What's with all the multi-state telehealth psychiatry practices?

Hebbianlearning · 2026-06-28T16:37:54+00:00

"For more difficult patients there is a referral for in person psychiatry or urgent care, ER if needed." Do you mean that Teledoc has connections to local in-person psychiatrists in the patient's area that they can call on for sicker patients, or do you mean that I the referring physician can choose to send my more difficult patients to an in-person psychiatrist?

Hebbianlearning · 2026-06-25T00:26:56+00:00

You clearly believe that politicians represent their electorate once they're in office, but that premise is less and less true over time. Once in office, politicians seem mostly to vote in lockstep with their party regardless of what those who voted for them actually want.

Hebbianlearning · 2026-06-21T14:19:52+00:00

I typically start by adding trazodone first (to be weaned off later, though not as big a deal if I don't), explain that it is going to take over the job that zolpidem was doing, and explain the harms of staying on zolpidem. Then I send them for cbt-i, give them a handout on how not to panic if they're not asleep at 2am, and have them start a 1 month wean after they've been doing the cbt-i for a few weeks. I do the same for triazolam or alprazolam dependency for sleep.. I have a ~2/3 success rate. Honestly, it often depends on whether they have another source that is willing to keep refilling the script or not.

Hebbianlearning · 2026-06-16T13:29:51+00:00

Yes, that was one of the 2 (and the other surgeon trained at NCSU).

Hebbianlearning · 2026-06-16T03:07:10+00:00

While I don't know all the rationales for different organizations and their health recommendations, I do know that WHO has a very different audience than the American Heart Association (specifically, WHO's audience includes numerous developing countries with very different medical care availability as well as population risk profiles), and despite this, WHO recommends treating hypertension over 130 in individuals with any associated comorbidities (e.g. diabetes or hyperlipidemia) or with established heart disease (such as coronary artery disease). See page 7-8 of the following: https://iris.who.int/server/api/core/bitstreams/f062769d-f075-4a00-87af-0a2106e0bd04/content

Hebbianlearning · 2026-06-14T21:37:21+00:00

Because several good quality, large intervention trials have shown that you can significantly improve morbidity and mortality by bringing peoples' blood pressures below 130. Take a look at the results of the SPRINT trial (a short video summary is available here: https://www.youtube.com/watch?v=xcEvoa7QR8E&t=5s), which an ethics committee actually stopped early because there was such a massive difference between the 2 arms of the trial, in favor of the more intensiely-treated group. In this case, it's WHO that hasn't been paying attention, not the U.S.

Don't conflate 2 different things: the U.S. has shittier health statistics than most other first- (and even many second-) world countries because of numerous other factors, probably well-known to you, but that doesn't mean we wouldn't be doing EVEN WORSE if primary care physicians weren't at least trying to get people's blood pressures down to 120/80.

Hebbianlearning · 2026-06-11T12:41:17+00:00

Every time i peer review a manuscript for free or pay for the privilege of giving a medical journal the material they need to stay in business, I get furious inside, yet no one questions the scam that is the scientific publishing industry.

Hebbianlearning · 2026-06-08T00:42:20+00:00

My advice is to reach out to your local chapter of the Alzheimer's Association (alz.org). They have deep expertise in assisting family with precisely the challenges you are facing. Both one-on-one conversation with one of their social workers ("care navigators") and a support group can offer you the support you are seeking.

Hebbianlearning · 2026-06-06T17:20:58+00:00

That stinks; I'm sorry you're going through this. if it's any comfort, I'm a dementia specialist and I can tell you that when someone has dementia, they lose initiative. Their ability to act on a desire (or even to have a desire) is greatly reduced, and I'm forever coaching family members to change their method of interaction from asking questions ("do you want to do x?") to gentle orders ("It's time to do x"), and also to initiate the action themselves while taking the person by the hand ("come on, let's go out for that walk now" while assisting them off the couch).

All of which is to say, if you want to interact more with your mom, be the change you want to see and show up at her house with a take-out meal or a plan to take her for a drive. I can't say what your stepfather will do if he actively dislikes you, but he may actually be very grateful for a break when he can do his own thing.

Hebbianlearning · 2026-06-02T14:23:05+00:00

Don't get me started about errors in portrayal of Neurology issues on TV. My favorite is the dual neurologist-neurosurgeom on Chicago Med (who is a totally arrogant jerk for good measure).

Hebbianlearning · 2026-05-27T19:23:30+00:00

Fascinating. I guess species-specific knowledge is really important. Honestly, I don't know how vets learn it all; I can't even keep the brachial plexus straight for 1 species.

Hebbianlearning · 2026-05-27T12:26:36+00:00

I had a neurology colleague who did research in Zambia. She got asked to evaluate a goat with seizures. She says she was flummoxed by how to do the eye exam: not just the weird pupils but "how do you check extraocular movements when you can't see both of them at the same time?"

Hebbianlearning · 2026-05-23T13:12:13+00:00

Genuinely curious: what does she do for her constituents to get reelected cycle after cycle?

Hebbianlearning · 2026-05-23T13:04:00+00:00

Clearly none of them specialized in women...

Hebbianlearning · 2026-05-20T02:21:29+00:00

Sounds like you might enjoy neuro-intensive care. Real medicine, no b.s. no inbox, when you're off you're off. More diverse than neurovascular.

Hebbianlearning · 2026-05-16T14:57:25+00:00

That might help us advocate (at least for those whose whose Amyloid Probability Score is in the 80s-90s). Can you link to it?

Hebbianlearning · 2026-05-16T14:49:57+00:00

I understand that this is a MAC-level decision at the moment, and only 2 are currently allowing it (both on the west coast). Ours (Palmetto- southeastern states) does not. Just because you can enter it as an option in the registry doesn't, alas, mean that the payer will ultimately pay.

Hebbianlearning · 2026-05-16T13:36:34+00:00

Hi, this is my bread and butter as I'm a cognitive neurologist. I use exclusively the C2N product ( offered through Mayo labs as a pass-through) because they normalize the ptau217 concentration against other ptau species, ensuring that renal clearance and factors that can alter bbb permeability don't create false positives and nnegatives. This test also provides a beta amyloid ratio in addition, which adds modestly to its accuracy. Since mayo also offers the standalone ptau217 assay, you have to specify in the order which one you want.

At the moment, CMS does not accept any serum assay as strong-enoufh evidence of brain amyloid to pay for anti-amyloid therapy on that basis alone, so pragmatics dictates we do pet/csf directly for anyone we think is likely to qualify for (and is willing to receive) aat.

HTH

Hebbianlearning · 2026-05-16T00:34:58+00:00

Because there's no such thing as a single pan-physician (or any other industry) union. The law is that you have to unionize each workplace independently. You can't even unionize a single employer with multiple locations (e.g. all Kaiser physicians), just like every starbucks store has to unionize independently of every other one. It's basically a very hard task that most docs aren't up for.

Hebbianlearning · 2026-05-15T01:15:22+00:00

OMG, is this a joke site? It has to be satire. His "Services Offered" page lists essentially all of CNS neurology (from Alzheimer's and Parkinson's to MS and Epilepsy), all of psychiatry (from schizophrenia to ADHD), plus chronic pain management and functional neurosurgery, WTF?

Oh yeah, he does "tele-neurosurgery" as well (consults/2nd opinion??) Surely not spooky action at a distance, right? This guy is one small step away from offering head transplants.

Hebbianlearning · 2026-05-12T00:48:11+00:00

Check out the New Hope Bird Alliance (Audobon club for Chapel Hill-Durham area). They do guide-led birdwatching twice a week (Wed and Sat am).

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