Corona Virus Tips

Corona Virus Office Policy Adjustments

In order to keep our community safe I am advising any patient who has any physical signs of infection (such as fever, cough, sore throat, nausea, malaise etc) to request a phone or video appointment on If you wish to arrange this just call the office and speak with Pam or leave a message. If you arrive at the office and are sick you will be sent home. Please consider the safety of others in making the determination.

Everyone is encouraged to practice the following safety measures to keep our community safe:

Wash your hands with warm soap and water for at least twenty seconds

Avoid touching your face

Cover cough or sneeze using your elbow and not your hand

Use alcohol based hand sanitizer that contains at least 60% alcohol, if soap and water is unavailable

Avoid close contact with people

Avoid shaking hands to prevent the spread of germs (consider a quick wave or elbow bump)

If you sneeze, cover your mouth with a tissue, throw it in the trash and wash your hands

Consider using a paper towel to tissue to open doors whenever possible


How To Dispose of Unused Medicine

Many people are unsure of how to properly dispose of old or unused medication. Many drugs can be thrown in the household trash, but consumers should take precautions before throwing them out, according to the FDA (Food and Drug Administration). A few drugs should be flushed down the toilet. Prescription “Take Back Days” as sponsored by the DEA and community medication take back programs also offer a safe easy way to properly dispose of medication. This is important to the entire community given the epidemic prescription drug problem in the United States. Most children and teens first obtain their drugs from their parents’ medicine cabinets or those of their friends.
FDA worked with the White House Office of National Drug Control Policy (ONDCP) to develop the first consumer guidance for proper disposal of prescription drugs. Issued by ONDCP in February 2007 and updated in October 2009, the federal guidelines are summarized here:
Follow any specific disposal instructions on the drug label or patient information that accompanies the medication. Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so. When a drug contains instructions to flush it down the toilet it is because FDA, working with the manufacturer, has determined this method to e the most appropriate route of disposal that presents the least risk to safety. Drugs such as powerful narcotic pain relievers and other controlled substances carry instructions for flushing to reduce the danger of unintentional use or overdose and illegal abuse.
Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Call your city or county government’s household trash and recycling service (see blue pages in phone book) to see if a take-back program is available in your community. The DEA (Drug Enforcement Administration), working with state and local law enforcement agencies, is sponsoring National Prescription Drug Take Back Days ( throughout the United States. The latest national event was on April 26, 2014 and 780,158 pounds of drugs were collected. If you live in Encinitas, you may go to the sheriff’s office at any time and drop off your medication in a kiosk located in the lobby, no questions asked.
If no instructions are given on the drug label and no take-back program is available in your area, throw the drugs in the household trash, but first: Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash. Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.
Before throwing out a medicine container, scratch out all the identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information.
Do not give medications to friends. Doctors prescribe drugs based on a person’s specific symptoms and medical history. A drug that works for you could be dangerous for someone else. When in doubt about proper disposal, talk to your pharmacist.
This information has been reproduced from FDA Consumer Health Information April 2011

2013 The Year of Change

Good bye to our standard 90862 and 90807 CPT codes. Many changes are occurring in mental health this year. The first changes occurred on Jan 1, 2013 with CPT codes being eliminated for mental health. This means that all psychiatrists will have to use the same codes that all other physicians use. This has resulted in having to use multiple codes to replace a  prior single code. As with most policy changes, this was implemented with good intentions but potential negative unintended consequences. This change was intended for psychiatrists to better document the complexity of treatment provided. Thus far it has created winners and losers depending on your insurance carrier. Many companies were not ready for this change despite at least six months advance notice. Problems thus far include rejecting the new valid codes, double copays charged to a patient for a single visit and delays in processing claims. If you are experiencing any of these problems, you may contact your insurance company to file a complaint and request reprocessing. You may also consider notifying your human resources department if you have a group insurance plan. The insurance commissioner for the state of California may be reached at 1-800-927-4357 or  written correspondence may be sent to California Department of Insurance, Consumer Services Division, 300 South Spring Street, South Tower, Los Angeles, CA 90013. Web site info can be found at; click on request for assistance.

Next stay tuned for updates on the latest edition of the DSM-5, Diagnostic and Statistical Manual of Mental Disorders, released in May 2013. In 2014 the ICD codes will be changing potentially increasing the number of codes to 68,000 from the current 13,000 in the ICD 9. The code set will be expanding from 5 positions to 7. In addition 2014 is the official start date of The Patient Protection and Affordable Care Act. The preceding transitions are unlikely to be smooth despite all the promises.

About Psychotherapy

I have chosen to continue training in psychotherapy after many years in private practice. This is considered an oddity by many given the trend and reliance on psychopharmacology by most psychiatrists. It is a fair question to ask why. I had the good fortune to have attended a conference on attachment based psychotherapy several years ago. I had no expectations on what I was to learn and witness. However, it forever altered my perspective on the role of therapy and personal transformation. Videotapes were shown that depicted patients one year AFTER  stopping therapy. It was obvious that the process of transformation had continued and seeing it on tape was quite impressive. Several of us in the audience started in our core training in Intensive Short Term Dynamic Therapy, ISTDP, just six weeks later. Core training is a minimum three year process.

ISTDP is one of the Experiential Dynamic Therapies, EDT. EDT is a collective term adopted by the International Experiential Dynamic Therapy Association, IEDTA. The IEDTA represents diverse techniques and outgrowths of a school of therapy that evolved from the work of Habib Davanloo.  Dr. Davanloo is the founder of Intensive Short Term Dynamic Therapy. His study of over 2000 videotaped therapy hours and forty years of systematic research identified and isolated therapeutic interventions that are transformative and sustained over time.

From the IEDTA Website “ EDT includes various psychotherapeutic approaches which share the common features of being psychodynamic in orientation and emphasizing the promotion of healthy emotional experience to foster rapid, deep and lasting therapeutic change. The efficacy of this approach is validated in numerous studies indicating positive outcomes for a broad spectrum of psychological and relational difficulties.” For more information please visit the IEDTA website: or