My Response to a Psychiatric Times Blog Entry by Psychiatrist Carol A. Paris M.D. Concerning the Tribulations of Working with Health Insurance Companies

It seems to me that this kind of criticism of the insurance industry misses the more important point. As a psychiatrist, I am not enamored of piles of paperwork, debating with peer reviewers, and feeling that my patients are sometimes denied important services on the basis of cost. But, many physician complaints about the system seem, to me, narrow in scope, if not downright self-serving.

I was practicing in California when managed care arrived in the mid 80′s. I hated those calls from insurance companies that made me feel that my competence and judgment were being questioned. Then again, some of my colleagues were keeping patients in the hospital until their insurance ran out, declaring them cured, and discharging them. And there’s the psychiatrist I knew who was billing for psychotherapy with a patient in an ICU who was in a coma. I accept the few bad apples theory, but physician greed certainly contributed to the backlash that occurred.

At the present time, over 16% of our population has no health insurance, yet we’re spending an almost identical proportion of our gross domestic product on health care, and bankrupting our system. All the complaining in the world won’t change the fact that something’s got to give. We can blame overpaid CEO’s, an excess of mid-level managers at the companies we revile, lawyers and politicians, but let’s look at ourselves. All too often, we think of our patients, our income, all the rewards we were promised for staying up all night studying or working 72 hour shifts as house officers, piling up debt while our friends were working for a decent wage and having fun.

We’re not entitled to anything. Nobody is. Let’s accept current realities or work to change them instead of holding pity parties for ourselves.

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Sleep versus Exercise

Long-term, severe sleep deprivation can result in severe illness, hallucinations and death.  That doesn’t mean that short-term lack of sleep has no adverse consequences.  Recent studies have found that even  several  days of  reduced or shallow sleep can accumulate and resemble the effects of several dozen hours of acute sleep deprivation. 

Sleep deprivation increases the risk of obesity, diabetes, and cardiovascular disease, which are among the medical conditions that we try to prevent via regular exercise.  Thus, even looking at the short-term, sleep deprivation has significant adverse effects that almost certainly outweigh the benefits of exercise.

The sleep versus exercise question has no black and white answer, since exercise is often beneficial to sleep.  Recent findings suggest that, contrary to popular belief, exercising vigorously close to bedtime does not cause insomnia. So my overall feeling is that, given a choice between sleep and exercise, sleep should be given priority.