I know, right?  Only ten?

A ridiculous story about a female medical student needing to go to appeals court to get extra time  during the medical licensing exam so she could breast feed her kid.

Here's why it's ridiculous.  If she had ADHD-- which does not exist as a physical entity but is considered an illness-- then she could get extra time.  But because it's a baby-- which does exist, but is not considered an illness-- then she is entitled to nothing.

Oh my God, thank you.

Exactly.

(If video does not appear, you are the victim of censorship. Remember, remember the 5th of November. Or just click here.)

Do you know how many psychiatry journals there are?  A lot.  I get 8 peer reviewed journals mailed to my house, not to mention the shopping bag/week of "Insights" and "Reviews" and "Expert Series."   What the hell could be in all these journals, other than drug ads?  Is the field evolving that rapidly?  I mean, just how much info can there be about Lamictal?

But I'm happy to announce that the hundreds of articles are all top notch, cutting edge stuff.  Let's look at a recent one, about how to conduct and document a suicide assessment. 

I'm a busy man, with a lot to read-- what are the main, state-of-the-art points that I need to know about suicide?  

Awesome. 

Also suggested was listening to patients, preferred over caning patients, which can sometimes be misconstrued as insensitive. 

"A student gunman remained on the loose Friday after shooting two students..."  He's male. No motive known.  Classes have been cancelled. School is on lockdown.

"The shooter is still at large," Carlos Holmes, a university spokesman, said at a press conference near campus. "Given the lessons of the past year, we cannot assume that he is not on campus."

The FBI is involved.  And everyone wants to know: is this Cho all over again?

Before you answer, let me give you one single piece of information, that should be irrelevant, that turns out not to be.

Someday-- right now-- your kids, and their friends, will be googling you.

Who's hot, and who's not?  Ok-- who's dumb and who isn't?  Were they different?

Now-- who knows way to evil power source? 

Wow.  Wow.  Fed cuts 50 basis points.

The Fed did the only thing it could do, given the circumstances.  Now people can maybe keep their homes, maybe we don't slide into recession.

But oil goes to $93 and gold to $800, and people think twice about buying corn.  Meanwhile GS goes to 220 and the Dow to 15000.  And the split between rich and poor becomes visibly wider.

Oh, you want a psychiatry angle.  Ok.  Zero percent chance of universal healthcare in the next 5 years.

(disclosure: long gold, GS, GOOG; short Iran and Angelina Jolie.) 

The headlines read, "Highest increase in youth suicide" and "girls aged 10-14 increased 75%."  And of course, the only explanation anyone seems to want to debate is antidepressants: was it too many prescriptions, or too few?   And self-righteous indignation all around.

Well, I did something apparently no one else cares to do: I looked up the individual suicides.  They are individuals, right?  With different reasons for doing things?  And guess what?  I have another explanation:  Ohio. 

145000 unique visitors may not seem like a lot to those in the porn industry, but it's a lot for me, and especially for a "throwaway post" like the one on Halloween.

Getting on Digg and the front page of reddit certainly is the cause of this, but not the explanation.  The post got over 200 comments, not counting what my spam filter destroyed; more importantly, the post went to places like metafilter, where it had over 170 comments-- more than any other post that week.

Why?

And it's wasn't this. 

Because it's true. 

Is the thing going to be serious, or not?  If you think not, then monitoring it won't make any difference because it won't be serious.  If you think it could be serious, then you should be monitoring it whether or not there are lawyers in the world.  Are you saying that the only reason you would take this thing seriously is because of lawyers?  Then thank God there are lawyers. 

If you blow it off and it turns out to be serious, then you made a mistake, you were wrong.  Then becomes the question of whether you were negligent.  Would others in your profession have also blown it off?  If so, then it wasn't negligence.

Doctors often think that if they don't do something- a test, document a finding, etc-- they'll get sued.  "I have to check the level."  "I have to document "no suicidality.""  "I have do an AIMS test."  "I have to give him a copy of the PI."  The reason is "I'll get sued if I don't."

But lawyers can't sue you for not doing these things.  They only sue you when something bad happens.    If nothing bad happens, you could be drawing penguins in your chart, lawyers will never know. 

Forget about lawyers. Be a doctor: do you need to check that thing, or not?  

If your clinical behavior is significantly different because of the existence of lawyers, you need a massive overhaul of your thinking and practice.  You have lost your way.  And patients will suffer.

(See #4.) 

Jerome Groopman's book, How Doctors Think, is porn for doctors.  While ostensibly about the ways in which doctors make errors, the real message is sure to elicit hands-free climax in clinicians: "good" doctors make fewer mistakes because they go beyond statistical probabilities and treatment algorithms to consider the whole patient.  They use their clinical judgment.  Many of the enemies are the usual suspects, insurance companies, Pharma. 

While the book is worth reading, it isn't worth reviewing, I'm afraid-- I'll egocentrically say I think I already covered much of his ground.

But what is worth reviewing is a review of his book, by Charles Lambdin, a grad student in psychology.  The review is called How Doctors Think They Think.  And it is outstanding. 

 
How a relatively unused metric can help you score chicks at the Limelight.

That's right, I said score chicks. You got a problem with that?

Yes, but it doesn't mean younger children can't be older than someone, too.  Everyone's a winner!

That said, according to USA TODAY and Science Magazine the oldest kids are the smartest.  Let's assume that this is correct.  What's the reason?