1/ Me: a thread about the importance of getting to know your patient, respect them, and create spaces for appropriate clinical care when rote guidelines would introduce harm.
An "expert":
Cruel, pedantic, and thoughtless.
The worst of people can beleive they're righteous.
2/ In case you're wondering about my thread which prompted it, it was this one.
I created it specifically to outline an example of when "going through the checklist" would be cruel and heartless.
3/ Please, if you take care of patients, never forget this important lesson.. you will always have rigid academics and administrators telling you that X, Y, and Z are required. And truly, a majority of the time you should do X, Y, and Z. Guidelines can be very helpful.
4/ But if your patient needs W, then goddamnit, justify it, document why, and move heaven and earth to get W.
Your patient always deserves to be treated like an important individual, not a cog in a machine.
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/1 Thread: Do better, American Suicide Organizations.
(content warning, obviously!)
If @afspnational incorrectly states "White middle age" as the peak rate of suicide, ignoring the Indigenous youth/young adult suicide crisis, that's a fail. Part of systemic racism.
4 Pics:
/2 LOOK AT THIS! AHHHHH! How could a major national organization not put this front and center about statistics?!?!
The rate of 15-19 year old Indigenous males is as high as almost EVERY white age bracket!
/3 For the past 21 years, the highest rate of suicide is Indigenous males, by 7%. The peak rate is between 18-27y at 33.6/100k
For White males, the "middle age peak" between 48-57 is 31.5/100k.
Since I've looked, I've not seen the AFSP mention this in their statistics page.
Because the media is obsessed with Japanese suicide data ("suicidal" Japan is a lazy, one-sided trope in Western news)...
First, here are the graphs for who suicides in Japan for the past 5 years, to Feb 2021!
2/ If we zoom into the men, we can see that there was a decrease in early 2020, an increase at the end, and things are back to normal-ish for 2021. In fact, 2021 is a record low for January and 2nd lowest for February.
3/ If we zoom into the women, we can see that there is again an early mild decrease followed by a SUBSTANTIAL increase at the end of 2020. Though things are still elevated in Jan-Feb 2021, much less so and hopefully on the way to normalizing.
Being a caring human being should come before "requirements", and though guidelines are largely helpful, one need not slavishly follow them as they can harm.
If exceptions required, document the reasoning.
This is GOOD care.
EXAMPLE:
/1
Content warning: suicidal thinking, depression
CASE (not real) Example:
An adolescent teen, "Javier", who I am seeing in the emergency department for depression.
As I get to know them, I start asking them why they're here, in the ER. What's gotten so bad.
/2
Javier:
"I was sent here by my counsellor because I told her I was having suicidal thinking. I told her because she asked but its not like I was going to do it... I just... sometimes I think about it. Soon as I said it, she ended the session and called my mom to take me to ER.
/3
The @FAIRHealth White Paper showing MH insurance claims in kids is being reported deceptively.
WRONGLY (!!!), people are using it as evidence that "Mental health claims are up in kids."
Why is that wrong? Let's break it down.
2/ What is it?
It's an insurance report that does a breakdown of 32 BILLION claim records, looking at month-to-month changes Jan-Nov 2019 vs 2020. It focuses on pediatric (13-18) mental health insurance claims:
* overall
* self harm
* overdoses
* diagnoses
3/ This very important part of the methodology is at the heart of the confusion on how this paper is being reported.
It is NOT looking at raw #'s increasing, it's looking at percentages of overall claims.
In other words, what % of claims were for mental health.
I have a condition called "Prosopagnosia" or "face blindness." It's a neurological disability my brain literally just does NOT TELL ME if I should recognize a face or not.
New hairstyle? new person!
Hoodie? no recognition!
Formal setting? who is that?
2/ Until I knew what this was, I was TERRIFIED of meeting or running into people. I would always criticize myself for "forgetting names" or "not being polite" when someone would tell me "hey, why didn't you say hi?" or "what you're just gonna walk by me?"
I felt rude. Uncaring.
3/ I went to med school! Oh god! Surgical masks and hoods. Scrubs. Everyone looked EXACTLY (not sort of) the SAME! My bosses would "pop by to ask me a question" and I wouldn't even recognize who they were. "Can you email me later?" "uh... sure... [oh no, who do i email?]"