Dr. Amen

[sunlioness]

I was wondering what, if anything, people could tell me about Dr. Amen. I just had a potential patient call me and state that he did not want an evaluation because he had seen Dr. Amen "the ADD expert" who had scanned his brain and told him that he had ADHD and needed a prescription for adderall. He wished me to provide this for him and seemed a bit put out when I told him that I do my own evaluations before making appropriate medication determinations.

But who is this Dr. Amen guy? Does he really scan people's heads and tell them they have ADHD and then send them home to ask a local doc for adderall? I gather he has a book. It says so on his webpage. And he has been featured in Parade Magazine.

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[ClinPsycMasters]

Man, this is tough. Sometimes it's easier to spot quacks but this is an award-winning well cited researcher and physician. However, having seen his website and reading about some of his claims, I have my doubts. Whenever science and helping profession becomes commercialized to this degree, skepticism about the claims is more than necessary.

I feel for those people who do not have the critical thinking ability or are so frightened and worried that they are drawn to bells and whistles, and unsubstantiated claims.

 

[maranatha]

We had a guy come through our psychiatric emergency room who was totally psychotic. He had stopped taking his meds claiming an evaluation from Dr. Amen "proved" he did not have schizophrenia based on neuroimaging. He wasn't my patient, but another clinician said his wife brought a report with him from Dr. Amen's evaluation. If this was true, this guy is making claims about imaging for clinical purposes that are not substantiated and potentially very dangerous. However, I can't say we know the whole story so I'd hold off on assuming things. For all I know, he wrote the report himself...

 

[erg923]

Reports that I have reviewed have largely been gobbledy gook that seemed to try interpret patterns of tracer activity as phrenology, along with lots and lots of overstatements regarding what we know about cognitive functions and brain structure. Behavioral recommendations were reasonable, but some of the medication recs seemed a little too aggressive. All in all it felt like they used SPECT like a party game (something fun and interesting) rather than a medical test. I am also not surprised that he is a neurologist and not a psychiatrist (I think) bc his evaluations never seem take into account other psychological/psychiatric factors (such as somatizaton/conversion) that could be contributing to the patients subjective complaints. There is is no consideration of, nor formal assessment for, feigning or exaggeration either. In short, he seems to simply take advantage of vulnerable people desperately seeking validation that there is an external cause for their problems.

 

[IAmAUser]

.

 

[medium rare]

I was wondering what, if anything, people could tell me about Dr. Amen. I just had a potential patient call me and state that he did not want an evaluation because he had seen Dr. Amen "the ADD expert" who had scanned his brain and told him that he had ADHD and needed a prescription for adderall. He wished me to provide this for him and seemed a bit put out when I told him that I do my own evaluations before making appropriate medication determinations.

But who is this Dr. Amen guy? Does he really scan people's heads and tell them they have ADHD and then send them home to ask a local doc for adderall? I gather he has a book. It says so on his webpage. And he has been featured in Parade Magazine.

He came to the very well-known, private, inpatient treatment program where I was training to promote his SPECT imaging program. He was trying to convince the program to begin offering SPECT imaging to the patients in order to more "accurately" diagnosis their illness and "more appropriately inform treatment" - to the tune of approximately $4500 a scan. While some of the images of scans were intriguing, they really offered little in the way of diagnosis beyond the information that could be ascertained from a solid clinical interview. As for Amen himself, the guy was one of the most profound narcissists I've ever met. I'll never sit through another of his talks again.

 

[ClinPsycMasters]

He came to the very well-known, private, inpatient treatment program where I was training to promote his SPECT imaging program. He was trying to convince the program to begin offering SPECT imaging to the patients in order to more "accurately" diagnosis their illness and "more appropriately inform treatment" - to the tune of approximately $4500 a scan. While some of the images of scans were intriguing, they really offered little in the way of diagnosis beyond the information that could be ascertained from a solid clinical interview. As for Amen himself, the guy was one of the most profound narcissists I've ever met. I'll never sit through another of his talks again.

Aren't they all? And the malignant kind too, I bet, with some antisocial tendencies thrown in there for good measure.

Okay, I have never met the guy who is obviously an intelligent person but based on his website and his claims, he is little too sure of himself and his views.

 

[sunlioness]

Thanks, everyone. This was my sense. Seeing a bunch of out of town people, charging them several thousand dollars only to send them home untreated with a dubious diagnosis and a stack of paperwork and telling them to "find a local doc and tell them you need Adderall" seems like a nice little racket. Funny thing is this guy, who apparently has no insurance, was not only bent out of shape that I wanted to re-evaluate him, but he also didn't like my self-pay fee for an initial evaluation. It is standard and nowhere near what he probably paid this Amen guy.

Anyway, I hope he doesn't call back. He actually didn't call initially. He walked into my office, through the waiting room and right into my actual office where I was on the phone and demanded to talk to me immediately. I gave him my card and told him to call me, but he just kept talking and in the end I actually had to be almost rude to get him to leave. I hope he doesn't call back. If he does and he hasn't actually had neuropsych testing to confirm an ADHD diagnosis, I'll tell him he needs to go get that first before I prescribe anything. That should be the end of it.

I've been getting a few dubious referrals for people who allege they have ADHD and just want meds. They all come from this woman in my building who bills herself as an ADHD expert, but she seems to think everyone has it. She will gladly tell you how she has it herself. At first I thought she was a psychologist who does therapy with ADHD folks. Come to find out that all she does are cash only evals (at over $300 a pop) for people who already think they have ADHD. But I don't know what she does exactly because it always seems to come out the same way: go to a local psychiatry department for formal testing and call me for meds. And she doesn't do any therapy. Just "evaluation". And although she has a PhD, I noticed recently that she doesn't call herself a psychologist which leads me to wonder if maybe she isn't licensed. And if not, she has a nice little racket going herself. There was one time SHE burst into my office herself because she was seeing a client who told her she was suicidal and she didn't know what to do with that. She wanted me to come up to her office and handle it for her. I'm not affiliated with the woman in any way. We rent office space in the same building. I told her no, and had to give her a brief mini lesson in assessing suicidality.

I've started telling people she sends to me to go get the testing first and then call me again.

 

[jettavr6]

I was wondering what, if anything, people could tell me about Dr. Amen. I just had a potential patient call me and state that he did not want an evaluation because he had seen Dr. Amen "the ADD expert" who had scanned his brain and told him that he had ADHD and needed a prescription for adderall. He wished me to provide this for him and seemed a bit put out when I told him that I do my own evaluations before making appropriate medication determinations.

I had a similar situation with a patient recently that I was evaluating in the pain clinic where I am training. The patient told me that she had all sorts of scanning done at the Amen clinic, and was told she had diagnosis x, y and z which needed treatment all of which were narcotics. She had not tried conventional treatments, and was unhappy when she didn't get what she wanted. To be fair, she did not provide any paperwork from the Amen clinic, she could have been just making it up.

 

[medium rare]

And although she has a PhD, I noticed recently that she doesn't call herself a psychologist which leads me to wonder if maybe she isn't licensed. And if not, she has a nice little racket going herself. There was one time SHE burst into my office herself because she was seeing a client who told her she was suicidal and she didn't know what to do with that. She wanted me to come up to her office and handle it for her. I'm not affiliated with the woman in any way. We rent office space in the same building. I told her no, and had to give her a brief mini lesson in assessing suicidality.

I'll bet she is not licensed and, therefore, cannot call herself a psychologist. Doubt her PhD may even be in clinical or counseling psychology - lots of these folks running around out there, unfortunately; I come across them all the time. You can check your state's Board of Psychologist Examiners website to see if she's licensed - if she is, she'll be listed.

 

[ClinPsycMasters]

I've been getting a few dubious referrals for people who allege they have ADHD and just want meds. They all come from this woman in my building who bills herself as an ADHD expert, but she seems to think everyone has it.

If I may digress from the main point of your reply, I think overdiagnosis by legitimate experts is also a problem. Knew a psychiatrist who specialized in severe mental disturbances and psychosis. You were guaranteed an antipsychotic prescription if you were referred to him. Of course this makes rational sense since only the more disturbed patients would be referred to him. Yet, when I was helping with the triage process and looking at the files, I got a feeling that some of the borderline cases may have been treated successfully with SSRIs had they not been referred to him. When all you have is a hammer....

 

[IvanPavlov]

Man oh man, Dr. Amen sounds like a huge quack, he reminds me of a chiropractor. Unfortunately the less intelligent members of society will fall for this type of nonsense. Could this be a tell, 1978-1982 Oral Roberts University, Doctor of Medicine Degree?

The only way that the public can protect themselves is to research various medical groups and find the best medical group in their area. Good doctors associate with other good doctors who self police themselves.

 

[snarfer]

Man oh man, Dr. Amen sounds like a huge quack, he reminds me of a chiropractor. Unfortunately the less intelligent members of society will fall for this type of nonsense. Could this be a tell, 1978-1982 Oral Roberts University, Doctor of Medicine Degree?

QUOTE]

I think the medical school he attended is fine as a few stateside medical schools folded due to regulatory and financial problems some 30 years ago. Medical training, as you know, extends far beyond med school and the most important training occurs in residency and fellowship and after taking all those medical board exams. If I had a concern about his education, it would be where he completed his residency at the military type academy. This is tertiary information but I have not heard good things about the attendings, didactics and clinical exposure at these places.

 

[notdeadyet]

If I had a concern about his education, it would be where he completed his residency at the military type academy. This is tertiary information but I have not heard good things about the attendings, didactics and clinical exposure at these places.

"Military type academy"? He did his residency at Walter Reed. Their Psych program ain't UCSF, but it's a better-than-average Psych program.

And the military residencies vary quite a bit by location, service, etc. I wouldn't paint "these places" with a single brush anymore than I'd talk about the quality of "midwest community programs" as a single entity.

This set-up looks a little like the psych equivalent of the whole body scan outfits...

 

[HMSPSYCH]

"Military type academy"? He did his residency at Walter Reed. Their Psych program ain't UCSF, but it's a better-than-average Psych program.

...

The military has their own psychiatry training programs? where have I been living?

 

[IvanPavlov]

The military has their own psychiatry training programs? where have I been living?

Yes, indeedy, U.S. Army Major Nidal Malik "AbduWali" Hasan completed his residency in psychiatry at Walter Reed Army Medical Center.


http://en.wikipedia.org/wiki/Nidal_Malik_Hasan

 

[push the button]

another thing to be aware of is how much SPECT is used in psychiatry....basically not at all, hardly even as a research tool. Just do a pubmed search of "spect and psychiatry". Next look at the Amer Acad of Child and Adol Psych website and see where you find SPECT mentioned as a useful tool. Basically when people are desperate they are willing to do anything to get answers.

 

[ClinPsycMasters]

another thing to be aware of is how much SPECT is used in psychiatry....basically not at all, hardly even as a research tool. Just do a pubmed search of "spect and psychiatry". Next look at the Amer Acad of Child and Adol Psych website and see where you find SPECT mentioned as a useful tool. Basically when people are desperate they are willing to do anything to get answers.

SPECT IS used in psychiatric research (mostly neuropsychiatry and also basic research) and may be used more frequently in the future.

But in Sunlioness' original post, the physician in question had scanned the patient's head and told him he had ADHD! Now we're talking diagnosis! This is not measuring [SIZE=-1]cerebral perfusion in patient with X disorder--merely a correlation--but using the data to draw diagnostic conclusions, something that is certainly unwarranted. [/SIZE]

 

[sunlioness]

That guy hasn't called back, thankfully.

 

[Doc Samson]

Check out the letters to the editor section of the September green journal for an update. Dr. Amen takes on some authors who had previously questioned his practices in the journal.

 

[Manicsleep]

Are his "pronouncements" or "evaluations", whatever they are called, absolute diagnoses?

 

[235750]

He did his residency at Walter Reed. Their Psych program ain't UCSF, but it's a better-than-average Psych program.

Having worked with USAF and Army HPSP psychiatrists, I can tell you they are some of the most well-rounded physicians I've ever known.

In addition to having excellent facilities, they really push their residents to be balanced docs. They require not only ACLS but ATLS. I've never heard of any civilian site with those sort of standards. Once they finish their residency, they regularly take call at the ED, not as psychiatrists but as the doctor on call. Military residencies usually make great doctors.

So, I'd argue that Dr. Amen is the exception to the rule.

 

[notdeadyet]

Military residencies usually make great doctors.

You might be a bit more enamored with the quality of military medical training than I am. Most military residencies suffer from low volume, skewed patient demographics, and faculty turnover rate that would set off alarm bells in any civilian program.

Psych and primary care are average to above average, depending on location. Pathology, once one of the shining stars of milmed is now below par. Inpatient internal medicine tends to be below par. Any of the surgical specialties and (most definitely) emergency medicine is below par.

Military docs tend to be great people, as there are more lucrative fields out there. But the quality of their residency training is pretty underwhelming.

 

[235750]

You might be a bit more enamored with the quality of military medical training than I am. Most military residencies suffer from low volume, skewed patient demographics, and faculty turnover rate that would set off alarm bells in any civilian program.

Hi NYD,

You're right many of the some of the things you said. The high turnover rate is very true. The military has many silly rules, including constantly PCSing people for reasons I don't understand.

However, I think your critiques about low volume, skewed patient demographics, and 'underwhelming' training are simply not true. Now, if you're talking about post-residency military practice in non-psychiatry fields, you are completely right: you end up treating 17-25 year-olds who don't for the most part never need treatment. I've talked to surgeons who felt pretty under-utilized.

But check out the ratio of psychiatrists to soldiers. In Lakenheath, England for example there are 2 psychiatrists for all deployed personnel in the country. That's over 50,000 servicemen/women and their dependents! You won't get any geriatrics, fair enough, but still, imagine being responsible for a population of that size. Those doctors are never bored and they have some great stories.

I'm not sure how you can look at the armed force's two main psychiatry training sites, Wright-Patterson and Walter Reed, and say there's low volume. Those hospitals are packed, over 18,000 psychiatric appointments per year, and Wright-Patterson even has a child psych fellowship. And again, if you look at their requirements of ACLS and ATLS for example, I think you'll see that few if any civilian sites can match that level of training. Look at their curriculum and you'll see just how much exposure they get to medicine, especially in times where many civilian residencies have only a month or two of inpatient exposure.

This is all really funny because I'm not a fan of the armed forces. You'd think I was a recruiter or something by the way I write, but I swear it's just profound respect for their programs and the physicians I've met.

 

[notdeadyet]

In Lakenheath, England for example there are 2 psychiatrists for all deployed personnel in the country. That's over 50,000 servicemen/women and their dependents! You won't get any geriatrics, fair enough, but still, imagine being responsible for a population of that size.

Your treatment would largely be limited to outpatient issues. If you have a schizophrenic break, you're given the boot from the military. Suicide attempt? Gone. Drug addiction? Gone.

Most folks with serious pathologies are discharged so you won't see them. Now, the VA will get to see them, but not active duty military. Like I mentioned above, you'll get a much more limited scope of psychiatry in the military than the opportunities you'd have in the civilian sector.

I'm not sure how you can look at the armed force's two main psychiatry training sites, Wright-Patterson and Walter Reed, and say there's low volume.

Outpatient, yes. But you won't be getting anywhere near the inpatient bread-and-butter that you'd get at a comparable civilian program.

And again, if you look at their requirements of ACLS and ATLS for example, I think you'll see that few if any civilian sites can match that level of training.

You're more impressed with the ACLS/ATLS thing than me. A psychiatrist that wanted to do either one of these courses could do so in a weekend.

Look at their curriculum and you'll see just how much exposure they get to medicine, especially in times where many civilian residencies have only a month or two of inpatient exposure.

Yep, they do do more inpatient medicine rotations than most residency programs. That said, inpatient internal medicine tends to be lower stress/less volume than civilian rotations (you carry less patients due to volume at most sites).

This is all really funny because I'm not a fan of the armed forces. You'd think I was a recruiter or something by the way I write, but I swear it's just profound respect for their programs and the physicians I've met.

I'm in the National Guard and steered clear of military residencies from doctors I've worked with and military rotations I've done. To each their own, but military medical training on the whole is subpar compared to civilian counterparts. The best military psych programs are comparable to average civilian ones. On a good day.

But I worry we're threadjacking here. Back to the scheduled Dr. Amen programming...

 

[235750]

Fair enough re: thread jacking, but I do want to say a few more things

Whilst I may hold military training in high esteem, I think you give too much credit to their working standards!

I've found that very few soldiers get discharged for medical or ethical reasons. Drug use, yes they do kick you out for that one, but ETOH abuse, domestic abuse, suicide attempts (unless it's results in a disability), and other seemingly pathological behavior, they're ok with. There was one guy who slit the throats of his dogs one day because he got in a fight with his wife. They deployed him the week after. Another man verbally threatened his wife with shooting her. He wasn't allowed to take his gun home anymore, but that was it. And I know of plenty of examples of suicide attempts where the person was ordered to therapy and put into a buddy system.

If you look at our armed forces, the military can't afford to let people go because as you pointed out retention rates are awful. The question the psychiatrist has to evaluate is, "does this person pose an immediate threat to his unit?" and if the answer is no, then back they go with a buddy who is held culpable for his or her actions. And that's it.

Besides, for every 1 service member there are 3 dependents that are free to abuse drugs, have schizophrenic episodes, be bipolar, etc. A civilian population of over 30,000, from ages 0-40s, with only two psychiatrists...that's incredible, no?

So, in summation, the armed forces is full of interesting psychopathology that would hold the interest of any practitioner, be it a resident or a full-fledged psychiatrist.

You are right that the bed capacity isn't huge at military bases, but that's exactly why military residents spend a lot of time at civilian hospitals that are huge. Again, check out walter reed or wright patterson for info on that (which is a civilian residency too)

I mention the ATLS as being an indication of their philosophy, which is a good one. Namely, they really are trained as physicians first and aren't allowed to forget their general training. That combined with the additional time in medicine to me says a lot about their commitment to training their physicians. And add to that regular mass causality simulations, I mean talk about CMEs...I think it's great, they get way more practice in general medicine

I didn't even mention the primary care docs that come back from deployment. Awful stuff, but man, those docs seem to know everything because they've seen and done everything

To each his own! Sorry for the thread jacking. I enjoy the discourse NDY

 

[sunlioness]

Heh. It's my thread and I found this discussion to be very interesting so no complaints from me.

My experience with the military is limited, but I believe the one medical school colleague who was on an Army scholarship and who ended up doing FP/Psych is really happy with her training. However I know of two others (both Navy) who were pretty unhappy and got out as soon as they could. One was IM and after her intern year was not allowed to complete the residency and was instead assigned to be a flight surgeon and run a medical clinic at an airbase on the Mexican border. The other was Peds and she said she saw nothing intern year (which makes sense because the only available population was children of active duty folks) and she elected to leave her residency after intern year to complete her service with the plan to pursue a civilian peds residency later. She ended up being a GMO on an aircraft carrier after one year of sub-standard pediatrics training. Said it was the scariest, most stressful experience of her life.

 

[235750]

ops

 

[notdeadyet]

Well, since the OP doesn't object to a little threadjacking...

I've found that very few soldiers get discharged for medical or ethical reasons. Drug use, yes they do kick you out for that one, but ETOH abuse, domestic abuse, suicide attempts (unless it's results in a disability), and other seemingly pathological behavior, they're ok with.

Good point. Milmed does lots in the way of screening. Folks get referred to psych for the reasons you mentioned as well as what are subclinical behavioral issues ("attitude"). My complaint with the training is that when it's a documented pathology of much severity, they're often chaptered out.

If you look at our armed forces, the military can't afford to let people go because as you pointed out retention rates are awful.

True. Which is why a lot of the lightweight stuff treatable by counseling stays in (and is often handled by counselors and psychologists). But the military also can't afford to keep in folks who look like they're going to become true psych-cases and put a drain on the overstretched medical system.

The question the psychiatrist has to evaluate is, "does this person pose an immediate threat to his unit?" and if the answer is no, then back they go with a buddy who is held culpable for his or her actions. And that's it.

Exactly. Lots of screening. Things requiring counseling and group therapy can stay. But in my limited view, I'd argue that that's a small portion of psychiatry.

Besides, for every 1 service member there are 3 dependents that are free to abuse drugs, have schizophrenic episodes, be bipolar, etc. A civilian population of over 30,000, from ages 0-40s, with only two psychiatrists...that's incredible, no?

Milmed training used to be much better. One reason it's been going down the tubes is for the reason you're describing...

MTF's used to deal much more with non-active folks. But the trend has been to restrict access more and more to active folks and farm out retirees and whatnot to Tricare-accepting civilian care. This is the big gripe, particularly among the procedural folks. The portion of patients that are the largely healthy 18-25yo demographic has been increasing and the real pathology has been shunted out.

So, in summation, the armed forces is full of interesting psychopathology that would hold the interest of any practitioner, be it a resident or a full-fledged psychiatrist.

Point of view issue, I guess. Military psych is a great place for screening, evaluation and counseling. If you're interested in more longitudinal and severe pathology, you're much better off civilian-side. If your interest is treating truly sick servicepeople, you'll get much better training and exposure at a civilian program with a strong VA component. That's where you'll find the crippling TBI, PTSD, psychosis, etc.

You are right that the bed capacity isn't huge at military bases, but that's exactly why military residents spend a lot of time at civilian hospitals that are huge.

When I was debating whether to join the military full-time or part-time and really investigated the military residencies, that was an argument that kept getting thrown back at me. "We get great training elsewhere..."

Okay...? If your bragging rights are the fantastic rotations you have at great civilian hospitals, I'd probably be better off doing residencies at those great civilian hospitals.

I mention the ATLS as being an indication of their philosophy, which is a good one. Namely, they really are trained as physicians first and aren't allowed to forget their general training. That combined with the additional time in medicine to me says a lot about their commitment to training their physicians.

The philosophy for training all residents widely in general medicine is to accommodate the GMO role and the idea that a intern-trained resident can be pulled from residency and put into a role as a general physician for two years. Not common in psych only because psych is an unpopular specialty. Happens to about 25% of Army EM docs vs. nearly 100% of Navy docs.

I didn't even mention the primary care docs that come back from deployment. Awful stuff, but man, those docs seem to know everything because they've seen and done everything

That's mostly spin. Most of the primary care docs who get deployed are sent to FOBs where they essentially do the role of a PA. Any life threatening emergency gets sent to a combat support hospital where you have the EM and surgery folks handle it. For every PCP in the thick of it at the CSH, you have about 40 stationed in FOBs where they mostly deal with MSK stuff other injuries that don't necessitate a trip to the hospital.

Surveys done have found that overwhelmingly the biggest gripe from deployed docs in the military is skill atrophy. There's too much downtime and very little action.

 

[notdeadyet]

I believe the one medical school colleague who was on an Army scholarship and who ended up doing FP/Psych is really happy with her training.

Extremely few spots for that program. your friend must have been fairly on the ball. Hope s/he likes the psych half, as that's where most of them are slotted afterwards (a real dearth of psychiatrists in the Army right now).

However I know of two others (both Navy) who were pretty unhappy and got out as soon as they could. One was IM and after her intern year was not allowed to complete the residency and was instead assigned to be a flight surgeon and run a medical clinic at an airbase on the Mexican border.

That's typical. Most deployments or stateside slots consist of doing sick-call for most of the time, which has to get pretty mind-numbing.

The other was Peds and she said she saw nothing intern year (which makes sense because the only available population was children of active duty folks) and she elected to leave her residency after intern year to complete her service with the plan to pursue a civilian peds residency later. She ended up being a GMO on an aircraft carrier after one year of sub-standard pediatrics training. Said it was the scariest, most stressful experience of her life.

Yeah, there have been a lot of folks pulled out of residency from things like Peds and get slotted as a GMO. I can't imagine being a half-trained pediatrician and being put on a boat in the middle of sea. Granted, very little actually happens, but when something does...

 

[sunlioness]

Extremely few spots for that program. your friend must have been fairly on the ball. Hope s/he likes the psych half, as that's where most of them are slotted afterwards (a real dearth of psychiatrists in the Army right now).

It sounded like a great program, even aside from being in Hawaii, which also sounds pretty amazing. Living all expenses paid on an island tropical paradise? Sounds great to me. But yeah, now she is doing almost exclusively psych (which is fine with her) and last I heard she was in Iraq.

 

[235750]

If hijacking a thread was a crime....

My complaint with the training is that when it's a documented pathology of much severity, they're often chaptered out...a lot of the lightweight stuff treatable by counseling stays in

I suppose this entire discussion is based on point of view because the things I mentioned- slitting dog's throats, threatening to shot your wife,etc- sound like pretty severe things to me! And they all went on to continue to serve. If your standard for 'severe' is Hannibal Lector [sic?], then fair enough, I guess they're not that bad.

Certainly your original point about the population being young (17-25) is quite true. Good for OB/sports med, but bad for most other fields.

And true enough, if you enjoyed working with schizophrenics you'd be out of luck. And you're right, you also don't get to follow up for more than a couple of years.

Yep, GMO required for Navy, that sucks, agree with you there.

But the military also can't afford to keep in folks who look like they're going to become true psych-cases

They also can't afford to, say, get rid of over a thousand Arabic translators just because they're gay. I mean, there's a shortage of them and people could die, so that makes no sense.

Unfortunately in my time working for the armed forces I found them doing a lot of things that didn't conform to reason. There are quite a few people serving who really don't belong there because of a serious mental illness. There are plenty of active duty folks walking around with PTSD, just as one example. Not to mention that the #2 killer in active duty forces is suicide, more common than being killed by enemy/friendly fire. Surely the pyschopathology is severe if so many are killing themselves.

More reasons not to join! So kids: stay away.

Surveys done have found that overwhelmingly the biggest gripe from deployed docs in the military is skill atrophy.

Again, surgeons and the like suffer big like I said. But I've yet to hear a psychiatrist gripe about atrophy of their skills, and I'd be interested if you have. Quite the opposite in my experience.

Meanwhile everyone knows at least a few civilian psychiatrists that would sweat at the thought of psychical contact with a patient.

Oh yeah one other thing.

I never said that armed forces hospitals are superior, what I'm saying is that their residencies are. The fact that they align themselves with excellent civilian academic/community hospitals is not a bad thing, it means you get the best of both worlds. And as I said, you can get the same training as a civilian because several of their programs are open to all.

But it is like you say a matter of opinion and that's fair enough.

I should probably study now or else, speaking of residencies, I might be forced to do mine down at that Florida correctional facility (it's real!) Sorry again for the hijack sunlioness, hope we haven't killed your thread

 

[hamstergang]

To return this old thread back to its original topic, I now have a patient from the Amen Clinic. I feel I can deal with the patient and family despite the obvious difficulties there. What I'm concerned about is that I plan to speak to the patient's doctor at the clinic for the purpose of coordination of care. But how can I speak to an absolute quack professionally?

I'm planning to play dumb to come across as inquisitive but open-minded. That's sort of my default position for navigating the world so the acting shouldn't be too hard.

 

[Ceke2002]

Egads! I just watched the start of a TedX talk by this guy and I had to turn it off less than 5 minutes in, because I was expecting him to go all Buffalo Bill and start saying 'it puts the lotion in the basket, or it gets the SPECT again'. Dayum he's creepy. *shudders*

 

[milesed]

We get this a lot from other doctors in out area. "Doctor ____ says I have ___ and said I need___."

We tell them our diagnosis is what we use to treat and records from others will be reviewed, but we may disagree. They are welcome to go back to Dr. __ for treatment, but there is usually a reason that doc is not treating them.

 

[MacDonaldTriad]

I haven’t seen Dr. Amen so I don’t know if he looks like a duck. I haven’t seen him walk so I don’t know if he walks like a duck. On the other hand, this amount of quack should be like the Schneiderian A criteria and count for at least two.
Can I have an Amen here?
I guess owners of SPECT scanners need to make up their losses somehow.

 

[slappy]

I haven’t seen Dr. Amen so I don’t know if he looks like a duck. I haven’t seen him walk so I don’t know if he walks like a duck. On the other hand, this amount of quack should be like the Schneiderian A criteria and count for at least two.
Can I have an Amen here?
I guess owners of SPECT scanners need to make up their losses somehow.

Presenting Dr. Daniel Amen, psychiatrist and founder of the Amen Clinics:

 

[MacDonaldTriad]

Good God, I only made it 2 minutes and all I heard was I, I, ..I.

 

[Shikima]

Megalomania knows no boundaries.

 

[OldPsychDoc]

Megalomania knows no boundaries.

I wonder if it is detectable on a SPECT scan, though...

 

[Shikima]

I wonder if it is detectable on a SPECT scan, though...

Likely not. But you can see it from outer space.

 

[Therapist4Chnge]

I didn't think I could dislike the guy more…until I watched (part) of that video.

 

[MacDonaldTriad]

He reminds me of the Walter Keane character in the movie Big Eyes. He makes me wonder if deep down he has convinced himself to believe in this, or if he is just making money without care for his own credibility or deception. Both are bad, but I’m thinking the latter after watching (some of) this. At least Dr. Phil and Dr. Oz aren’t as painful to watch. ( I always wanted to use the barf icon.)

 

[smalltownpsych]

I actually made it to the point where he said, "the real reason to not use drugs is they damage your brain" and then I couldn't take anymore.

 

[erg923]

I actually made it to the point where he said, "the real reason to not use drugs is they damage your brain" and then I couldn't take anymore.

His clinic(s) is know for being a bit heavy handed with their psychotropic recs, are they not?

 

[smalltownpsych]

His clinic(s) is know for being a bit heavy handed with their psychotropic recs, are they not?

Of course. I'm guessing it goes like this. "These drugs cause this brain damage that we can see on your brain scan so you need to take these drugs to fix it. That will be X 1000's of dollars please." I did have a couple of patients that spent 5k to get their kids on methylphenidate after a definitive brain scan for ADHD from him. Most of my patients can get the same dx and tx from the family doc for a lot less money.

 

[slappy]

Using (requiring) SPECT scans paid for by the patients (as opposed to being paid for by an organization funding a research project or the collection of data) to diagnose/treat ADHD violates standard of care.

 

[Ceke2002]

Presenting Dr. Daniel Amen, psychiatrist and founder of the Amen Clinics:

Yep, that's the same video I watched and started backing away from slowly from. I just wasn't sure what the rules were on posting a Doctor's actual likeness on here, I mean names are one thing, but videos and photos I was unclear of so I was kind of waiting to see if someone else posted it.

I seriously cannot watch that entire video, the guy makes my skin crawl. Is there something a bit wrong with him? (I mean apart from the fact that he's practicing quack medicine).

 

[Ceke2002]

The Amen Clinics Method Explained by Founder Dr. Daniel Amen (complete with friendly animations and patronising, egotistical narration).

Allow me to try and sum it up for those of you who don't wish to subject yourself to 12+ minutes of TL;DW

Many treatments in Psychiatry are no better than 50 years ago. If you go to a Doctor and explain what (mental) health symptoms you're experiencing you will receive a diagnosis and be placed on medication. Abraham Lincoln went to his Doctor and explained his symptoms and received a diagnosis, somehow this equates to 'ur doing it wrong'. Psychiatrists are idiots who don't understand the very organ they purport to treat because they virtually never look at it. Having virtually never looked at a brain before they just guess a diagnosis based on the presentation of a client's symptoms - Stop it! Stop it at once! There are 7 brain types associated with Anxiety and Depression, 7 types of ADD, 6 types of Addicts, 5 types of over eaters, and a Partridge in a Pear tree - Dr Amen knows all this because of his writings. The Amen Clinic has worked out that one size fits all treatment doesn't work (apparently Psychiatrists have never considered this before). To prove the vast superiority of their targeted brain technique, the Amen Clinic has just published an extensive 6 month study! featuring a pool of 500 Psychiatric patients! Success, quality of life, animated diagrams with an arrow shooting off the charts! Unlike those other Doctors who base their diagnosis on things like presenting symptomology and history taking (and are wrong, very, very wrong, just ask Abraham Lincoln), the Amen Clinic is different in that they start by taking a detailed history, involving their patients filling out a 25 page form of information about themselves as well as gathering information from outside parties (somehow this history taking is totally different to the history taking any other Doctor would perform on a newly presenting patient, because 25 pages you guys!). In doing the history taking the Amen Clinic looks at four important circles of a person's life - Biological, Psychological, Social and Spiritual (again this is something that clearly no Psychiatrist has thought of doing themselves in the history of ever). Blah blah blah genes, blah blah blah detailed family history, blah blah blah diet and exercise levels, blah blah blah head injuries and exposure to toxins - oh look, now we're taking a detailed psychological and social history covering such areas as past trauma, attachment issues and current stressors - unlike those Psychiatrists who are completely wrong in taking a detailed history of reported issues, and symptomology, The Amen Clinic is completely right because reasons damnit! (also not forgetting most Psychiatrists have never seen a brain before and therefore are making wild guesses, unlike the Amen Clinic who apparently have X-ray vision before the patient's brain has even been scanned). It is also apparently very necessary to ask a patient what they're actually doing on this planet when moving onto spiritual matters. But wait, there's more! Come in for your 25 page, four circle evaluation and receive your bonus Brain Spect Imaging - ADD road maps! animated brains with compasses! Blah blah blah we have another study (note to narrator: don't forget to over emphasise every second word or so, just in case we can't comprehend the magnificence that is the Amen Clinic's published studies). Ooh look, more tests, we haz a computer, neuropsychology, skilled Doctors, another arrrow shooting off a chart - look in the sky, it's a bird, it's a plane, no it's the Amen Clinic! And now we're onto 'we have standards don't ya know' - medications bad, Amen Clinic fix by prescribing medications...sorry 'targeted medications' (insert picture of brain that appears to be sitting in its own urinary incontinence because, what? - oh wait, it's just being watered with non toxic treatments from a targeted watering can, this makes so much more sense now). Super fun happy brain bounding up a stair case! Brain reserves! Awww look at the adorable Neurons! I HATE THIS GRAPH! Wait, what? Oh, okay, now the arrow's going downwards (also aging brains, less activity, hey look we did another study, Dr Amen's planning to go all 'Eye of the Tiger' on his brain at some point). Several more minutes of this, plus some other stuff I'm sure is super important (like grid iron players, vitamins, and getting smacked in the head), but now I'll allow Dr Amen to give the final summation - "The Amen Clinic's method is to use the least toxic, most effective treatments informed by imaging in bio, psycho, social, spiritual context." (unlike Psychiatrists who do almost exactly the same thing, but are totally wrong, because BRAAAAIIINNNNSSS!)

 

[slappy]

http://www.ncbi.nlm.nih.gov/pubmed/20439400
&
http://www.ncbi.nlm.nih.gov/pubmed/20826857

He also seems to have published a fair amount in such widely read journals as Advances in Mind-Body Medicine, or some such.