32 thoughts on “About

  1. As a fellow South Carolinian and RN for 27 years I came up on your blog on Kevin MD and as someone whose life broke apart from mental illness ten years ago I could not believe I finally found someone who gets it.That understands how we are treated or not treated is maybe the better term.As a nurse working in an OR doing trauma before I became ill I loved my patients and though they were some of the toughest patients I truly can say I treated them with respect and everything I had to give.It mattered not to me if it was a drug running gunshot wound or auto wreck with a broken leg.They were sick and suffering human beings I was there to help.I was shocked beyond belief when I entered into my first psychiatric hospitalization and was treated like a common criminal.All the dehumanizing things that you write about I have endured over the years.They were hard enough to tolerate as a sick patient but I never lost my soul and heart as a nurse and just could never understand how they could treat their patients the way they did.It haunts me to this day and I have surprised even myself that my tears are flowing as I write this because of all the pain it brings up.However as your words so humanly portray I don’t have to tell you these things.You get it! Thank you for your support.


  2. Karen,

    Such a powerful comment. Man.
    Thanks for that.
    Those are the kind of memories I would like to cut way down on for patients that we see from here on out.



  3. Dr. Smith,
    Wonderful blog, entertaining, and informative for someone like me who knows NOTHING about medicine. My husband is a Psychiatrist and I emailed some of your posts to him. The posts will put a smile in his face! I love my husband even more now knowing what crap you guys have to put up with. And this whole time I was envious because he worked in an air condition building. Tsk tsk tsk.

    Thank you,


  4. Carey

    Thanks very much for reading. I hope you come back often.
    I have to wonder though-why do you know nothing about medicine if you are married to a psychiatrist?



  5. Hi Dr. Smith,
    I grew up in a third works country. “Doctors” were old village men and women. They pounded native plants to cure illnesses. If someone was going insane, they were given a blessing to kill the demons.
    Came to America, met and married my husband ( ped, psych, c&a psych m.d.) and I was somewhat afraid to learn more about his profession. I probably would prescribe 2 smacks to the bratty 8 year old that kicked his Grandma in the knee because she turned the tv. THIS is why I’m not a doctor. The kid might have a chemical imbalance and probably needs meds.
    Anyways, my husband is mum about work. He works long hours and we don’t see him as often as we like. When he comes home he just wants to spend time with us and be the family man. It’s probably best not to know about what happens at work. I might say some ignorant things!

    Good day 🙂


  6. Carey,

    Thanks for that. Makes much more sense now that I know the context.
    Your husband is most likely a very smart man to come home, leave the work behind, and be with you and the family in real time, with good focus.
    Thank you for reading. Hope I don’t let the cat out of the bag for your husband!



  7. You nailed it: “Close Encounters of the Emergency Kind”. We shared this one on our FB page. Thank you for taking the effort to write this, as we are so very grateful.


  8. What a wonderful article: Close Encounters… If we had more MD’s like u what a different world this wd be. I want to applaud one I knew, Jerry Duckman. He knew he couldn’t get the right formula for each person BUT what he did give everyone was a kind, loving, understanding ear. No matter how a person felt when they visited jerry, they came out feeling that “all was ok”, just because he LISTENED to them. Bless u, atheist Jerry. You brought G*d to more people than anyone I ever knew. Thank u Greg Smith. you sound like jerry reincarnated!


  9. I read your post on KevinMd and wanted to say how wonderful it is to know that you are so caring and there are good doctors out there. I have had a bad experience with a doctor who got mad at me for trying to be helpful and correcting him on a mistake he was making about my medical problem. Because he got angry he wrote in my medical records that I abuse heroin, cocaine, mushrooms, marijuana and alcohol. It is not true. He saw my medical conditions on my history form and wrote those lies about me so that my condtions wouldn’t be taken seriously. And because of that I haven’t gotten the proper medical treatment I should be getting. it will follow me to any provider I go to and is permanant in my medical records. It is horrible and there is nothing I can do about it. I can prove he lied and I can prove from my past medical history that it is false by tests that are negative for those things. But the damage is done. He became a doctor to help, not harm. Reading that there are caring doctors keeps me hopeful that eventually I will see a doctor that won’t blow me off and will give me proper care (so far it has only damaged me). While my situation isn’t exactly the same as you were writing about it was a great read, so I wanted to say Thanks for posting something important.


  10. Hello: I read your post today with great interest, having recently encountered significant barriers to care in an ED; physical health problems were compounded by mental health issues, and a raft of prescriptions coordinated by no doctor in particular. (I should have coordinated them, but was not quite able to do so.) In general, Percocet, Ambien, and Klonopin (prescribed for chronic pain) may not be the best combination for someone struggling to manage depression (Cymbalta and therapy). Because I write about health care and health policy in terms of aging, and my interactions with ED staff had a Twilight Zone quality. As you well know, an aging America will age with its mental health and substance abuse problems, compounded by other chronic conditions, and we are poorly prepared to respond to their likely needs. I like your proposals, but wonder how they will ever be enacted.


  11. Janice,

    Thank you for your reply.

    Yes, you are right in that we are all going to age and bring our current problems right along with us as we do. They will have to be addressed somehow.

    As other commenters have stated, one of things that would make some of this a lot better is an infusion of money to upgrade facilities and procedures. That may not happen any time soon. In lieu of that, we as providers and patients and family members are going to have to demand changes that can be made, even little ones, that improve care. This could be done locally, through hospital boards of directors, through advocacy groups and through state legislatures.

    I don’t think we have the option to coast or to ignore the problem. That’s the one thing I’m sure of.

    Thank you for reading and commenting.



  12. Hi Greg,

    I just composed a comment, but believe I lost it in the ether. So I’ll try again! There is no doubt that sheer demographics will force us to confront issues of an aging America, a world that will include some people who have endured a lifetime of mental health issues, and others for whom problems like dementia and delirium will be new and unfamiliar.

    I write for a group whose aim is “to make it safe to grow old” by creating better ways to care for frail elders. Like you, we try to create a voice that demands change. In the end-of-life arena, we have so far to go, but are often working with people who are so vulnerable, they do not realize just how inadequate that care often is.

    I think that incremental changes will add up, but it will take a much larger paradigm shift to see real improvements in the lives of people. 24-hours of suicide watch is but a sliver of what people need most when they show up in the ED, if it is what they need at all. I’m not sure how one generates such reforms, but know that doing so is critical.




  13. Janice,

    I agree.

    I’m not sure how we’re going to do this either.

    Part of the reason I write is to get the word out there, to educate and to inform. I’m so busy sometimes, like we all are, that this is the best I can do right now. After writing my post this morning about patient privacy in the ED, I have to get ready to work a sixteen hour shift.

    I just know that it is important to have the conversation. To let people know, whether it’s patients or families or providers, that we can only tread water for so long before we start get really tired and there is a real danger of drowning.

    I will check out your web site and the work your group is doing. I appreciate your reading and caring.



  14. Glad there are clinicians like you, serving patients and changing th system.

    My colleague, Joanne Lynn, uses a metaphor from a family rafting trip. She tumbled out of the boat and got stuck on a rock. She had to choose between her terror on the rock, or trying something different. The current health care system is that treacherous river, one that has the potential to take many down.


  15. I am a professional health care economist with a longstanding research focus on emergency medicine and also father of a recently diagnosed child with bipolar I. As you might imagine, I follow your blog closely, with keen interest, and strongly held positions — many of them orthogonal to conventional wisdom. Thank you for your great and much-needed work. There is a web site, http://hcupnet.ahrq.gov/HCUPnet.jsp, which provides definitive data on ED and inpatient care. To put your experience in perspective, in 2010 there were roughly 40 million patients with inpatient stays nationwide, including new moms and newborns; and there were 25.6 million all-listed diagnoses of mental illness among those patients. Of course some patients have more than one diagnosis and perhaps more than one inpatient stay. Of these 25.6 million all-listed diagnoses, 3.9 million were for mood disorders and 0.8 million were for schizophrenia. Similarly, there were 140 million ED visits nationwide, and within these there were 24.9 million diagnoses of mental illness, including 5.5 million with mood disorders and 0.9 million for schizophrenia. These strike me as truly STAGGERING numbers. A July 2013 article in JAMA shows mental and behavioral disorders as being as prevalent among those under age 65 as everything else combined, except for musculoskeletal diseases and disorders. Given these sorts of numbers, it simply must be the case that these illnesses touch a very significant fraction of American families, and so I do not understand why society views these individuals as “mental defectives.” We can do better and I so appreciate and value your efforts to help people understand the issues.


  16. David,

    Thanks for that excellent comment!

    I am humbled and appreciate your kind words.

    Yes the harvest is plentiful and the laborers are few. I am trying to change my little corner of the wor


  17. David,

    Sorry, but the reply decided it would post itself before I was ready to! I am trying to change my little corner of the world, but it’s going to take people like you and many others to make their voices heard on these issues, in the hospitals, the clinics, the legislatures and other places that have the wherewithal to do something about the problems.

    Thanks again for reading and commenting. Hope you come back often.



  18. Greg,

    I read your post “If not us, who? If not now, when?” by way of hearing about your blog from kevinmd. I appreciate your honesty. I’m a PGY2 in psychiatry in NYC, and I wonder how I might have the time/energy to try to change Systems when I’m just struggling to learn which drugs interact with which others and what cytochromes are involved and what do I say to my patient who is actively hallucinating and convinced that everyone hates him (those topics have been on my mind the past couple of days). I hope I find a way to be an activist while being a clinician. Good luck to you, too!



  19. Sarah

    Welcome and thanks for reading and commenting.

    Your job right now is to learn your craft and learn it well. That’s your only job. Do your very best.

    There will be time for activism as you settle into the profession and find the right path for you.

    I’m so pleased you stopped by to read. Please come back and comment often.




  20. Dear Greg Smith, MD – very impressive and admirable work you are doing. A caring service for those in pain. Illuminating writing. Thanks for your heart for suffering souls.


  21. Had to say hello – we share a name and I work in the Policy Unit of the Royal College of Psychiatrists in the UK so it seems we have mental health in common too!

    All the best – I’m looking forward to exploring the blog.


  22. Bonjour,

    I’m a 18 y old friend of Jeff Pullium who told me about you.
    Your blog is fantastic, quitte powerfull and energising in its spontanéité and thoughts in such a way that even if i don’ t know anything about psy medicine or so, i’m enjoying your words as they say and carry human values and concern that i feel. It is universal.
    Thank to you for all this and also because you give me the envy to share also my words, so i may “end” to start my first blog as well! 🙂




  23. Dr. Smith really enjoyed your insightful comments. In a profession where burn out can run rampant it’s nice to see someone so caring and dedicated to the individuals he works with. Keep up the great work.


  24. I love your blog; your views on life and the world, but today it’s just not hitting the spot.
    What do you say to patients when they’re unwell and losing hope? How do you minimise the voices and restore perspective? How do you restore the beauty in the world?


  25. I wanted to comment on your blog post “Abdication” but couldn’t find a comment option there. You are absolutely right about too many of today’s parents abdicating their role and responsibility, indeed their moral obligation, to raise their children. Parents seem afraid to “upset” their children with expectations of a certain standard of behavior, and keep them in emotional “bubble wrap” so they don’t learn how to cope with disappointment and distress. As a mental health provider/physician in college health, I’m seeing the results of the lack of parental mentoring and shepherding of their children and it isn’t pretty. Thanks for taking on the tough topics!

    Liked by 1 person

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