A physician is held responsible for a patient's outcome. But the patient cannot choose his physician. The patient must select from a limited list chosen by the health plan. The physician does not have adequate time to be with the patient. Providers must follow benchmark standards, viz., 15 minutes for an established patient. Failure to achieve the standards can produce a scorecard that could take away hospital privileges. The regulatory burden takes away even more patient time from a physician. Before electronic prescribing, it required less than one minute to write an Rx and give it to the patient. Now (unpublished data) it takes roughly ten minutes to get through all the screens, security protocols, and data input to use e-prescribing. Keep in mind that the efficient physician has only 15 minutes total with the patient, and the doctor still must fill out insurance forms and HIPAA compliance directives! The physician cannot choose the best drug for his patient — the pharmacy benefits manager chooses. During COVID, Washington decided medications for all Americans, one-size-fits-all. Physicians who tried to use their best judgment on a specific patient rather than follow Fauci edicts were stopped. Some were subject to disciplinary action, even firing. The doctor does not choose the patient's intervention. The health plan and/or insurer decides what procedure will be performed, where, who does it, when, and even if it is done. The patient or consumer does not pay the doctor or seller — the third party does. Washington dictates "allowable reimbursement" and then repeatedly reduces the amount. All of the above results in an M.D. shortage that, taken to its furthest-most outcome, could and probably has lead to death by waiting and regulations, like a human "queue." Hopefully, no Americans die waiting in line for technically possible care that does not arrive in time to save them. Those statistics are hard to track. Hopefully, enough American continue to become doctors not because of the paycheck, but because of the belief in the Hippocratic Oaths and the joy of helping others.

A fascinating article on the impact of treated vs untreated ADHD and social outcomes for young adults. Basically, NOT getting ADHD treated showed a much higher increase in unemployment, education, and overall satisfaction with life. Click here to access the PDF article that just came out in a prestigious psychiatric journal this month.

A recent CVS Health® survey found that young adults and physicians continue to see the country struggling with mental health, but most Americans aren't seeking care. But 85% agree digital health services like telehealth -- offered here! -- has made mental health more accessible. Six in 10 (60%) respondents aged 18-32 say they are concerned about their mental health, and two thirds (67%) say they know a lot of people in their community that are struggling with mental health issues. Most physicians (56%) also report declining mental health among their patients. However, only 1 in 10 (12%) Americans regularly see a mental health professional like a psychiatrist, psychologist, psychotherapist, or well-being therapist. About six in 10 (58%) respondents aged 18-32 report that social media has negatively impacted their mental health, compared to just 22% of respondents age 57+.

This link shows all the drug-company producers of Adderall, which doses are having supply problems, but most importantly, when the supply is expected to increase. Most seem to target April 2023. Not sure how frequently this page is updated, but looks to be the most accurate source of information since it's coming from the FDA.

Written by Marc Siegel, MD, a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a TV medical analyst: "The COVID pandemic has created a perfect storm for this problem, by sequestering and isolating our kids to the point where they increasingly seek outlets on social media and become trapped inside a world they think they can orchestrate even as they feel less in control in the real world. Multiple studies have now shown that close to 20% of our teens are depressed, and TikTok may be one way to seek out freedom, even if it embroils you unwittingly in an addictive trap. One recent Center for Countering Digital Hate study found that when researchers posed as 13-year-old users and searched and liked mental-health videos, they received potentially harmful content (including about eating disorders and self-harm) from TikTok every few minutes or more. A Canadian Journal of Psychiatry analysis of highly sought TikTok videos about ADHD found that more than half were misleading."

The past 12 months have been the worst I've ever seen in terms of the supply of generic Adderall (both instant and extended) for my ADHD patients. I've never seen things this sparse in my 15 years or so. The problem is highlighted in this article, and presented further in the physician-led video.

(Click on the Headline above) This is a very good op-ed article describing the importance of a doctor being able to set boundaries for their patients, help them, but not cater to specific requests. Many doctors fear being rated poorly on review sites or facing complaints from patients, but most every doctor is trying to do the right thing. Psychiatry, more than any other field, is an art. The art of medicine.

I created a comprehensive video of almost everything I know about ADHD, and how I go about choosing the right medication for a patient. This videos covers all children, teenagers, and adults. I discuss the following: 1) the clinical definition of ADHD (as documented in the Diagnostic and Statistical Manual of Mental Disorders-version 5), 2) the different types of ADHD medications on the market, and 3) how I go about helping patients choose the best medication. Hopefully, you will come away with a greater understanding of this complex diagnosis, and you will be armed with a great deal of knowledge if/when you speak to your provider or others about ADHD. The target audience is anyone, really: patients, caregivers, advocates, students, colleagues. Knowledge is power! Feel free to make an appointment with me if you live in Virginia or North Carolina and are interested in beginning ADHD treatment. Just go to the Appointment Request Form at the top of the page, fill out some basic information, and our office will be in touch.

There's a national shortage of ADHD medications, especially Adderall (generic specifically) that has been well documented over the past year. In this video, I share some reasons or theories I have as to why that may be occurring.

High use of telemental health services by patients with serious mental illness (SMI) who live in nonmetropolitan U.S. counties is associated with improvements in key outcomes, including greater posthospitalization follow-up, new research suggests.