tag:blogger.com,1999:blog-7772182113499451603.post7174148744286261684..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: At The Edge Of My Notes........George Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-7772182113499451603.post-55177502316122619852016-03-07T10:24:47.644-06:002016-03-07T10:24:47.644-06:00I am not a physician but I am attentive to physica...I am not a physician but I am attentive to physical symptoms and try to explain possible connections to lifestyle and mental health issues. As an addiction and eating disorders counselor I was very glad you addressed the risks of over exercise. Most healthcare professionals praise patients who engage in excessive exercise and reinforce the use of monitoring devices, not asking the right questions. The overlap between compulsive behaviors, anxiety associated with these behaviors and distorted goals, inefficient sleep, malnutrition (often disguised as "healthy") and use of weed/alcohol/ xanax to stop the thoughts at the end of the day has to impact many systems in the body. I know my limitations as a licensed mental health counselor so when I have a possible concern I want to collaborate with their physician. If a client is not responding to the medical recommendations perhaps consulting with a mental health professional would be helpful - it's too easy to miss the small window of opportunity to help people. Thank you for this comprehensive article. Lena Sheffield, LMHC, MAC, CAP Miami, FLUnknownhttps://www.blogger.com/profile/03475328193554280966noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-7685251398632065392016-03-06T12:34:42.320-06:002016-03-06T12:34:42.320-06:00I personally have joint hyper-mobility and issues ...I personally have joint hyper-mobility and issues with anxiety but have not found compression type devices to be terribly helpful. I suspect that the anxiety most related to blood pooling and responsive to specific treatments there would be somatic.Simonhttps://www.blogger.com/profile/00479654709456729629noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-55780152435914051932016-03-06T11:57:50.771-06:002016-03-06T11:57:50.771-06:00Simon,
Thought about it for a second and blood pr...Simon,<br /><br />Thought about it for a second and blood pressure drops and blood pooling may be a common precursor for anxiety in a number of situations - the cannabis smoking (heart pounding and anxiety) comes to mind. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-58013801979692351882016-03-06T11:42:47.073-06:002016-03-06T11:42:47.073-06:00Thanks for that link Simon.
That NASA physician I...Thanks for that link Simon.<br /><br />That NASA physician I referred to had the same theory about blood pooling. They used a MAST suite like device to see if that was effective for anxiety and I think they found that walking seemed to work as well. That was back in about 1992.<br />George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-73514342737111524412016-03-06T08:00:47.373-06:002016-03-06T08:00:47.373-06:00There is also this: http://www.scientificamerican....There is also this: http://www.scientificamerican.com/article/people-who-are-double-jointed-are-more-likely-to-be-anxious/Simonhttps://www.blogger.com/profile/00479654709456729629noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-27795132827234553932016-03-05T17:45:47.537-06:002016-03-05T17:45:47.537-06:00Hi Wandal,
Thanks for your detailed reply and t...Hi Wandal, <br /><br />Thanks for your detailed reply and technical pointers. I have used Dragon to dictate into a large EHR, with some success. In a subsequent system it was a total nightmare and that system would dump entire dictations so that they would need to be done again. I spent an entire summer redoing notes because of that incompatibility. I am currently using the system described above on the front end and dictating via phone line to a service that apparently uses a sophisticated voice recognition program to rapidly complete the dictation and file them securely into the EHR. It remains a huge waste of time, especially when I recognize that most physician employees do not get separate time for dictation. On another thread I was told that natural language recognition software would not be at the stage I want it to be for another decade or two. That dooms another generation of physicians to part time stenography.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-81383995622951629872016-03-05T15:35:26.579-06:002016-03-05T15:35:26.579-06:00Hi, George. I read and enjoy many of your blog pos...Hi, George. I read and enjoy many of your blog posts: fun and informative. The recent one (below) re use of notes and work flow was quite revealing . . . a topic I’ve seen very little of in training, literature, M2M, etc. A large segment of my practice is evaluative in nature so I’ve had to fine tune assessment and associated work flows. Like you, I have my favorite tools and much of it a mixture of art, science and personal preference. The interview, note taking, dictation, report/note prep all interweave and I’ve enjoyed setting it up for maximum efficiency. <br /><br />There is no one way to do it but, for me, I have a 1 page template that I take notes into . . . kind of an outline and, like you, I use a lot of codes, abbreviations (kind of like my own shorthand) and some sketching. The general flow of the session is top to bottom but with a lot of exceptions driven by the patient/physician interaction. As things come up that I think are important, I put a dot in the margin then come back and drill down on the dots . I take photos of the patient and their ID/DLic and execute releases as needed.<br /><br />Later, I dictate to my ‘virtual assistant’ (off site); we use a report/note template similar to the one I use to take the notes and use a lot of codes, phrases, macros, auto text, etc. This can be taken to the next level via a macro program; Pathagoras (http://www.pathagoras.com/index.html) is my favorite and especially helpful on those occasions when I choose to do the report/note prep without dict/transcription assistance. Post transcription, the draft comes back to me (online encrypted) in less than 24 hrs; I add color photos of the patient and their ID/DLic, edit to final and attach relevant medical/psych literature to support the Dx, conclusions and recommendations. I’ve worked with my off site assistant long enough that we are to the point where I can often fax/scan my raw notes to her and she can produce 80-90% of the report cutting out dictation time and leaving me to complete the Summary & Recommendation section on my end. The next step that I’m working on is to have the patient log into my web site and complete a detailed history for my review before the initial session.<br /><br />WandalWWWhttps://www.blogger.com/profile/01726183030404796629noreply@blogger.com