Month: May 2020

Choose Integrated Care

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

In my previous post, I talk about the difference between psychiatrists and other mental health professionals. I also introduce the topic of the biopsychosocial formulation, which is the psychiatrist’s tool to formulate the psychological, social, and biological determinants of an individual’s psychopathology.

The biopsychosocial formulation integrates the different dimensions of human life to give us a clear picture of the predisposing, precipitating, perpetuating, and protective factors underlying a person’s illness. The psychiatrist is the only mental health professional with the expertise to treat all these dimensions; however, even psychiatrists do better if they belong to an integrated team of providers.

In integrated care models, providers share information and work together to deliver high-quality treatment. Systems like the VA and Kaiser are integrated, along with many other health care systems. I personally recommend integrated care systems to all my friends and family.

Some clinics/systems may be integrated but not have psychiatrists. This may be alright, so long as the available providers can fulfill all the needs of the biopsychosocial formulation. For example, mental health nurse practitioners can prescribe medications and treat the biological components of disease; social workers can address social dimensions of illness; and, psychologists can examine and treat psychological needs. Ideally, these providers, along with primary care, should be working together as a team.

These are difficult times for all of us. It is natural to feel more anxious or depressed. If these feelings are impacting your daily function, it may be helpful to talk to somebody. Your primary care doctor may be the first person to ask about therapy and treatment resources. They may have embedded mental health professionals in their clinic who can provide support and help. Remember, if possible, choose care that is integrated.

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The Expertise of a Psychiatrist

/ Jame A. Agapoff, MD, MS (she/they) / 1 Comment

During these difficult times, mental health symptoms are on the rise. Some may be considering re-engaging with mental health, while others may be considering getting help for the first time. Many people are unaware of some of the differences between psychologists, psychiatrists, and therapists/counselors. This short blog series will explore some of these differences to help you make an informed decision about your care.

Counselors/Therapists: Anybody can call themselves a counselor or therapist. That doesn’t mean they are all bad. I work with several Licensed Clinical Social Workers (LCSWs) who are very good at therapy. They also bring in the expertise of social work, which can help navigate difficult family problems. LCSWs can add specialized training and certificates to their degrees, making them proficient in family counseling, addiction counseling, trauma counseling, etc. LCSWs typically have Master’s Degrees. Many other providers who call themselves therapists or counselors do not have advanced degrees. They may have certificates for specific therapies like LCSWs. Botton line: if someone calls themself a therapist or a counselor, I think it’s important to know their credentials.

Psychologists: Psychologists are Master’s or Doctoral level practitioners who specialize in non-pharmacologic treatments, specifically the evidence-based treatments. There are two doctoral-level tracks a psychologist can take: Ph.D. or PsyD. For the sake of this post, just note that Ph.D. programs are often considered more rigorous and research-based, and PsyD programs are more clinically based. If your provider is licensed, you know they meet a general standard of knowledge to practice in that state.

Because of their doctoral-level training, psychologists are doctors, but they aren’t medical doctors who hold advanced medical degrees (either M.D.s or D.O.s). This means that they can’t prescribe medicine. Depending on your needs, it’s essential to know this distinction before you make an appointment.

Psychiatrists: A psychiatrist is a medical doctor (M.D. or D.O.) who has completed a 4-year residency training program in psychiatry. After residency, some psychiatrists further specialize in areas like child psychiatry or addiction psychiatric, which requires additional years of training (a fellowship).

In the U.S., medical degree programs are highly selective and regulated under the Association of American Medical Colleges (M.D. Programs), or the Commission on Osteopathic College Accreditation of the American Osteopathic Association (D.O. Programs). This is also true of psychiatric residency programs that are accredited by The Accreditation Council for Graduate Medical Education (ACGME). If your doctor is a psychiatrist, he/she would have graduated from both medical school and residency.

A Board Certified Psychiatrist is a psychiatrist who has taken the additional step of taking an all day-knowledge test demonstrating expertise in the field and maintains his knowledge through a series of learning activities to ensure he is up to date on all the latest medical information. If a psychiatrist tells you he is “board eligible,” it just means he can take the boards.

Psychiatrists bring together clinical expertise, research, and medical knowledge. For each patient, we complete a biopsychosocial formulation, which synthesizes psychological, social, and biological factors of disease. We then formulate which factors are predisposing, precipitating, and perpetuating. This then forms the basis of our treatment plan and recommendations.

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SMART Goals

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

The COVID-19 pandemic has changed the way many of us do business. As we adapt to new routines we may take a fresh look at our goals.

SMART is an acronym to help you set goals that are clear and attainable. I learned about this tool during a recent military training as part of my work with the U.S. Army Reserves.

The following definitions are from the online SMART course from the Yellow Ribbon Reintegration Program online course.

Specific
The goal states exactly what you want to accomplish and is focused on only one particular area or aspect.

Measurable
A measurable goal is one for which progress can be monitored. You can tell when it is achieved.

Achievable
Goals should be reasonably achievable considering the time, talent, and resources that are available to devote to the goal.

Relevant
This means that the goals you set should be applicable to your personal situation.

Time-bound
This means you should set a timeframe or deadline for when you will accomplish your goal.

This framework is a helpful way of framing one’s goals. I recommend setting short (days to weeks), medium (months), and long-range goals (years). Personally, I have found that writing down my daily activities and creating a goal board, are good ways for organizing and meeting my aspirations.

Life is a challenge. It is also full of opportunities. The ability to plan and delay pleasure can help us achieve our goals and thrive. May you all be healthy, wealthy, and wise!

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The Food Supply Chain Was Already Broken

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

The recent events at the Tyson Meat (Animal) Processing (Killing) facilities is an opportunity to reevaluate America’s relationship with food. Since the 1960s, American farming has created a supply chain capable of feeding the world. Famine is not something seen in America today, and this is in part due to large scale industrial farming.

The industrialized food chain reduced the diversity of goods consumed by Americans and increased their consumption of products like dairy, eggs, and meats. Billions of dollars have been spent by this industry to convince us that these products are not only safe but healthy. As all of us who grew up in the 1980s and 1990s, “Milk does a body good.”

Is this sustainable?

The land and resources dedicated to “meat” farming are legion. 90% of the Amazon rainforest cut down since the 1970s has been used to support grazing livestock. Dairy cows can consume up to fifty gallons of water per day; and, it takes about 2400 gallons of water and 10 pounds of grain to produce 1 pound of meat. A majority of plant-based crops grown are now used to feed livestock. The excrement and other wastes generated by industrialized farming contaminate water sources and destroy surrounding ecosystems. Despite these alarming statistics, meat consumption continues to rise yearly.

America needs a sustainable food chain that considers animal suffering. Every second, 2000 animals will die. 200 million animals will be slaughter today. This year, billions of animals will be slaughtered for a product that is unhealthy and not needed for survival. The conditions these animals live and die in are beyond appalling, and every time we choose meat, we choose to continue the cycle of suffering over-and-over.

This food supply chain was unsustainable and broken before the COVID-19 pandemic. Perhaps this is an opportunity to reevaluate the capacity of the human heart. I believe our love and compassion are greater than our desires. A plant-based food supply chain that is healthy and sustainable is the first step to a better you, a better me, and a better world. Let us choose to break this cycle forever.

 

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