anyone checking out Carlat's new book?

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Suedehead

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I've been a fan of his for a while now. Dig his Carlat Psychiatry Report newsletter and like his book on psychiatric interviewing.

I'm just finishing his new book - Unhinged: The Trouble With Psychiatry, A Doctor's Revelations About A Profession In Crisis.

It's pretty sweet. wondering if anyone else has delved. I'd like someone to offer a counter to some of the points he makes.
 
I too am a fan of Carlat, in fact a few months ago he came to the board and there was some debate.

While I agree with Carlat, that our profession needs some fixing up, I had strong disagreement with his support of a bill in Oregon that would've allowed psychologists to prescribe medications. Carlat, in some articles in Psychology Today, presented the field of psychiatry as one where we just prescribe pills and not investigate several medical conditions.

E.g.
http://www.psychologytoday.com/blog...prescription-privileges-conversation-part-one

I don't think I have to inform you that lithium, antipsychotics, valproic acid, carbamazepine and several other medications by the standard of care require more than just a simple prescription. They require actual medical training to interpret labs, monitor metabolic status, and side-effects of the medications. These are all aspects I felt Carlat minimized, which in effect is misleading the layman that reads this article.

I found that ironic because the Carlat Report is very well written and does emphasize good medical knowledge.

I also don't believe our profession's need for fixing up is specific to psychiatry. In almost all fields of medicine, I've noticed medical doctors not emphasizing the educational and psychotherapeutic aspects of medical care. I think it's in large part due to the market incentives and lack of quality care within the medical profession.
 
I am very hesitant about Carlat now, which is a huge about face given that I once thought the guy walked on water.

He thinks it is quaint when he gets scolded by Mina Dulcan. He gives a gosh-gee-golly defense when one of the worst conflict of interest situations in the history of child psychiatry results in just plain rude behavior (his justification for why this okay was the weakest, worst apology in modern history). And he recently tried to play Gotcha! with Tom Insel because, gasp, Nemeroff is still allowed to apply for NIH funds (which is not the same thing as recommending him to Miami).

As I've said before, he's turning into the Ralph Nader of psychiatry: a guy who once saw things that were wrong and then did good work to fight the things that were wrong, who then started alienating people, getting reckless, and writing books.

I still respect Ralph Nader and Daniel Carlat. But I don't know if I trust their judgment as much any more.
 
The problem,, IMHO, with a blog is if you actually open up for real, you're going to have several comments that are not walking on the high-ground. That's what I think is going on with Carlat and his blog.

If I had my own blog, during fellowship, you'd see a lot of complaints written on it. I've worked this year with one of the top guys in the field. The guy expected me to do my best and had very high standards. If I had a blog where I vented all of my frustrations, I'm sure I would've mentioned here or there how I didn't like my butt being kicked. It might've given others a bad impression.

But overall, the program was great. It's probably been the best curriculum I've been through. My butt getting kicked was often due to my mind going through the ego-dystonic process of seeing mistakes I was making and seeing better ways to do things. People tend to vent frustrations on blogs.

But a problem here, is that like any psychiatrist (or any doctor for that matter) putting up their opinions in a public forum will alter people's perceptions of that doctor, for better or worse.

If a doctor for example were to go on some roman orgy website (and I'm only using that example because it was used on the TV show ER, this has nothing to do with Carlat), and mention his name and how he wants to hook up with others for the local orgy, sure it'd negatively affect people's perceptions of that doctor, even if that doctor was the best in the area. Just like we don't want to hear about our local pastor's sex tape that might've leaked onto the internet and gone viral.

This is probably one of the reasons why thelastpsychiatrist.com keeps his name anonymous. Carlat's report is an excellent source of information. I'm still a big fan of it and him.

But getting to your Nader analogy, I very much disagreed with the Oregon bill, mainly becuase it left ambiguity as to WTF was supposed to happen if the "physical" health professional and the psychologist disagreed. This can and would lead to several legal problems concerning responsibility and the operation of care if the bill was passed. Having someone being specifically pinned having the final say on a medication certainly points to who is responsible IMHO would be needed. How do I know this? I see several psychiatric patients where their PCP is ignoring some medical issues, and I, as another medical doctor, but not the doctor in charge of that specific medical condition, am very very frustrated. At least in this situation, there are some guidelines pointing to who is responsible for what, and I can do what I can up to where those guidelines tell me what to do. Supporting that bill IMHO did seem a bit Naderesque.
 
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