Thoughts and observations on a wide variety of subjects…
Added later: this is of purely historical interest, if that. I added a category “outdated,” but maybe “obsolete” would be more accurate…
I tend to be a late adopter of operating systems. I went from Windows 95 to XP to 7, skipping Vista, Me, and a number of other dogs whose names I can’t even remember. I would still be running XP except that when my son switched from Linux to Windows 7 I sat up and took notice. Continue reading “Mavericks Upgrade: Go For It”
In the third grade, our teacher Mrs. Smithy read us The Lion, the Witch and the Wardrobe, the first of C.S. Lewis’s Chronicles of Narnia, in which a group of kids find a secret door in the back of a wardrobe and enter a fantastical, undreamed-of world.
In the fifth grade, in 1968, I became part of a group of kids that had found such a door. The group was called the RESISTORS, and the door led to the world of computers and what is now called “information technology.”
The group met in the house and barn of Claude Kagan, an engineer at the Western Electric Research Center in Pennington, NJ, near Princeton, where I grew up. Claude was a complicated guy, by turns fun-loving, cantankerous, generous, childish, and more—but unswerving in his commitment to value of letting young people learn things and above all do things. The principles of the RESISTORS were “Hands On” and “Each One Teach One,” and those principles have stood me in good stead for the last 45 years. (As I side note, last night I read a piece by Atul Gawande in the New Yorker in which he wrote that an essential realization in the dissemination of the medical miracle of oral rehydration was that when teachers fanned out to villages, the teaching was much more effective if the villagers made the solution under the teacher’s instruction than if the teacher “showed them how.” This was one of the first things we learned as RESISTORS: if you are teaching people things, THEY should sit at the Teletype [a primitive 100 bps terminal, which no self-respecting Bangladeshi villager would tolerate today] and YOU should sit next to them, talking them through it.)
We used a number of computers and computer languages, but the computational beating heart of the group was Claude’s PDP-8 computer at Western Electric, which we would dial into from a Teletype in his house. It ran Trac, a computer language designed by Calvin Mooers, an independent thinker based in Cambridge, Mass. The PDP-8 had 4K of RAM. Yes, 4K, i.e. one one-millionth of the amount of RAM in the two-pound MacBook I’m typing on right now. RAM was insanely expensive because it was made of little magnetic “cores” which were hand-strung, reportedly by armies of Filipinos. OK, actually it had 4K of 12-bit words, so technically you could say it had 6K bytes. A “Trac processor” (interpreter) could fit on such a machine, with some room left over for user-written scripts (programs). There is really no computer today so minuscule that Trac makes sense as a language, and even fewer people would ever have heard of Trac today if Ted Nelson hadn’t happened upon the RESISTORS and mentioned Trac in Computer Lib.
OK, so I went to renew my DEA number… maybe I let it go a little longer than I should have. (Are a lot of these posts starting with “OK”? A little anxiety there, maybe?)
In addition to wanting to know your state controlled substance number (in Massachusetts, the MCSR), they (now) need to know the expiration date of your state certificate.
The only problem: there is no expiration date printed on the MCSR certificate. The other only problem: when you search the web and get to the Mass DPH “FAQ” page, you are told that the certificates do not actually expire, they are “recalled” every few years at the pleasure of the Mass DPH.
Continue reading “DEA number renewal needs (non-existant) MCSR expiration date SOLUTION”
OK, we’re all freaking out about the new psychiatry billing codes and the documentation requirements that go along with them, right? Especially the E/M codes that replace the 90862 medication follow-up.
Continue reading “Evaluation & Management (E/M) “encounter form””
I tweaked the ROS section of history to have a complete list of systems, and better prompts.
I also modified the file names so that they have the date on them. I will leave old versions up, to reduce possible confusion. I’ll try to remember to update the original post (at tiny.cc/cpt2013) so that it links to the blog entry for the latest update.
I’m making progress on the form for sessions/encounters and I hope to post it soon.
2013 CPT Codes for Psychiatry pdf version
2013 CPT Codes for Psychiatry .doc version for revision/remixing; more info with original post at tiny.cc/cpt2013
If you’re a psychiatrist (or psychiatric RNCS) in the US reading this, you are almost certainly aware that all of our billing codes changed on Jan 1, 2013. If you are like most of the psychiatrists I know—at least in private practice—you are at least somewhat freaked out by this. If so, keep reading. If not—for example, if you’re not a psychiatrist in the US—stop reading this immediately and go do something more interesting, like… well, like just about anything other than memorizing a phone book. (There used to be things called phone books… never mind.)
I made up a one-sheet reference, which I think can help with the codes. There are links to it at the bottom.
I just got home from the UK where I attended the three-day IEDTA meeting and a three-day ISTDP immersion course taught by Jon Frederickson and Rob Neborsky. Both were excellent.
Over the past several years, I have been watching a spectrum of ISTDP practice and trying to understand their common elements and differences are. Other than at conferences, most of the work I’ve been exposed to so far has been from Allan Abbass and Jon Frederickson. The immersion was the first chance I had to see Rob Neborsky’s work in the style that he and Josette ten Have-de Labije have developed.
Trying to fit their work together with what I already understood led me to a new way of thinking about it, which I found helpful, and which I’ll describe here. There are no new concepts here, but I think it’s simple, direct terminology that can help us understand what people are doing from a unified standpoint.
Continue reading “Affect Defenses and Relationship Defenses: a Unifying Approach to ISTDP”
Added later: I never completed this post, but it lets me know when I first got involved in no-knead baking. Lots more posts on bread later.
My aunt was a great, adventuresome cook (and author of the carefully-historically-researched, critically well-received Little House on the Prairie Cookbook). When I was around 8 years old, she taught me how to make bread. Maybe five years after that, at Christmastime, I made bread for friends and dropped it at their house (for a number of years after that, I was known to some grandparents only as “the boy who made the bread”). It was a great project for a kid to spend a day doing: combine the ingredients, let it rise, knead, rise more, punch down, etc etc. Most people I know don’t have that much time on their hands.
My wife has been a Mark Bittman fan for some time and I was interested when she pointed out his no-knead bread recipe. I looked at it and noticed that you need to bake the bread in an enameled Le Creuset-style dish. I didn’t have one and wasn’t keen to invest that much to find out whether I like something or not. But I think it was looking through the comments to that article that I was eventually led to “Artisan Bread in Five Minutes a Day”
Added later: at the time I wrote this, I was able to provide links to the individual comments on Morris’s series that I was responding to; sadly, they were not “permalinks” but “ephemalinks,” and I did not think to preserve the text of the comments themselves.
I can’t resist taking one last stir at the dying embers here. @LG #6: I join many others in thanking you for what seems to me to be a very able and cogent summary. And as you say, it has been an interesting week, certainly very different from just reading a series in the newspaper. @Skoorby #66: thank you for your very interesting description of the process of following this and other writings and discussion; I can relate to pretty much all of what you said, and I think it’s a valuable contribution as we adapt to this brave new world (in small letters, i.e. Shakespeare more than Huxley) of the web.
I finally hit my limit today, and I had some time, so I wrote a comment on Errol Morris’s 4th installment of his “Ashtray” series on the Times web site. Comments are limited to 5,000 characters and the site cheerfully informed me that I had minus 1520 characters remaining. So here it is in its entirety:
There is apparently yet another Thomas Kuhn here, one I don’t think he would have ever anticipated: the Thomas Kuhn who threw the ashtray. Speaking as his son I have to say that, try as I might, I just can’t get myself to believe that he threw that ashtray.
I am not someone to take the ramparts to defend my father against every allegation. He was a complicated guy and he did a lot of things. Many were admirable. Some were absolutely indefensible.
What we’re seeing here is not a rejection of his views; it’s a rejection of a caricature of his view. He never believed in any sort of relativism that says there is no truth other than the point of view people take on it. He believed very much in truth, but he also knew that understanding what it is to be true is much more complicated than it might first appear.
He certainly made mistakes, and I certainly heard him say things that I knew to be false but that he believed based on his own distorted point of view. But I don’t believe I ever saw him say anything that he knew to be untrue. He believed in truth, and he believed in truthfulness. He had a bad temper at times. He could be angry, he could yell, he could behave quite badly, but I never, ever saw him be violent, threaten violence, or throw anything, not even the pencil that was perpetually tucked behind his ear. I’m prepared to believe quite a few unflattering things about him, and to say some myself (though mostly in private), but I just can’t get myself to believe that he threw that ashtray, and neither can anyone I’ve talked to who knew him well—among whom there is quite a spectrum of overall opinion about him. (I should say here that, as a few commenters have noted, he could also be generous, helpful, understanding, encouraging, and more.)