Mental Health Blogs

Archive for May, 2010

Seriously, it’s not that I don’t have any original stuff. There’s a deeper essay waiting for the pen, all about food being the thing women, men, too, obsess about most– weight, to be more specific– and how money rivals this.

But let’s just settle for one out of the two, okay. It’s summertime.

Have you seen Up in the Air? If you haven’t, think twice before reading on. Not that it’s a must-see, but maybe it should be. For Up in the Air is an emotional vehicle. We hear what have to be real stories told by actors who appear to be real people, stories about the torment of unemployment: the initial impact of losing a job; the mental anguish of facing foreclosure, the loss of status and purpose, bankruptcy and shame; suicide. Required reading? Walter Kirn wrote the book. Maybe.

If you’re me and you travel a lot, the opening sequence is captivating– aerial photographs like the ones I’m always snapping with my phone. Some of us really, really like flying, despite the hassle, the aggravation in line, the paranoia of security, the wait. The cancellations. I’m taking off for a couple of days this week, that’s the plan, and my excitement is palpable. Some of the twitter in my belly has to do with being up in the air again.

Ryan Bingham (George Clooney) loves flying, likes the feeling of living out of a carry-on, paring down his possessions to what he can pack into a light-weight vessel on wheels. He is a motivational speaker, talks ad nauseum about the backpack, how if you filled one of these with all of your possessions, all that you have, all the things you own, packed in all of your friends, your family, your people, you would find that you are mightily burdened.

All of this, he implies, the weight of living as a social animal, being grounded, is a burden.

Live like Ryan Bingham and set yourself free.

Has he got OCD, Obsessive Compulsive Disorder? Sure, maybe. Or is he Schizoid or Avoidant disordered, fearful of people to the degree of self-imposed isolation? Nah. He speaks to people for a living, empowers them to be good with a solitary independence, tells us to look forward, unafraid. And he has relationships with women, is handsome and so socially fluid; he even falls in love. (The female supportive actors make the movie, by the way, Anna Kendrick, Vera Farmiga)

Ryan has an agenda with that backpack metaphor, even if he believes in it. What he is really doing, when he tells people that life as a social animal is a burden, a life full of possessions is too hard, is a verbal equivalent of slight of hand, a con.

He works for an outsourcing company. You may be familiar with these. They take the pinch out of unemployment, present you with the package, the severance, point to the finger to other sources of employment. Ryan has the ugly job of having to tell people,

“You’re fired.”

He doesn’t say it like that, he says it nicely. He relabels the experience as, “All great people have been let go.”

Or, “Now you have the opportunity to do what you’ve always wanted to do.”

Or, “Now you can be great, meet your aspirations.”

If you’ve ever treated anyone who has lost a job, the same words, maybe, have come from your mouth. They can be soothing, they can be true. They are a Bandaid, you both know this, but you’re not applying it unless the patient has opened with the concept first, alluded to relief and desire to pursue a dream, sees the possibility. You both know that being let go means there’s a likelihood you may lose everything, certainly much of the life you’re accustomed to living, the one you have grown to know, maybe even love.

You don’t lose your family, however. You don’t lose your soul. You don’t lose your goodness, all that is you, or you shouldn’t, when you lose your job. We hear this in the denouement, at the conclusion of the film.

Real people, people who just couldn’t be actors, speak into the camera to tell us the rest of the story, as Paul Harvey used to say. This air of documentary makes the film so appealing, so real to those of us who don’t mind a little reality in our escape. Escape is therapeutic. The movies can be therapeutic, some more than others.

That’s what happens in therapy. Real people tell real stories, and when the story is about job loss, we talk primarily about how job loss can change one’s role in life, identity. But that is changing all the time, identity, anyway. Change is sometimes inspiring, often painful, and in this case, the change of role, the challenge is gut-wrenching, a test of one’s mettle. We shrinks subtly suggest:

Don’t let the test destroy you. Stay alive, stay well for your family, if not yourself, but do it for you, too. They can’t take that away from you, who you really are, your essential goodness

This is a crossroads. Things will change. You will survive. What was that Spock line?

Oh yes. And prosper.

Perhaps.

And yet, to minimize what has been lost? Unfathomable, unconscionable, very bad technique. Platitudes are a condescension on the part of the therapist, or the employer, assuming the hatchetman is thinking he can really minimize the pain, that by waving a magic wand, speaking with snake oil, that we’ll will fall for the politics. Now you can be great.

Now you will be broke. How is that great? How at all is that great?

When it comes down to money, everyone obsesses. Thus the job of therapy, when money is the crisis, is to increase denial, distraction, help a person draw upon resources and finding new ones, problem solve, and most importantly, stay clear of self-pity, for this eats a person up from the inside out. We might suggest that one of the resources is spiritual resolve, too.* Attention to anything outside oneself, if not just anyone, be stabilizing. (Be careful here, pick your charities wisely).

We don’t say it, but we tiptoe around it.

It’s not all about you, is the truth. Get out of bed. Do something. Anything. You’ll be more tolerable to live with if you do.

Job loss is stress, in no uncertain terms, and managing it is the art of good problem solving, coping strategies, and most of all, maintaining supportive relationships.

So nurture these, I tell people. And while you’re nurturing, grab some dinner with friends. Maybe share a salad.

therapydoc


*Spiritual stuff-  I originally put up some of the cognitive therapy that goes into this, but took it down, sorry. 

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I’m fine, how are you?

Seriously, when the weather gets good in Chicago, it just doesn’t get any better than this. Yeah, so the allergies kill you, but a person’s muscles need the heat, and it’s finally, finally, hot.

What’s on TV?

This morning I’m up a little late and a little groggy and shuffle off to the family room. Like many couples who believe that television in the bedroom is bad for a certain type of intimacy, we make it work to have to watch, and I have to negotiate stairs to find one. FD has brewed the coffee. He’s nowhere to be found.

The remote is mine.

Nothing like morning news teams.

Here’s the good news. ABC is having a contest to name the new Shedd Aquarioum beluga whale. Despite rumors that these creatures can and will eat their trainers (or is that another whale, help me here), the Shedd tells it like it is:

A beluga’s mouth is permanently upturned like a smile. It’s easy to connect with these sociable whales as they glide by in their Oceanarium pool: They might turn a curious gaze your way, crinkle their melons (foreheads) and whistle—or even spit a stream of water!

You can enter the contest at ABC if you have a good name for this little guy.

A good name is everything, really, which is why I’m still boggled at all the sex. Sex, sex, everywhere. It’s only Tuesday, but a quick sample of the kinds of things a person like me hears, rounding the weekend:

(1) men need Viagra, perceive that women need them that way, (nobody wants to work at anything anymore)

(2) fourteen year old kids need birth control,

(3) and the usual beef: I’m just not interested in sex, doctor.

Not to minimize, these are the concerns of the day, not depression, not anxiety. Mostly sex, which is fine, important, and very, very good for one’s mental health. Or bad, depending upon the context. That who, what, when, where and why, thing.

On the 6 am WGN news, it’s Sex in the City every day for a week, fashion shows and interviews with starlets.

I didn’t have time to catch the interview this morning, had to turn off the teev, blog about Law and Order.

Last night it was crunch time to book a fare to Atlanta. So nervous, I had to enter my credit card information five times (wish that were an exaggeration). All day, beat myself up for having waited too long. Chicago to Atlanta round trip should be, at worst, $189 on Airtran, and flights were running $217 each way! But FD promised me they would come down and my son texted me that sure enough they had, so there we are, scoring one of these more reasonable (thanks Airtran) flights, no longer staring at the screen, dejected.

When FD breezes through the front door and shouts, “Law and Order! Final episode!”

“I never recorded Law and Order,” I tell him, pretty sure he doesn’t know how to use the DVR-D.

“I did,” he brags.

“You’re my hero!”

So we book our trips, shut the browser, don’t look back, and settle into the final episode. Law and Order, in case you’ve been truly withdrawn or in solitary, is

the longest-running crime series and the second-longest-running drama series in the history of television, now in its 20th season on NBC.

And wouldn’t you know (serious spoilers coming up, stop reading now) the final show is about a blogger! Unfortunately, he makes bombs. But he’s discovered, lost his cover, because he blogs and has told all, vented on the Internet. It’s going to be epic, he tells us, his exit from the world.

He has also put up pictures of naked girls on his blog, his undoing. Somebody doesn’t like this, that a picture of his unclad teenage daughter is floating around cyberspace, and has reported it to the police.

No pics of the bombs and guns here, or the naked teenager, sorry. Cruise around, I’m sure you can find both someplace else, if you’re that interested.

Anyway, we learn that the bomber is a disgruntled teacher, not a gruntled student. This NYC teacher suffered disciplinary measures and to stay salaried while the case against him is under investigation, must spend 8 hours a day in “the rubber room.” Sort of like detention for teachers, but they do crossword puzzles while on the dole.

The injustice of this, confinement to the rubber room, ostensibly for minor indiscretions like ruffling a kid’s hair, or advising a kid, If you don’t study, you will be not rise above stupid, makes a professional angry. But most don’t leave the rubber room after a hard day of puzzles to make bombs to blow up their school. The mental health issue isn’t explored, unfortunately, there’s no time to really assess why anyone would do this. We assume, stress. But for all I know, I’ve bastardized the entire story line altogether while grabbing chips from the pantry.

I imagine that this is vengeance, and our bomber, Moot, has a severe case of one of the disorders in the DSM IV-TR, probably one that will be stricken from the DSM V, coming to us in a few more years. You’ll get a review soon. I’m in favor, is all I can say.

The issue of privacy is ascendant, that I get, in this last episode. Executive Assistant D. A. Michael Cutter has assembled a grand jury and is asking a crowded roomful of parents for permission to detain 2800 students, to interview them and scan their laptops for clues. Uh, uh, says the grand jury. In fact, we’d like you to ditch the entire inquiry altogether!

That’s not gonna’ happen. Finally, finally, Sam Waterston – District Attorney Jack McCoy, convinces a teacher to rat out the bomber. He is the best, Sam Waterson. Nobody will ever replace him in this type of role. Nobody. All of us want our sons to grow up to be just like Sam.

Meanwhile, we learn whether or not Lieutenant Anita Van Buren (S. Epatha Merkerson) either has a recurrence of her cancer, or is in remission. The docs are going to call her any minute to let us know.

And if you think I’m going to tell you, forget it. That would ruin everything.

Modern Family? Everyone, everyone, everyone, tells me they know a couple like Mitch and Cam. This can’t be. There is such a thing as hyperbole.

Can this be? Seriously? But they are the funniest, the most lovable, except for maybe, Manny, Rico Rodriguez, lower left.

Thirty Rock, and we’ll be finished.

therapydoc

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The American Psychiatric Association’s Annual Meeting began on Saturday and goes through to Wednesday.  Lots of great talks here.  I’m trying to learn a lot more about TMS (Transcranial Magnetic Stimulation), for one.  There have been a number of talks on the use of social media, as well, including the use of blogs, facebook, and twitter.

I’ll post more soon, but just wanted to give our readers a heads up on the meeting.  Also, you can follow the twitter stream on tweets from the meeting on TweetChat using the hashtag #APANOLA2010.  A stream of these tweets is in our sidebar for the rest of this week, and is also below in this post.

Get the Tweet Blender widget and many other great free widgets at Widgetbox! Not seeing a widget? (More info)

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Some posts you write for them.
Some you write for you.

There’s a chill in the early morning air; it’s May, not June, and I’ve got on a good Republican wool coat that my Mom gave me a few months before my father passed away. We were on the way to the hospital, talking about how we both needed coats for the winter, and I complained that Uncle Sam takes so much of my take-home that it’s a luxury I don’t usually afford myself, buying a coat.

“I have one that will fit you,” she says. She’s a fraction of her former self. She can’t wear it anymore.

So it feels good, this black wool coat that is no longer in style, for the shoulders are huge, even without the shoulder pads. I ripped those out, gave it a hard winter, the coat, by spring have ruined the pockets. Decimated them in record time. She might have said something about that once, not anymore.

I’m walking to shul (Yiddish, rhymes with pull, depending upon your dialect, means synagogue) for Saturday morning services, am going to the early service, the one that starts at 7:30, am a fashionable half-hour late. FD always attends this one, but I don’t because most of my friends, if they attend at all, go to a later service, and I like to see them, catch up on the news. But I’m not in the mood to talk today, not even with friends.

Do you ever feel that way? Like you just don’t want to talk to anyone? Your mouth feels stuck. You get to know the inside of your lips. You notice things about them you never noticed before.

The kids came over for dinner Friday night, always the ray of sunshine, goodness. Empath Two, the almost psychologist, is planning a small celebration for my son, her partner-by-legal-contract. He’s now a lawyer. We talk menu and reflect upon the graduation. Although it was wonderful, the graduation precipitated the worst negative interpersonal interaction (code for marital fight) that FD and I have had in years.

FD doesn’t like getting anywhere early, hates wasting time, and he had three hospital “emergencies.” I’m supposed to pick him up at 1:03 for the graduation. I wait until 1:20 and am about to leave without him when he finally exists the hospital, opens the car door. I say nothing, think, we’ll make it.

But I’m driving like a maniac, because doors will close at 2:15, and my mother-in-law is in the back seat, and traffic is murder this Sunday afternoon and parking will take time. FD is on my right, trying to coach me on how to drive, always appreciated. I’m seething, he’s nervous, too, and contrite, I can tell. I’m trying to get a traffic report, like this will matter at this point, and the well-intentioned announcer warns,

“You don’t want to miss. . .”

I shut it off.

“My son’s graduation from law school!”

I shout this at the radio. It’s tense, not funny, my tone of voice. Still, we laugh, all of us, to shake off the tension, at least I hope my mother-in-law is laughing.

But the kid, the kid, we’re so proud of him. The books on his desk intimidate me, and all of us are very proud of that, feeling intimidated by a kid in his mid-twenties. Our kid. We’re proud of all of our kids and their accomplishments. Awed.

But today, six days later, I feel so useless.

As a mourner I can’t make him a party, my new lawyer. Not only that, I don’t feel like making him a party. It all works out well in the end because Empath Two not only feels like making a party, but is doing all of the work. I’m not even making the potato salad, although to be fair, I offered.

It’s a small party, a few friends, some family. I can miss it.

They say that the way Jews mourn is elevated, absolutely brilliant. Those who study mourning rituals for their sociology or psychology classes agree that the week after the death of a first degree relative, the shiva, that full week dedicated to nothing but receiving visitors, grieving, is inspired. There’s no leaving the house for work, or shopping, no cooking, no cleaning, no bathing, either, although some make exceptions.

Cultures within cultures vary, and some make it into one long party, this first week of mourning, but you’re really not supposed to. You’re supposed to sit, preferably on a lower chair, like a patio chair, and chill. You face your visitors who are also sitting, sometimes in rows, for there are often many sober visitors lending dignity to the occasion. Their presence, just sitting, honors the dead.

You can talk about the deceased, if you’re a visitor, but otherwise you wouldn’t open the discussion. The mourner leads and if the mourner wants to talk about baseball or the economy, then that’s what you talk about. But nobody’s flipping on the radio. There is no rock and roll, and in the evening before bed, no movies, no teev for the mourner. I didn’t want to watch anything, not even Glee that week, and muted the Academy Awards the week after.

In fact, for a year, if it is a parent that you are grieving, a Jewish mourner doesn’t go to parties, doesn’t listen to any music at all! Can you imagine? FD is a musician! Should he not play in his own home because I am a mourner and will hear it, unless of course, I’m in the shower? Honey, would you mind taking a shower?

For the first two months following my father’s death, he didn’t play, but he plays a little now.

Occasionally, while listening, the it’s not what we do raises it’s head, that cognitive dissonance. My brain can’t absorb it, the conflict. It doesn’t feel right, doing what we don‘t do, listening to music.

Hey, he’s not playing the Goyescas.

But I’m not turning on Miley or ColdPlay. I just can’t. Not listening to music on the radio has been a challenge, that’s for sure, but it is what it is. And listening to the news is getting very old, because the news is really depressing, the same newscasts over and over again. Shoot me. (No disrespect to those of you who are sensitive to the thought).

I have a best friend who is marrying off her daughter in a few weeks. Ordinarily I’d take part in that celebration, or would try to participate. But I won’t even be going to the wedding, and I won’t be making a shower or a party the week after the wedding for the family, either.

We never quit with these after-the-wedding-dinners-for-the-children-of-our-friends, our relatives, the Polish, the Greeks have nothing on us. We basically wine and dine and bless a bride and groom for a whole week. We try to get the new couple off to a good start. Their whole first year, in fact, is a special year. The groom would never go off to the army in his first year of marriage if they lived in Israel. The bride wouldn’t either, I suppose, since women serve in the army there.

You don’t make the connection between the seven days of mourning following the death of a first degree relative and the seven days of feasting following a marriage, or the customs of the following year, not until you’ve lost a first degree relative. Sevens everywhere, and ones.

Such conflict! Any rabbi would say, Go ahead, you can go to the wedding, especially if she’s like family, the bride, like a niece. Go to the graduation party. But because in our family we don’t do this, in my head it’s an impossibility. And my friend certainly understands, as do the kids. They wouldn’t come to one of my parties either, were the situation reversed, G-d forbid.

So I’m walking to the synagogue wearing a winter coat in the springtime, but feeling good about it, if a little quiet, and I flash on last night’s dream.

There I am, at a party. It feels perfectly natural, too, being around people celebrating, and the music is good. There’s definitely music. It occurs to me that I’m not supposed to be there, not supposed to listen to music, to celebrate.

I wake up in a panic, relieved. It’s just a dream. It’s like an eating on Yom Kippor dream (rhymes with dome-keep-poor– refers to the Day of Atonement), eating on the holiest day of the year, a day of contrition, a 25 hour fast, no food, no water, nothing by mouth, no leather shoes, no anointing.

Hysterical, that so many of us have this dream on Yom Kippor, the eating dream. You wonder, why it’s so common, and then, if you’re me, you realize that both psychological drives for dreams are at work, wishes and fears. Eating on Yom Kippor? A Jewish person who is fasting on the holiday (a happy holiday, ironically) either wishes it or fears it, or both!

Jews, we could safely say, make themselves a little crazy, this is no chiddish (rhymes with kid-ish, hard ch, means newsflash).

And yet, it seems everyone has their neuroses and solutions. Whenever I’m talking to someone who works a program– and I talk to so many people who work 12-Step programs, and more people who should be working programs –maybe for gambling or over-eating, abusing alcohol and drugs, or abusing themselves with sex, or compulsive spending, or they’re working an Anon program, a program to cope with someone else’s issues, now their issue by proxy, or a program for co-dependency– sometimes when I’m with a program person I’ll say,

“It works, if it does, I think, because many of us need structure, some kind of program, a credo of do’s and don’ts that make sense, a way to make our lives and our behavior meaningful. Religions are basically program. There’s small comfort in knowing what you’re supposed to do.”

And that’s what we’re looking for, right, even in therapy? At least some of the time.

therapydoc

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We’re going to start working on The Suggested Reading section for our book. We know what our favorite books are, but if you’ve read something that’s been helpful, we might want to include that. Needs to be mental health related, doesn’t need to be either by or for psychiatrists. We welcome your suggestions! And thanks to Alison who gave us The Noonday Demon.

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http://psychiatrist-blog.blogspot.com/2010/05/stressed-out-shrink-rapper.html

Yes, shrinks get stressed out, too. Can I tell you about it?

I hate paperwork, in case I never mentioned it. And I hate dumb things that are mandated by institutions and don’t make sense. So I’m getting ready to go to APA this weekend ( see you there?) and I’m trying to tie things up. It’s not going so well. Here’s my list:

MEDICARE.
Remember I told you that I moved and tried to change my address with Medicare? Ah, 221 downloadable forms on the Medicare website, and not one of them is a change of address form. To change my address, I had to re-enroll. 27 pages. Then they wanted my office utility bills. But I don’t have utility bills, they are included in my rent. I faxed my rent invoice–it has my address, and it says “office rent” on it. It’s a very nice office. I figured I was done.
Two days ago, I got a letter from Medicare. I’ve been denied my application as a Doctor of Medicine. I can appeal. Why? I didn’t send in three things: 1) Downloadable form 558 giving access to my bank account so they could pay me. Only I’m not an in-network doc. They don’t pay me. Ever. 2) my participating agreement. I’m non par and wish to stay that way. 3) my utility bills as proof of address. Am I the only doctor who rents space with utilities included?
I called. Twice. If I won’t give them my bank account numbers and routing information, I’m out. Which means I have to leave my clinic job where I’ve been for 12 years. I don’t have to fill out a participating agreement. And they’ll take another copy of my rent invoice. I have 30 days to appeal. From the date on the letter which came 2 days ago. The letter is dated in April (it’s now May 20th). And I’m really not happy about giving them my bank account information—what happens when they pay me for patients I see at the clinic? I’m salaried there, I don’t get paid by the patient, the clinic does. If I do nothing, I’m quickly opted out, and that’s a good thing…unless you’re my Medicare patient and you no longer can get reimbursement or you’re the clinic that wants me there. Have other people had to give their bank account info to change their address? Never done this before. Time expended: who knows. Hours. If you’re a non-par provider could you offer some words of wisdom here/?

Next problem:
Clinic says I need to be tested for TB along with all the other employees. So I get a ppd placed, no big deal. Only I work there one morning a week, and in the past, I’ve read it myself or had a dr. friend sign off on it, because it’s a hassle to get to the hospital, park, and take off work for this. Now I’m told I can’t read it myself or have another doctor read it, unless it’s an internist, pediatrician, or pulmonologist. Okay, found a friend, still have to get the form faxed in. Time expended: 2 hours.

Next problem:
My cell phone blitzed last night. I called. They said I needed updates and they’d push them through. Whatever. The phone worked, I thanked them, and half an hour later, I was on my merry way. Only then the phone didn’t work. And my kid’s phone didn’t work. I called back I held. I powered off, I powered on, I removed the sim cards, I read the numbers, I switched the sim cards, I powered on and off and ate the batteries and prayed for ducks to come. The phones aren’t reading the sim cards. I need to get new ones. Okay. Hours. I got to work today. The phone works fine. I called AT&T. Can’t be the sim card. Husband’s phone works fine. Must be the degrading tower. What’s a degrading tower? Does it crumble? Why does husband’s phone work? Very strange, no explanation, but tonight, all the phones work. Time expended: 2.5 hours.

I suppose the last thing is the book. Time expended 4,237 hours. Our editor wants it in Mid May. I think that happened. It’s almost there. We still need a little polish on the last few chapters and a table of contents and Suggested Reading . If you know a shrink book that’s been helpful to you, please let us know in the comments===we’ll try to stick it in.

Hanging on for: http://www.patobriens.com/patobriens/havefun/hrricane.asp

Thank you for humoring me tonight, please send a bill

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As you may remember (or might want to forget) we three Shrink Rappers are writing a book. Taken in bits from our blog, it’s a more serious endeavor to describe what it is psychiatrists do and to explain and discuss our work. It’s written for anyone who is interested in psychiatry–the lay public and students of the field, but not for psychiatrists.

It feels like we’ve been at this forever and a day. We put the proposal together, we searched for a publisher, there was the whole approval process, and finally a contract. The contract was an eighteen month project, so our drop dead date is in late June, and we’re about ready to drop dead. Final draft here, and we are so grateful to our patient families, and our reviewers. It’s nothing short of a miracle that I haven’t killed Roy. Really. And vice versa, I’m sure.

So we’ve had an issue that we’ve been stuck on, and if you’ve been following us throughout this, you know that we can’t figure out what to name the book! For a while, we were using Off the Couch…and I liked it and ClinkShrink liked it, but Roy didn’t and our editor was blah on it, and then last week, another book was released on psychoanalysis called….Off the Couch! So much for that.

Tonight we got together with a mission: Name That Book. We came up with Four potential titles. I’m fine with all of them. And once again, I’m asking your opinion. Please, no Sex with Fish recommendations.

Details: more to follow, but the book, whatever its name might be, will be released in Spring of 2011 by Johns Hopkins University Press.

Please bear with us and vote once again on a possible title!

Which Book Name Do You Like?Market Research

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I got a letter today from a patient asking me to explain why I’ve billed him roughly $4.50 more than Medicare allows. He included a statement from…?Medicare or it’s administrators saying that this lower amount is the Medicare-allowed amount and that if his doctor charged more, a refund is due.

Every year, in December, I try to figure out the Medicare fees. Mostly I call a shrink friend who is in the same jurisdiction who is also a non-participating Medicare provider, which is different then someone who “opts out.” I have to charge the Medicare amount, but it’s always this funny challenge to figure it out just how much that is. At one point, I couldn’t even figure out where I practice—in Maryland there are two districts, 01 and 99, and my office appeared to be located in neither. So now I think I know where I am (no one else I asked was completely certain either). For the record, it’s not easy to find the fees, they vary by district and by procedure and by whether you are a facility or non-facility, participating, or non-participating, and there is the limiting fee and caps, and it gets mailed to me as a CD that doesn’t open, and it’s not on a website that I can find and the psychiatric society doesn’t always have any better luck, and some of my friends are “participating” and have different fees, and most have “opted out” and one just can’t deal so he doesn’t charge any Medicare patient any fee and he doesn’t submit…easier to work for free.

Okay, so every year for the past couple of years, Medicare is cutting fees by 21% or 24%. But at some point, Congress changes their minds and undoes the cut, so I’ve taken to keeping my fees the same, with the idea that it will be easier to reimburse patients (or credit their accounts) then it will be to tell patients that I was wrong to drop my fees and they now owe me money. And every year, Congress votes, after a period of ranting and uncertainty, to undo the fee cut. This year, Congress seems to vote to delay the cut multiple times every few weeks. I called a friend, he got a similar letter from a patient. The tone of the letters imply that we are purposely overcharging or willfully committing Medicare fraud.

The executive director of our state medical society got pulled in. He sent out a newsletter from the Medicare folks. It states:

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