Clinical Documentation Quotes

Yet, in the middle of all this grief, I realize there’s a part of me clinical enough to want to document it. People talk about artists like they’re these sensitive, delicate beings who don’t use the toilet, but I think the real ones are something else. They’re users. They’re mercenaries. They’re hunters. And they don’t let anything – other people, or themselves – get in the way of it.

In a modern twist to the classic overeating experiments, Feltham decided that he would eat 5794 calories per day and document his weight gain. But the diet he chose was not a random 5794 calories. He followed a low-carbohydrate, high-fat diet of natural foods for twenty-one days. Feltham believed, based on clinical experience, that refined carbohydrates, not total calories, caused weight gain. The macronutrient breakdown of his diet was 10 percent carbohydrate, 53 percent fat and 37 percent protein. Standard calorie calculations predicted a weight gain of about 16 pounds (7.3 kilograms). Actual weight gain, however, was only about 2.8 pounds (1.3 kilograms). Even more interesting, he dropped more than 1 inch (2.5 centimeters) from his waist measurement. He gained weight, but it was lean mass.

For the past twenty-five years, the psychiatric establishment has told us a false story. It told us that schizophrenia, depression, and bipolar illness are known to be brain diseases, even though—as the MindFreedom hunger strike revealed—it can’t direct us to any scientific studies that document this claim. It told us that psychiatric medications fix chemical imbalances in the brain, even though decades of research failed to find this to be so. It told us that Prozac and the other second-generation psychotropics were much better and safer than the first-generation drugs, even though the clinical studies had shown no such thing. Most important of all, the psychiatric establishment failed to tell us that the drugs worsen long-term outcomes.

Viley’s Harry, Charles and Lew. Theo felt whipsawed. Troye may have portrayed these men as individuals, but perhaps only in the same clinical way that he exactly documented the splendid musculature of the thoroughbred. It was impossible not to suspect some equivalence between the men and the horse: valued, no doubt, but living by the will of their enslaver, submitting to the whip. Obedience and docility: valued in a horse, valued in an enslaved human. Both should move only at the command of their owner. Loyalty, muscle, willingness—qualities for a horse, qualities for the enslaved. And while the horse had two names, the men had only one. Theo let the resentment rise inside him.

According to an article in the Washington Post: The Food and Drug Administration has repeatedly urged antidepressant manufacturers not to disclose to physicians and the public that some clinical trials of the medications in children found that drugs were no better than sugar pills, according to documents and testimony released at a congressional hearing yesterday. Regulators supressed the negative information on the grounds that it might scare families and physicians away from the drugs, according to testimony by drug company executives. For at least three medications, they said, the FDA blocked the companies' plans to reveal the negative studies in drug labels.

Frontline nurses came up with and implemented two more elements of the patient safety system: Safety Action Teams and Good Catch Logs. Safety Action Teams were self-organized groups of nurses who met to identify and reduce potential hazards in their clinical areas. Second-order problem-solving indeed. The Good Catch Logs were a way of celebrating near misses: by documenting good catches, nurses identified additional opportunities for process improvement.

While some accused and convicted child molesters have inappropriately influenced the media, the public, and many in the clinical and legal professions by claiming that traumatic amnesia does not occur in child sexual abuse, workers in the field of trauma psychology have accumulated solid empirical evidence over the past 100 years that it does occur and is common. Its existence and natural history are documented throughout the clinical literature. from: Traumatic amnesia: The evolution of our understanding from a clinical and legal perspective, Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, Volume 4, Issue 2, 1997

Or when you keep a sex-addiction meeting under surveillance because they’re the best places to pick up chicks.” Serge looked around the room at suspicious eyes. “Okay, maybe that last one’s just me. But you should try it. They keep the men’s and women’s meetings separate for obvious reasons. And there are so many more opportunities today because the whole country’s wallowing in this whiny new sex-rehab craze after some golfer diddled every pancake waitress on the seaboard. That’s not a disease; that’s cheating. He should have been sent to confession or marriage counseling after his wife finished chasing him around Orlando with a pitching wedge. But today, the nation is into humiliation, tearing down a lifetime of achievement by labeling some guy a damaged little dick weasel. The upside is the meetings. So what you do is wait on the sidewalk for the women to get out, pretending like you’re loitering. And because of the nature of the sessions they just left, there’s no need for idle chatter or lame pickup lines. You get right to business: ‘What’s your hang-up?’ And she answers, and you say, ‘What a coincidence. Me, too.’ Then, hang on to your hat! It’s like Forrest Gump’s box of chocolates. You never know what you’re going to get. Most people are aware of the obvious, like foot fetish or leather. But there are more than five hundred lesser-known but clinically documented paraphilia that make no sexual sense. Those are my favorites . . .” Serge began counting off on his fingers. “This one woman had Ursusagalmatophilia, which meant she got off on teddy bears—that was easily my weirdest three-way. And nasophilia, which meant she was completely into my nose, and she phoned a friend with mucophilia, which is mucus. The details on that one are a little disgusting. And formicophilia, which is being crawled on by insects, so the babe bought an ant farm. And symphorophilia—that’s staging car accidents, which means you have to time the air bags perfectly

These senators and representatives call themselves “leaders.” One of the primary principles of leadership is that a leader never asks or orders any follower to do what he or she would not do themselves. Such action requires the demonstration of the acknowledged traits of a leader among which are integrity, honesty, and courage, both physical and moral courage. They don’t have those traits nor are they willing to do what they ask and order. Just this proves we elect people who shouldn’t be leading the nation. When the great calamity and pain comes, it will have been earned and deserved. The piper always has to be paid at the end of the party. The party is about over. The bill is not far from coming due. Everybody always wants the guilty identified. The culprits are we the people, primarily the baby boom generation, which allowed their vote to be bought with entitlements at the expense of their children, who are now stuck with the national debt bill that grows by the second and cannot be paid off. These follow-on citizens—I call them the screwed generation—are doomed to lifelong grief and crushing debt unless they take the only other course available to them, which is to repudiate that debt by simply printing up $20 trillion, calling in all federal bills, bonds, and notes for payoff, and then changing from the green dollar to say a red dollar, making the exchange rate 100 or 1000 green dollars for 1 red dollar or even more to get to zero debt. Certainly this will create a great international crisis. But that crisis is coming anyhow. In fact it is here already. The U.S. has no choice but to eventually default on that debt. This at least will be a controlled default rather than an uncontrolled collapse. At present it is out of control. Congress hasn’t come up with a budget in 3 years. That’s because there is no way at this point to create a viable budget that will balance and not just be a written document verifying that we cannot legitimately pay our bills and that we are on an ever-descending course into greater and greater debt. A true, honest budget would but verify that we are a bankrupt nation. We are repeating history, the history we failed to learn from. The history of Rome. Our TV and video games are the equivalent distractions of the Coliseums and circus of Rome. Our printing and borrowing of money to cover our deficit spending is the same as the mixing and devaluation of the gold Roman sisteri with copper. Our dysfunctional and ineffectual Congress is as was the Roman Senate. Our Presidential executive orders the same as the dictatorial edicts of Caesar. Our open borders and multi-millions of illegal alien non-citizens the same as the influx of the Germanic and Gallic tribes. It is as if we were intentionally following the course written in The History of the Decline and Fall of the Roman Empire. The military actions, now 11 years in length, of Iraq and Afghanistan are repeats of the Vietnam fiasco and the RussianAfghan incursion. Our creep toward socialism is no different and will bring the same implosion as socialism did in the U.S.S.R. One should recognize that the repeated application of failed solutions to the same problem is one of the clinical definitions of insanity. * * * I am old, ill, physically used up now. I can’t have much time left in this life. I accept that. All born eventually die and with the life I’ve lived, I probably should have been dead decades ago. Fate has allowed me to screw the world out of a lot of years. I do have one regret: the future holds great challenge. I would like to see that challenge met and overcome and this nation restored to what our founding fathers envisioned. I’d like to be a part of that. Yeah. “I’d like to do it again.” THE END PHOTOS Daniel Hill 1954 – 15

The psychological impact of trauma in both the military and civilian arenas has been documented for well over 100 years [1], but the validity of the traumatic neuroses and their key symptoms have been continuously questioned. This is particularly true for posttraumatic amnesia and therapeutically recovered traumatic memories. Freud’s [2] abandonment of his seduction theory was followed by decades of denial of sexual trauma in the psychoanalytic and broader sociocultural realms [3]. Concomitant negation of posttraumatic symptomatology was noted in regard to the war neuroses, emanating equally from military, medical and social spheres [4]. Thus, Karon and Widener [5] drew attention to professional abandonment of the literature on posttraumatic amnesia in World War II combatants. They considered this to be due to a collective forgetting, comparable to the repression of soldiers, but instead occurring on account of social prejudices. He further noted that the validity of memories was never challenged at the time since there was ample corroborating evidence. Recent research confirms the findings of earlier investigators such as Janet [6], validating posttraumatic amnesia of both civilian and military origin. Van der Hart and Nijenhuis [7] cited clinical studies reporting total amnesia for combat trauma, experiences in Nazi concentration camps, torture and robbery. There is also increasing evidence for the existence of amnesia for child sexual abuse. Thus, Scheflen and Brown [8] concluded from their analysis of 25 empirical studies that such amnesia is a robust finding. Since then, new studies, for example those of Elliott [9], have appeared supporting their conclusion. This paper examines posttraumatic amnesia in World War I (WWI) combatants. The findings are offered as an historical cross-validation of posttraumatic amnesia in all populations, including those subjected to childhood sexual abuse.

I have chosen to use the terms lesbian existence and lesbian continuum because the word lesbianism has a clinical and limiting ring Lesbian existence suggests both the fact of the historical presence of lesbians and our continuing creation of the meaning of that existence I mean the term lesbian continuum to include a range—through each woman’s life and throughout history—of woman-identified experience; not simply the fact that a woman has had or consciously desired genital sexual experience with another woman. If we expand it to embrace many more forms of primary intensity between and among women, including the sharing of a rich inner life, the bonding against male tyranny, the giving and receiving of practical and political support; if we can also hear in it such associations as marriage resistance and the ‘haggard’ behavior identified by Mary Daly (obsolete meanings ‘intractable,’ ‘willful,’ ‘wanton,’ and ‘unchaste’ a woman reluctant to yield to wooing’)—we begin to grasp breadths of female history and psychology that have lain out of reach as a consequence of limited, mostly clinical, definitions of ‘lesbianism.’ Lesbian existence comprises both the breaking of a taboo and the rejection of a compulsory way of life It is also a direct or indirect attack on male right of access to women But it is more than these, although we may first begin to perceive it as a form of nay-saying to patriarchy, an act or resistance It has of course included role playing, self-hatred, breakdown, alcoholism, suicide, and intrawoman violence; we romanticize at our peril what it means to love and act against the grain, and under heavy penalties; and lesbian existence has been lived (unlike, say, Jewish or Catholic existence) without access to any knowledge of a tradition, a continuity, a social underpinning The destruction of records and memorabilia and letters documenting the realities of lesbian existence must be taken very seriously as a means of keeping heterosexuality compulsory for women, since what has been kept from our knowledge is joy, sensuality, courage, and community, as well as guilt, self-betrayal, and pain.

One hundred twenty-nine women with previously documented histories of sexual victimization in childhood were interviewed and asked detailed questions about their abuse histories to answer the question "Do people actually forget traumatic events such as child sexual abuse, and if so, how common is such forgetting?" A large proportion of the women (38%) did not recall the abuse that had been reported 17 years earlier. Women who were younger at the time of the abuse and those who were molested by someone they knew were more likely to have no recall of the abuse. The implications for research and practice are discussed. Long periods with no memory of abuse should not be regarded as evidence that the abuse did not occur. Journal of Consulting and Clinical Psychology, Vol 62(6), Dec 1994, 1167-1176

On the one hand, I recognize the power of the placebo effect: if you believe it’s working, it may well work. If you think an object brings you luck, you are more confident. And yet what the Italian students in the “lucky” seats showed wasn’t confidence; it was overconfidence. They thought they were doing better, but the evidence didn’t actually back them up. And then there’s the flip side of the placebo, the nocebo effect: the belief in evil signs or bad luck. It turns out people can literally scare themselves to death. If you think you’ve been cursed or otherwise made ill, you may end up actually getting sick, failing to improve poor health, or, yes, dying altogether. In one medically documented instance, a man was given three months to live after a diagnosis of metastatic cancer of the esophagus. He died shortly after. When his body was autopsied, doctors realized that he had been misdiagnosed: he did indeed have cancer, but a tiny, non-metastatic tumor on his liver. Clinically speaking, it could not have killed him. But, it seems, being told he was dying of a fatal illness brought about that very outcome. In another case, a man thought he was hexed by a voodoo priest. He came close to death, only to recover miraculously after an enterprising doctor “reversed” the curse through a series of made-up words. In yet a third, a man almost died in the emergency room after overdosing on pills. He’d been in a drug trial for depression and decided to end his life with the antidepressants he’d been prescribed. His vitals were so bad when he was admitted that doctors didn’t think he would make it—until they discovered his blood was completely clear of any drugs. He’d been taking a placebo. Once he found out he had not in fact taken a life-threatening quantity of pills, he recovered quickly. The effect our mind has on our body makes for a scary proposition. Belief is a powerful thing. Our mental state is crucial to our performance. And ultimately, while some superstitions may give you a veneer of false confidence, they also have the power to destroy your mental equilibrium. I like to think of this as the black cat effect. You see one cross the parking lot as you walk to a tournament. You brood about the bad luck. Your game is thrown off. You blame the cat. You bust. You feel validated. Superstitions are false attributions, so they give you a false sense of your own abilities and in the end, impede learning.

We get paid much more to keep someone on dialysis than to keep them off of it. If we don’t achieve dialysis metrics—like avoiding dialysis catheters or providing a certain dose of dialysis—known to best result in long-term benefits, we are financially penalized. But create a fistula in a little old lady that usually requires interventions to make it work and keep it working and make her stay on the dialysis machine as long as it takes for the numbers to look right, then essentially get a bonus. If we see an in-center hemodialysis patient four times in a month, we stand to make 50 percent more money than if we only saw her once. And the nephrologist really only has to see the patient once each month—if a physician assistant sees the patient the other times, we still get paid. We would have to document a comprehensive medical history and examination over the better part of an hour with a patient returning to clinic twice to see the same money—and good luck trying to justify why that was clinically necessary to do. The second, third, and fourth in-center hemodialysis patient visits can be more like drive-bys—a simple documentation that we (or the physician assistant) “saw” the patient, with no notation of time required. Private insurance companies and the Medicare ESRD program pay top dollar for dialysis care, not clinic visits. It’s profitable to build another dialysis center, but we haven’t figured out how to build comprehensive outpatient palliative care services.

What was the new research he was referencing? A research document that claimed to show benefit to masking based on reviewing a collection of studies, which somehow ignored all of the randomized controlled trials showing no effect from masking. These kinds of glaring omissions have been a continuous problem among scientists desperate to justify the implementation of masks despite the gold standard of evidence indicating they would be effectively useless. One randomized controlled trial did occur during 2020, conducted by researchers in Denmark. Those researchers’ objective was clearly stated: “To assess whether recommending surgical mask use outside the home reduces wearers’ risk for SARS-CoV-2 infection in a setting where masks were uncommon and not among recommended public health measures.”25 Given all of the pre-COVID scientific research, it should come as no surprise that the results showed no benefit to mask wearing to protect against infection with COVID-19. The Denmark researchers’ summary clearly identifies the lack of any significant impact: “The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers.” Thousands of Danes were enrolled in this trial, the most comprehensive effort by any scientific researchers to study the potential effect of mask wearing by the general public. Participants were provided high-quality surgical masks, not the cloth face coverings recommended by many public health agencies. In the best approximation of a gold-standard clinical trial that researchers could design, the results showed absolutely no statistically significant benefit. The findings, surprisingly, received no major media attention, nor did they generate questions for the expert community that now universally embrace masking.

He loved the idea of this country (theory and practice often being diametrically opposed), but the manner in which the original documents of freedom had been mangled to steer corporate/military interests drove him close to clinically insane. I believe it was grief for a nation that finally killed him.

And then there’s the flip side of the placebo, the nocebo effect: the belief in evil signs or bad luck. It turns out people can literally scare themselves to death. If you think you’ve been cursed or otherwise made ill, you may end up actually getting sick, failing to improve poor health, or, yes, dying altogether. In one medically documented instance, a man was given three months to live after a diagnosis of metastatic cancer of the esophagus. He died shortly after. When his body was autopsied, doctors realized that he had been misdiagnosed: he did indeed have cancer, but a tiny, non-metastatic tumor on his liver. Clinically speaking, it could not have killed him. But, it seems, being told he was dying of a fatal illness brought about that very outcome. In another case, a man thought he was hexed by a voodoo priest. He came close to death, only to recover miraculously after an enterprising doctor “reversed” the curse through a series of made‑up words. In yet a third, a man almost died in the emergency room after overdosing on pills. He’d been in a drug trial for depression and decided to end his life with the antidepressants he’d been prescribed. His vitals were so bad when he was admitted that doctors didn’t think he would make it—until they discovered his blood was completely clear of any drugs. He’d been taking a placebo. Once he found out he had not in fact taken a life-threatening quantity of pills, he recovered quickly. The effect our mind has on our body makes for a scary proposition.

Psychedelics were introduced to mainstream science in the 1940s and 1950s. After researchers studied them and, in some cases, self -experimented, it was determined that psychedelics were physically safe and able to be introduced into therapeutic contexts (dos Santos, Bouso, Alcázar-Córcoles, & Hallak, 2018). Humphrey Osmond, the British psychiatrist who coined the term “psychedelic” in the 1950s, found tremendous improvement in patients with alcoholism after a single LSD session, as an example.  Grinspoon and Balakar have noted that the scientists studying psychedelics were not considered counter-cultural or radical in their beliefs (Grinspoon & Bakalar, 1979). Before the Controlled Substances Act (CSA) rendered psychedelics such as LSD illegal in 1971, over 40,000 patients experienced psychedelic therapy sessions that were documented in over a thousand clinical papers.

The final summary of the Pfizer’s six-month clinical trial data—the document that Pfizer submitted to FDA to win approval—revealed one key data point that should have killed that intervention forever. Far more people died in the vaccine group than in the placebo group during Pfizer’s clinical trials.

After spending the day in a school vaccination clinic, a colleague of mine quipped: “Every time you add a question to a form, I want you to imagine the user filling it out with one hand while using the other to break up a brawl between toddlers.”6 Applications for government benefits might be completed under similarly chaotic circumstances. Users who have a lot else going on in their lives need to be able to apply for the service without an undue burden of time, technology, and cognitive overhead. If they’re asked for documentation, the documents need to be ones they have access to. If they need to correspond with the program, there has to be a way for them to do so even if they lack a stable mailing address. If they have family who are undocumented immigrants, they may need reassurance that applying for a program won’t get them or their relatives in trouble.

The auditors reported a scene of pure chaos. “Drugs were given to the wrong babies, documents were altered, and there was infrequent follow-up, even though one third of the mothers were marked ‘abnormal’ in their charts at discharge. The infants who did receive follow-up care were, in many cases, small and alarmingly underweight. ‘It was thought to be likely that some, perhaps many, of these infants had serious health problems.’”16 When Westat chose a random sample of forty-three of those infants to examine, all of them had “adverse events” twelve months after the study terminated. Only eleven of them were HIV positive.17 When Westat confronted Dr. Jackson’s researchers with study discrepancies, they admitted that they routinely applied more lenient standards for their Black Ugandan subjects than FDA rules required for US safety studies.18 The PIs admitted to systematically downgrading standardized definitions of serious adverse events to adapt to “local standards.” Injuries that researchers would score as “serious” or “deadly” if they happened to white Americans became “minor” injuries when Black Africans were the victims. Under their relaxed rubric, clinical trials staff scored “life-threatening” injuries as “not serious.” When they reported them at all, NIAID classified mortalities among its African volunteers as “serious adverse events,” rather than “death.” NIAID’s Ugandan team had entirely neglected to report thousands of adverse events and at least fourteen deaths.19

Lind’s 1747 experiment looked at scurvy. Twelve sailors who had the illness were divided into six groups. The accommodations and diet of all the sailors were identical, but each received a different remedy: one group received cider; one got seawater; another, “elixir of vitriol”; the fifth group, two oranges and a lemon; and the sixth, a mix of spices with barley water. It was the first documented clinical trial in medical history.

Salmon calcitonin (SCT) has been an available therapeutic agent for over 30 years. The analgesic properties of SCT have been documented in several prospective clinical trials. Studies that

The full story of Osama Bin Laden’s long fugitive exile in Pakistan may never be known. He appears to have lived in about four different houses in towns in the northwest of the country before moving to Abbottabad in August 2005, where he remained until his death. Kayani had been I.S.I. director for less than a year when Bin Laden set up in Abbottabad. The Al Qaeda emir and his family enjoyed support from a sizable, complex network inside Pakistan—document manufacturers, fund-raisers, bankers, couriers, and guards. His youngest wife, Amal, gave birth to four children in Pakistani hospitals or clinics after 2002.

In 2010 and 2015, the FDA released a pair of draft “guidance” documents on “Adaptive Design” clinical trials for drugs and medical devices, which suggests—despite a long history of sticking to an option they trust—that they might at last be willing to explore alternatives.