primed for destruction.  Take the Ebola Matter as reported today, Oct 3rd.  People worry about suicide bombers, well, what about this image:



Maybe destruction from within is a goal of those who hate and detest this country and what it stands for.  You can dismiss this concern, or, wait for real consequences to play out and how the “leaders” handle it.  From afar, maybe in bunkers, while you all are left to fend for yourselves.

Read or watch the TV miniseries by Stephen King, The Stand, and see what might actually be applicable.  But, things to play with and watch on your screens, sorry to interrupt your lack of vision.

the link to amuse and consider:


Oh, and who are these persistent 30-40% in polls who think the president is doing a fine and capable job?  His minions?  Gotta love politics…


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