07.25.09
Posted in Personality, Contributors, CBT, Stress, Anxiety, Depression, Uncategorized at 2:41 am by admin
THOUGHTS FROM AFAR
I know almost noting about he American health system. But I am an Israeli, UK educated physician working in management dealing with mental health care reform.
So here is my twopenneth of thoughts.
I do know that no one buys a pig in the poke. Today’s medicine is expensive, incoherent and economically unsound. These conditions make a ‘tax led’ expansion nigh on impossible.
I think that we should consider what can be done and how?
The driving force for change may be political. But change has to encompass both delivery and payment.
I will develop a theme that states basically that costs and delivery can and must be altered before payment can be tackled.
Payment is pivotal in the making of universality.
REFORM:
There is no such thing as reform in medicine. There are far too many vested interests, preconceived ideas and established practices.
To make life easy lets call the involved parties shareholders.
Shareholders must want change. The change has to be as a constructive evolution and not a threatening revolution.
There can only be small, graduated and, hopefully coordinated incremental changes.
All reform has to have both a strategy and tactics.
Each change must be seen as being beneficial to most and detrimental to none.
In other words every shareholder must see some befit before he will take some risk. The benefit must be tangible and the risk less than such. It cannot be the opposite.
DESIRES:
What do we want to do?
Most encouragingly all the shareholders agree about what they want and do not want.
They want comprehensive, coherent professional care.
They do not want to have their economic status threatened. The user does want affordable health care. The industry member wants to maintain their income level.
So far so good.
So let’s take the first step that is accepted by all.
Lets just save money.
FISCAL PRUUDENCE:
We’ll examine but two issues.
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Litigation:
The cost of insurance coverage is enormous.
We could offer an alternative coverage. The choice would be of the individual but the premium would be affected accordingly.
We would need to set up a State Quality Monitoring Board[SQMB]. The SQMB initially would have the following powers:
- Arbitrate in all litigation concerning mal-praxis.
- Set maximum sums to be paid according to misdemeanor.
- Set and monitor accepted practices in utilization of ancillary medical diagnostic services.
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Reduced expenses:
On signing to being in a program that is under the aegis’s of the SQMB the premium could be reduced if the patient also agrees to:
- Wherever possible, as the treatment of choice, use generic medications.
- That all laboratory services would be done in accordance with absolute, medical needs. Put bluntly, not because I may get sued or it would be nice to have the tests but because I need this test to do good medicine.
If we get this far, and we can, we will see savings.
So we can move to the next step.
EFFICIENCY:
Medicine is a system of services. More often than not the patient is not doing what he should. Quite often he is doing what he should not be doing, or could be doing it somewhere else cheaper.
As a rule of thumb the patient:
- Should know what he is to do.
- Be followed up to ensure that he is doing, as he should.
This means evolving a system of care that has a case manager.
This involves profound conceptually and structural changes in the delivery of medicine.
As the patient is liable to have many needs his medical needs are holistic and should be dealt with at the community or primary care level.
The care manager should know:
- What is needed?
- Where is it best done?
- Has it indeed been done?
This means several things:
- We resort to the idea of the centrality of the Family Doctor.
- A nurse does the case working.
- Case management is a ‘medically based decision’. It is not fiscal. It is an essential part of an efficient delivery.
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Cases are managed at the level of the family Doctor.
- Referrals and recommendations are from and to him alone.
- The ‘specialist’ is redesignated as a ‘consultant’.
For this stage to work effectively the Family Doctor Practice should be reasonably large so that it can negotiate with experts and providers in the field. THE FAMILY DOCTOR IS THE TEAM LEADER .
The enlarged family practice should subscribe to the SQMB.
The setting up of the family practices would be the corner stone of health reform
I would consider favorably:
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That subscription to a practice would be:
- Per annum at a fixed fee with a basic health basket [Number of visits, hospitalization days, lab costs] per family.
- FFS above the basic basket. This aspect would be monitored and authorized by the SQMB.
- That the SQMB would offer assistance in negotiating between the Family Practices and between both insurers and other health providers [hospitals, labs and etc.]
IN THE FULLNESS OF TIME THE ENLARGED FAMILY PRACTICE WOULD BECOME THE CORDINATING BODY IN CHARGE OF THE PATIENTS COMPRHENSIVE NEEDS.
In other words we now have three well-delineated bodies:
- The professional hub – based firmly on the Enlarged Family Practice
- The administrative hub- based firmly on the state based SQMB.
- Payments – Private and non-private insurers.
UNIVERSALITY:
Only when medicine has been rationalized can it become universal. We cannot expect the State to foot the bill when the medicine is neither rational nor cheap. Medicine has to become professionally and fiscally rational. Only then can further decisions be made.
This decision is UNVERSALITY OF SERVICE.
The decision is twofold:
- Political.
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Fiscal:
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What is the State paying for?
By my proposals the Sate would know what are the expenses involved.
-
How does the State pay?
This decision is purely fiscal. Medicine, as such, has no part in this discussion.
-
How will the State know that I got what it paid for?
By setting up and developing the SQMB we have the basis for an answer.
Universality has a temporal dimension. The SQMB should also be placed in charge of evaluating, developing and training professional man power so that future needs will be met.
In summary:
I suggest series of changes none of which threaten any one. A clear distinction should be made between means of payment and means of service. Limiting expenses in medicines, procedures and insurance coverage should initially reduce costs. Service should be rationalized by developing in tandem the ‘Enlarged Family Practice’ and the ‘State Quality Monitoring Board’ [SQMB].
When costs and services have become coherent and rationalized the cost of universality of care and the political implications can begin.
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02.07.09
Posted in CBT, Personality, Stress, Depression, General, Anxiety, Uncategorized at 4:39 am by admin
ASHDOD UNDER FIRE:
In retrospect:
A child of the ‘60’s has a curse and blessing. We have musical ADHD. We think in terms of either song or film titles. Or at least that is my excuse.
Let me encompass my recollection my way. They are mine to encompass. They are personal. So, selfishly, I will present them to assuming that you too have my presentational preferences.
MOON RIVER: A song about a man and his river.
“Two drifters off to see the world. There is such a lot of world to see….
… But we are after the same, Rainbows end — it’s waiting round the bend —
Moon River and me”
Like a river we flow with our experiences.. Rocks like experiences become part of that river. We flow with it. Sometimes our river is placid. Sometimes it is a surging torrent casting all before it. Sometimes it breaks its banks. Experiences are forever entering the river. The river carries them along. Sometimes it does so with ease. Sometimes they cause eddies and turbulence. Sometimes the experience dams the stream. The dam causes flooding mud and devastation. Afterwards the stream is reduced in its vigour and richness.
But all in all the quality and richness of our river is the sum of our experiences and how we flow with them.
As we navigate the river of our life we are aware that we may hit a rock. That brings me to my next point of departure:
A ROSE BY ANY OTHER NAME: A Shakespearean quote used as a book and film title. It means so many things. But the bottom line concerns conceptualisation and reality.
At time of extreme stress we tend to a few things to cope.
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In acute danger we survive. We do so by either running, freezing so as to avoid attention or crying for help. They are highly efficient mechanism. We survived the jungle with these gambits. They do not need changing. They are certainly not a cause of remorse, shame or self-rebuke. When your life is at threat that is what you do. We secrete massive amounts of adrenalin. The adrenalin turns off everything that is superfluous. This includes thinking. At this moment we react. Adrenalin turns on everything that we need. I speeds our heart, it cools us with sweat, and it prepares our muscles to run. It causes us to cry, literally for help. Crying is a highly efficient way of gaining attention and help. Screaming is even more so. Most important it changes our sense of time. Past and future al virtually erased. The present is as if slowed down.
At that moment our stream has stopped.. This stage is called fear. It is a distinct, well-coordinated reaction to a highly defined cause. Our life is in real danger.
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Immediately after the danger there is a stage of recuperation. The danger has passed. The adrenalin is still highly active. Time is still slowed down. It is still hard to think in our usual logical way. We are still in a state of arousal. It takes adrenalin a good few hours to burn off. Afterwards there is a feeling similar to a hangover or ‘crash’. We feel tired and listless. We may feel sad. It is the adrenalin. That is all. Our appreciation of time is still not as it was. We can drift back to the event. But now it is a memory. We remember the event as a memory. The memory can be vivid. The memory of our pain and fear can be almost as if they were re-happening. But they are not. The sadness and pain diminish slowly but surely. We all remember when we lost someone dear. Maybe through death. Maybe someone you loved very much loved you less. But we have all experienced the first day. As if there will never be another day. But there is. This is a real pain. The sense of sadness and tiredness is real.
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The recuperation becomes in the days to come a memory. It is an unpleasant memory. You have learned the hard way that your experience could have ended your life. A lesson learned the very hard way. You will be reluctant to remember. But you will be equally reluctant to endanger yourself in ant similar way. This is how we have not only coped but learned how to avoid danger.
Now what has this to do with “A rose by any other name”? Because these stages are blandly called ‘anxiety’, ‘depression’ or ‘adjustment disorders’. They most certainly are not. They are normal healthy reactions.
So what is anxiety? Anxiety is the fear of something unknown. Now I will say something that may seem odd. Please be patient with me. It is not the event that is the fear but the inability to know the likelihood of it happening. Anxiety is not merely the fear of something unknown. Anxiety is caused by the inability ascertain the likelihood of the event happening.
Let me give you an example. We all know that we will die. We are anxious obout death only when we are not certain that it is not imminent. Generally but always the sufferer can point to the cause of his anxiety. When he cannot as he has so many the same principles applies. The anxiety is the inability to say what the likeliness is.
We not only flow with our river of experiences. We navigate our river too. In our river here are rocks. We know that. They are only important when we do not know at what depth they are. If they are near the surface then the navigator is alert. He is anxious. If the rocks are defined then he suffers from ‘specific anxiety’. If he feels that there are undefined rocks but he cannot ascertain if they are not immediately imminent then the navigator suffers from ‘General Anxiety’. The shallower the river, the more it is blocked ‘upstream’ the closer the rocks are to the surface.
So what is depression? Depression is a sense of loss accompanied by grief and often anger. After, any event for better or worse, the river of your experience continues to flow. If you have left something behind that you wanted with you, there is a sense of loss. Your river of life has lost its richness and quality. This is true depression.
So you see life’s quality is about the depth and quality of our own river of experiences. How we flow with them. How we deal with events is called coping. Coping is a mixture of ability, expectation and complexity of the problem.
At critical moments when a bomb falls we can do but a few important things.
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Expectation: By carefully explaining what is happening to the traumatized person one can efficiently and effectively change expectations. In the early stages[ hours to days] it is generally more than enough to simply explain to the person what is happening to him as it happens. In other words to minimize his criticism of himself. Avoid the ‘name of the rose’ mistakes. Avoid labeling.
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Strengthen and enrich his ‘river of experiences’. Help him identify with the events, to feel actively involved in a struggle that he identifies himself with. To use examples in his past where pain passed.
If you can get into his river, help him enable the flow to restart then you have helped. To survive remember to get out of his river and back into your own.
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11.09.08
Posted in Personality, Diet, CBT, Depression, Anxiety, Uncategorized at 6:28 am by admin
‘She is a very beautiful lady. I have never really seen her. Just glimpsing the occasional glimpse. I have sent her letters and I have received answers. Maybe one day I will see her.’
That incredible description was written by a Pharmacologist about receptors.
There was another beautiful lady, by the name of Barbara. Her boy fried dedicated his Ph. D. thesis with these words ‘To the beautiful Barbara’.
This how Barbiturates — the first ‘non natural’ sleeping pill came into being.
Judith is a beautiful lady too. She cares about her beauty. So she is worried about being overweight. This article is for her.
Judith knows that I am deaf. But strangely the conversation that invariably I did not hear was when my body spoke to me.
But this ’self deafness’ is the root cause of being overweight.
Normally your body says to us very clearly that you are hungry and when you ‘have had quite enough thank you’.
But you stopped listening a long time ago. So your body resorts to new strategy. It goes onto an emergency footing. It is as if your body no longer trusts you to look after it in a normal and regular way. In fact your body stopped talking to you. It adopted a new ‘independent strategy’.
And the new strategy is:
* Eat as often as you can. Grab snacks.
* Get on board as much high calorie food as possible.
* Eat as much as you can till you feel full.
Not hard to see why you are putting on weight is it?
How do you start listening and trusting what your body is telling you?.
Well you have a problem with that. Your body has lost faith in you. It is not telling you when it is hungry, really hungry that is.
Your body does not really trust you enough to again abandon it and it’s needs. Your body depended on you for a regular supply of calories. And you let it down.
You have to prove to your body that you are reliable.
You have to prove to your body that you are really listening.
But to do that you have to convince your body to speak to you again.
And that is quite a long process.
You can do it in stages.
* Start eating three regular meals at set times. The adage about breakfast being the most important meal of the day is true.
* Between meals religiously eat a fruit or raw vegetable.
After a while something interesting will happen. You will start feeling hungry. Just before eating you will feel hungry.
Congratulations. Your body is speaking to you. Don’t be too overjoyed. You have not entirely regained its trust. But your body will start telling you something else. It will start telling you when you are satiated. It is a different feeling from that of ‘being full’. At this point your body is prepared to rely on you to give it the calories that it needs at the time it needs them.
But if you want you can encourage your body to speak. Chew slowly. Sometimes it is not too clear to you if yur body wants to calories or water. At each meal drink water as you eat.
We are almost there.
Now that you are talking to each other you can begin a dialog. But you both must be honest and open.
Don’t fool your body into thinking that it just got sugar by using an artificial sweetener. Be fair. Either use natural sweeteners or don’t use them at all. Sweeteners do not satiate your need for sugar. If you pull a trick on your body, your body will trick you in return. Just by avoiding all sweeteners, included in soft drinks,.
You can now set yourself a realistic diet that you can maintain.
My tip would be this. Never eat potatoes, rice or bread on a weekday. Eat vegetables instead. I won’t go into Glycine Index. Or even how beneficial exercise is.
There you have it, Judith. My letter to a beautiful lady. I hope it gives you all that you want.
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07.21.07
Posted in Personality, CBT, Stress, Depression, Anxiety at 2:19 am by admin
Cope better.
But how can you?
Make your coping styles more effective.
But how?
The answer is free Online Self-Help CBT.
Let me explain why. My name is Dr. Michael Benjamin. For 38 years I have studied how people cope. As a Psychiatrist I learned how central coping styles are. Let me share what I have learned:
Coping styles are a mixture of experience and personality. By personality I mean the way that we think, feel and behave in given situations.
Are you getting a little edgy? How do I change my personality? Don’t worry you will not.
There is a dyad that we all accept as true. Feelings and thoughts, they interact and effect each other. Feelings and thoughts are the reaction to an event. Very often we have thoughts or basic assumptions which are completely wrong. The assumptions are unchallenged. They generate feelings. These feelings generate thoughts. Vicious circles are in the offing. A reaction to an event becomes prolonged. The reaction outlasts the event. The thought feeling dyad has led you into a mood. The mood makes it harder for you to cope.
Some people are very bad with their basic assumptions. They exaggerate. But by their very nature basic assumptions are unchallenged.
Cognitive Behavioural Therapy [CBT] is the way to challenge and change theses assumptions. Online Self-Help CBT is a very effective, easy tool to use. Almost immediately you feel a sense of mastery. You start to cope better. You will rapidly observe traits. Similar, wrong assumptions crop up regularly. You change them individually. Then you will soon see and change traits.
Maybe you wish to exchange experiences. A burden shared is a burden lessened. Online Self-Help CBT allows you to participate on a e-Group designed to do just that.
Dr. Michael Benjamin.
Psychiatrist
myRay: http://www.myRay.com Free Online Self-Help CBT
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07.08.07
Posted in Personality, CBT, Stress at 11:00 pm by admin
Real leadership is about the ability to lead.
You need to know where you want to go and make sure that you are being followed.
One important parameter is forgotten. A leader has to be aware of his team’s ability to follow.Can all your team members do this? Can they follow you?
Leadership is not only about your ability to lead.
It is also about your ability to identify those who can follow.
More importantly to identify those who cannot.
Can all his members cope? Can they function under pressure?
20% of the population is going to develop anxiety or depressive states. This does not happen overnight. Members of this population exhibit ‘poor coping styles’. They are driven, rigid and not happy. They may seem to be conscientious and even an asset. But if you could do something, don’t you think that you should?
What can you do?
I have built a free, non-commercial Online Self-Help site. myRay [http://www.myRay.com] is easy effective and improves quality of life and coping styles. myRay [http://www.myRay.com] is designed for people who are prone to depression and anxiety and yet are still functioning relatively well.
myRay [http://www.myRay.com ]
can be recommended with discretion and without fear of insulting anyone.
I hope that this is food for thought.
I want to stress that myRay [http://www.myRay.com ]
is free. The user is free to use it as often and for as long as he wishes.
With kindest regards
Dr. Michael Benjamin
Psychiatrist
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