On guns and mental illness

It’s the anniversary of several mass shootings and with the most recent congressional baseball game incident, gun rights has come back into the news.

This topic has always frustrated me.  And here’s why.

The Pew Research Center recently did a survey and found that 89% of their respondents strongly or somewhat favored preventing the mentally ill from purchasing guns.  (link: http://www.pewsocialtrends.org/2017/06/22/americas-complex-relationship-with-guns/ )  In other words, most Americans are associating mental illness with gun violence.  And that simply is not true.

Those with mental illnesses are no more violent towards others than those without mental illness.  Certainly there is the issue of harm towards themselves, but that’s a different topic altogether.  Here we’re talking about people jumping on the “oh he was a wacko/crazy, or he was psychotic, or he had to be seriously mentally ill” bandwagon every time a mass shooting occurs.  Then they try to make laws restricting mentally ill people from buying guns.

Which mental illnesses?  I’m sure lots of people will say schizophrenia or bipolar disorder (due to how Hollywood depicts us), maybe depression, but what about ADHD/ADD, eating disorders, generalized anxiety disorder, autism spectrum disorders? They’re all in the DSM.  If we count every mental illness that is in the psychiatrists’ book, that encompasses way too much of the American population.  Some might say just ban people with “severe/serious mental illnesses” (SMI) from purchasing guns.  SMIs are defined by law anyway (I can rant about this all day too).

How exactly do they expect to check whether you have a “restricted” mental illness before selling the gun?  Demand a letter from a physician? So much for health privacy.  Apparently that only applies to those with real medical diseases.  Let’s perpetuate that stigma against mental illness, shall we?

Don’t get me wrong.  I have absolutely no interest in owning a gun.  I live in the safest neighborhood in my city, but I can understand if people who do not have that luxury (or perhaps like to go hunting) would choose to buy one.

I think everyone who owns a gun should be properly trained, practice regularly at ranges, and pass annual safety tests.  However, I  will not deny someone who has no criminal history the right to purchase a gun simply for having an arbitrarily-defined group of medical diseases.  The ACLU and several other mental health and disability advocates agree with me, but the media and general population seems to have other ideas.  I’ll just leave you with this article from a couple months ago:

http://www.nationalreview.com/corner/444582/no-gop-did-not-just-repeal-background-check-system-or-give-guns-mentally-ill

 

Fête de la Musique

When I visited Paris a few summers ago, I was lucky enough to see the Fête de la Musique.  On the summer solstice, musicians gathered together and performed on street corners, museums, concert halls, and many other venues.  It was wonderful hearing such talented amateur and professional musicians – all for free!

In recent years, the festival has spread to other countries and I made sure to attend a few concerts in my city last year.  Unfortunately, we didn’t have street musicians but they did open up a few of the parks to everyone who wanted to play.  Seeing little kids sit cross-legged on the lawn and watching the musicians intently gives me hope that arts (especially classical music) will continue to play a role in people’s lives.  Music conveys emotion to me in a way that nothing else does, so I can’t wait to see the performances next week!

 

Multilingualism

I met a visiting medical student from Germany this week.  He talked about how he did rotations in France awhile back, and now seeing how the US system works.  It occurred to me that he must be fluent enough to converse to patients in French, German, and English!  Though heavily accented, his English was impeccable.

He asked me if I spoke French, since I had visited for a few months while studying abroad.  Embarrassed, I admitted that I knew very little, as I was in Paris and everyone spoke to me in English anyway as soon as I introduced myself.  (They don’t like us Americans butchering their language I guess…)

I wonder why foreign languages are not emphasized here.  Spanish is incredibly helpful in the healthcare setting, and using a telephone-based translator often results in miscommunication between physicians and their patients.  In some cities, Arabic, Chinese, Polish, and a slew of other languages are spoken by a significant portion of the population.

Public schools already face budget cuts, and “non-essential” subjects such as foreign languages, arts/music, and P.E. are often the first on the chopping block.  Foreign language classes not only teach you reading/writing/speaking, but also the history and culture of those who speak that language.  One of my French teachers was Canadian, but I’ve known others from the many African countries who also speak French.

Maybe some of the xenophobia or distrust of anyone who looks “non-American” could be prevented if we exposed children to more cultures through language classes. I wonder if the multilingualism in Europe helps promote acceptance of others.  I think we are a little spoiled being native English speakers, with English being almost a universal language around the world.  It’s so much more challenging to learn a second language as an adult, and I really hope that the next generation of kids will have the opportunity to do so.

Work and smartphones

Cell_phones_2005Remember these?? It’s amazing how technology has improved over the past decade.  I remember growing up with corded phones and dial-up internet, and computers were these slow clunky things.  Now everything can be accessed from a single smartphone.  Google tells you the answers to everything.  You can sync your music, or your fit bit.  You don’t need a physical map to navigate a new city.  Sounds great, right?

Well, all good things in life seem to come with a catch.

Instant accessibility is great – until you don’t want to be accessible 24/7.  We love our smartphones today because we can text, email, or call anyone anytime.  Chances are they have their phones with them all the time and will reply quickly.  But what if it’s your boss?

I received a message from my supervisor at 11pm last week.  I wasn’t at work, but it had to do with a work-related issue.  Can I ignore it and pretend I never saw it until the next morning?  Or does it need to be addressed immediately?  (FYI, I saw it and responded within an hour). Our medical school actually sent out an email a while back explicitly stating that it was our responsibility to check our school emails regularly, and reply in a timely manner.  But what does that mean?

The line between work and life has become blurred.  In the past they had to call you at your house phone and probably leave a message on your answering machine.  They couldn’t expect you to be at home waiting for a little red light to start flashing.  Now they know that they can reach you on your cell phone in an instant.  Work now follows you, wherever you are and at all hours of the day.  When I check my email in the evening after work (or morning before work), I usually have 5-10 emails waiting in my inbox.  I am constantly connected.

Sony_Xperia_Z

Certainly, in the old days (and even in more rural areas now), physicians had always been on call virtually 24/7.  Maybe they had a partner so they can split the evenings 50-50.  However, anything outside “normal” work hours was reserved for urgent matters and didn’t occur every day.

Now I find myself reading messages from work all the time.  It might be just a little note, or a reminder, or a question from someone.  But they quickly add up.  Sometimes I  wonder what would happen if I just shut off my cell phone after I get home.  Would the world fall apart? Probably not.  It has become ingrained in our heads that we must check our emails at least 2-3 times a day, and for me, that usually means work- or school-related emails.

So what do we do about that?  I honestly don’t know.  We all want things, and we generally like to have them quickly.  Smartphones let us achieve that.  I don’t think we should go back to the old phones where talking was the only available function (though I could write an entire post about how this generation no longer talks on the phone anyway).  Besides, I like the internet.  A lot.  Our society as a whole has become dependent and addicted to our smartphones, and I doubt that will change.  But I wonder if there isn’t a way we could disconnect, so that we can experience and enjoy the rest of our lives outside of work without distraction.

Image from Wikimedia Commons:  (top)Cell phones 2005, By Larry D. Moore, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=30478111  (bottom) Xperia Z By Clivejb – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25178264

Graduation

This time of year is always exciting – with people celebrating finishing high school, college, or grad/professional schools.  But it’s bittersweet.

Graduation_Thinker_LuMaxArt

I’m happy for all my friends who graduated this year, of course, but I am equally sad that I have to say goodbye to them.  It seems like every four years, I become friends with many wonderful people, but then I have to start over when I (or they) move away.  Staying connected on Facebook just isn’t the same.  And phone calls?  What’s that?  So antiquated…

Graduation ceremonies also remind me that I’m not done with my training (but others are).  Obviously it’s not a competition to see who gets there first, but there’s always that tinge of disappointment.  Compared to my classmates, I’m old.  I also took time off during medical school to deal with mental illness.  Sometimes I regret doing so, because it meant I wouldn’t graduate with the classmates I started with.

Oh well.  I’m super proud and happy for all of them and will miss them greatly, but I wish them the best on the next journey of their lives.  I’m sure they will become wonderful surgeons, pediatricians, internists, or physicians in whatever specialty they matched in.  Maybe someday our paths will cross again.

Image: “Graduation thinker” By lumaxart – EbonyG00052_LuMaxArt, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=3590827

A Distractible Mind

Sometimes I get really distracted while studying.  It usually begins with a random thought or question that pops into my mind.  Next thing I know, I’ve spent twenty minutes browsing the Internet on that topic (or tangential ones).  It’s really terrible.

To make up for my lack of productivity, I figured I’d share a few of my detours just for fun.  No judging!

1. What is a philosopher’s stone and why was it changed to sorceror’s stone in the 1st Harry Potter book?

2. What does “clap back” mean?

3. Let’s browse reddit.

4. When does the next exhibit at the art museum start and end?

5. What does BB cream stand for?

6. What’s y’all qaeda?

7. Hmmm I haven’t checked my favorite medical blogs in awhile.

8. There’s too much unnecessary medical jargon. Is there a medical term for hiccups too?

9. When does the next Google pixel  come out?

10. I’m hungry- let’s find recipes that are way too complicated.

Google is so amazing, yet so dangerous 🙂  Time to stop procrastinating now…

Health insurance: coverage for mental illness?

The latest news surrounding ACA and AHCA got me thinking about this topic, but I’ll try to stick with health insurance issues and leave politics out of this post.

It shocks me how little we learn about health insurance and the American healthcare system in medical school.  Sure, we had a couple lectures covering general facts such as the lack of access to healthcare, how our country does not have a single payer system but maybe ought to, that Medicare is for the elderly, and Medicaid is for low-income women and children.  That’s great and all, but they never taught us anything practical that we could use to help our patients.  In fact, I didn’t even know what the terms deductible, copay, coinsurance, or balance billing even meant until I was diagnosed with bipolar disorder and had to navigate this:

VanDusen_Botanical_Garden_maze

I am very lucky to have student health insurance.  Some students may complain about how everyone must buy the plan (or have something equivalent), but I don’t think they realize just how well-covered we are.  Compared to the similarly-priced individual plans I found in our state’s marketplace/exchange, we have a ridiculously low deductible and out-of-pocket maximum.  If we use our hospital-affiliated student health clinic, all visits and labs are in-network and completely free.

But most importantly for me, our student plan has great mental health coverage.  Whether I seek a psychologist or psychiatrist in-network or out-of-network, I have the exact same copay and 100% coverage (at the adjusted fee determined by the insurance company of course).  That was literally a life-saver for me.  Maybe it was an intentional decision by our school, as depression, anxiety, and addiction often plague physicians and those of us still in training.

Brass_scales_with_flat_trays_balanced

This past year I also read about parity laws – which mandated that mental illness cannot be treated any differently from other “physical” illnesses.  The Mental Health Parity Act signed in 1996 by President Clinton required health insurance companies to charge the same copays and offer same benefits ($$-wise) for mental illnesses as any other medical illness.  Of course, these companies got around this in many different ways, so the Mental Health Parity and Addiction Equity Act (2008, George W. Bush) tried to close some of the loopholes, then the Affordable Care Act (2010, Obama) finally mandated that mental illness benefits must be included in every plan.

You’d think that would be enough laws to fix mental healthcare and provide services to everyone, right?  Unfortunately, there are plenty of reports and articles in the news stating that these laws are not being enforced.  There’s also a shortage of behavioral health providers overall.  Reimbursement rates for office visits are low, and coupled with the additional billing hassles and headaches, very few want to deal with insurance anyway.  My psychiatrist and psychologist both have agreements with our medical school to take our student health plans, even though they didn’t accept any others.

I think there are a couple points to take away from all this.

  • Our health insurance system is too complicated — everyone needs to be better educated and informed (including doctors!)
  • Although I have great mental health coverage, that is not true for many others.
  • Politicians can bicker over drafts and pass laws all day long, but it doesn’t mean those laws will actually be enforced or translate into what they intended.
  • Having insurance is different from having access to healthcare.

I don’t know how to solve our healthcare problems, but right now I have little faith in our current lawmakers’ abilities to fix them.

 

Images: (top) Vancouver Hedge Maze, By Stan Shebs, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=602013 (bottom) By Toby Hudson – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27707265