Thank you very much for your interest in Dr. Fred Miley's psychiatric practice.
This
page from our office brochure is intended to anticipate questions that
often occur to people seeking help for themselves or others in coping
with stressful changes, negative feelings or behaviors, destructive
relationships or traumatic events. (Please excuse any duplication of
information presented on other pages of this website. Any suggestions
for its improvement will be appreciated).
Professional Credentials
Fred
Miley, M.D., a Florida licensed physician since 1967, has been in the
solo private practice of psychiatry since 1973. He moved from Miami to
Ocala in 1981 and has served on the consulting staffs of both Ocala
hospitals.
He holds a Master of Science degree in school
psychology from Illinois State University and a Bachelor of Arts in
psychology from Illinois Wesleyan University. A 1967 graduate of the
University of Missouri School of Medicine, he had completed his
internship and his psychiatry residency at the University of
Miami/Jackson Memorial and VA Hospitals, had served two years as a U.S.
Navy physician and practiced psychiatry in North Miami for almost ten
years before moving to Ocala.
He has also served as a clinical
instructor at the University of Miami Department of Psychiatry,
supervising senior psychiatry residents in psychotherapy techniques and
is currently Visiting Clinical Professor at the University of Florida
Department of Psychiatry. He annually attends more than twice the
required number of continuing medical education courses.
Community Service and Affiliations
Dr.
Miley often gives talks on depression, anxiety, eating disorders,
stress management, coping with illness, parent/child and marital
relationships. He has served as guest lecturer for the Central Florida
Community College School of Nursing and patient advocacy organizations
such as DBSA, NAMI, Hospice, CHADD, and ostomy, cancer, chronic pain
and depression support groups, as well as Ocala and Marion County
managerial staffs and the Sheriff's Department. A participant in Marion
County's model indigent We Care program since its inception, he is also
the Chairman of Marion County's Community Crisis Response Team. As
Chair of the Medical Strike Team's Critical Incident Stress Management
Committee, he is responsible for psychotrauma triage in local
disasters.
While an active member of the American Psychiatric
and Florida Medical Associations and the Marion County Medical Society,
Dr. Miley has served twice as president of the North Central Florida
Psychiatric Society. He is currently Vice President of the over 1,000
member Florida Psychiatric Society, which named him "Private
Practitioner of the Year 2000" and has been nominated for
President-Elect to serve in 2004-2005.
What Comes First?
Please
remember that the relationship between YOU and Dr. Miley comes first.
He works for and with YOU, not your insurance company, employer,
attorney or relatives. Therefore, your confidentiality is protected
beyond what is required by Florida and federal laws. A time-limited
release form signed by you is required before he will send any
requested reports to or discuss your treatment with anyone else.
Office Hours
Except
for holidays, the office is open Monday through Thursday from 9 a.m. to
6 p.m. At other times or in an emergency, please call the office and
leave your message with the answering service operator. Dr. Miley will
soon return your call. Vacation coverage is provided by selected local
psychiatrists.
This office has 24-hour telephone coverage,
either by the office manager, Mrs. Marietta Chaky, or an efficient,
personal answering service, to take accurate messages and to assure you
access to Dr. Miley in genuine emergencies.
Appointment Policy
When
you call to schedule your office evaluation or follow-up session, you
will receive the earliest available time. To schedule a visit prior to
your regular appointment, please call and ask to be notified of any
cancellations which may occur on short notice. To make this option
available to others, please give 24 hours notice if you cannot keep
your scheduled appointment, to avoid being charged for your reserved
time and to allow that time to be assigned to someone else.
Medication Policy
Dr.
Miley provides integrated care, combining psychotherapy with
recommended medications when indicated. However, there is no guarantee
that medication and/or psychotherapy will produce a desired result.
Should
an adverse or allergic reaction occur, please advise this office at
once. Also please provide at least three days' notice to arrange for
your prescription refill, and provide your pharmacy's telephone and
prescription number when requesting a prescription refill.
In
order to properly monitor your response to medications, Dr. Miley must
see you in the office at least once every three months. Otherwise you
will become an inactive patient and prescriptions cannot be renewed.
Hospitalization Policy
If
you and Dr. Miley agree that you would benefit from a therapeutic team
effort available only in an inpatient setting, you may elect to become
a patient at an area psychiatric hospital. As a hospital inpatient, you
will be treated by your hospital's staff psychiatrist. After discharge
Dr. Miley will, if you choose, continue your outpatient care.
Payment Policy
With
the exception of patients referred by Comprehensive Behavioral Health
Care, this office does NOT accept payment/ assignment from insurance
companies or Medicare and requests payment in full when your office
services are rendered. We DO work closely with you to expedite your
prompt insurance reimbursement. At no charge, your insurance claims
forms will be processed and submitted quickly, usually the same day of
your visit. Because you have paid for services, your insurance carrier
will be asked to send your reimbursement directly to your home or
mailing address. This procedure encourages prompt claims processing.
Any insurance benefits received by this office will either be endorsed
and forwarded to the person who made the payment or applied to any
outstanding balance on your account.
Please remember that
payment is due at the time of service, no post dated checks will be
accepted, and a returned check will incur the standard fee of $25. To
avoid misunderstandings, please discuss frankly with Dr. Miley or Mrs.
Chaky any questions regarding your services, fees or payments.
Office Location
From
S.E 17th Street please enter Laurel Run at the 22nd Avenue intersection
stop light and turn right into the upper level parking area. Wheelchair
accessible parking is in front of Building 200. Follow the walkway on
the left to the southeast corner of that building and Suite 203. Thank
you for giving up your time to read this and, if any questions remain,
please call our office at (352) 629-4448.
The Oath of Hippocrates (circa 460-377 B.C.)
Twenty-five
centuries ago Hippocrates was a very influential Greek physician who is
today considered the Father of Medicine. His writings not only had a
great impact on the content of Greek medical thought, but also on the
ethics of medical practice. This is the same Oath that I and my
classmates took upon our graduation from medical school (back in the
20th century). - FM
I
SWEAR by Apollo the physician, and Aesculapius, and Health, and
All-heal, and all the gods and goddesses, that, according to my ability
and judgment, I will keep this Oath and this stipulation to reckon him
who taught me this Art equally dear to me as my parents, to share my
substance with him, and relieve his necessities if required; to look
upon his offspring in the same footing as my own brothers, and to teach
them this Art, if they shall wish to learn it, without fee or
stipulation; and that by precept, lecture, and every other mode of
instruction, I will impart a knowledge of the Art to my own sons, and
those of my teachers, and to disciples bound by a stipulation and oath
according to the law of medicine, but to none others. I will follow
that system of regimen which, according to my ability and judgment, I
consider for the benefit of my patients, and abstain from whatever is
deleterious and mischievous. I will give no deadly medicine to any one
if asked, nor suggest any such counsel; and in like manner I will not
give to a woman a pessary to produce abortion. With purity and with
holiness I will pass my life and practice my Art. I will not cut
persons laboring under the stone, but will leave this to be done by men
who are practitioners of this work. Into whatever houses I enter, I
will go into them for the benefit of the sick, and will abstain from
every voluntary act of mischief and corruption; and, further from the
seduction of females or males, of freemen and slaves. Whatever, in
connection with my professional practice or not, in connection with it,
I see or hear, in the life of men, which ought not to be spoken of
abroad, I will not divulge, as reckoning that all such should be kept
secret. While I continue to keep this Oath unviolated, may it be
granted to me to enjoy life and the practice of the Art, respected by
all men, in all times! But should I trespass and violate this Oath, may
the reverse be my lot! --------------------------------------------------------------------------- Source: Hippocrates, Works trans., Francis Adams (New York; Loeb) vol. I, 299-301.
Thoughts on Depression
By Fred Miley, M.D.
It
has been said that depression is “the common cold of psychiatry.” While
that may be true in terms of its prevalence, common colds rarely knock
a person out of work for weeks or months, interfere with relationships
or end with a fatal result. However, depression can do these things and
more if left untreated. The most common physical symptoms of depression
are fatigue, pain (especially headaches), digestive complaints, anxiety
and sleep disorders.
Once the so-called vegetative signs of
depression occur, you are already in trouble and suffering from more
than just sadness or a normal grief reaction. Loss of appetite, weight,
sleep, interest in your normal activities and the ability to have fun
may be your unconscious attempts to tell the world that you have lost
something more significant. Perhaps it’s a job, a relationship, a
bodily part or its function, or more dangerously, your self-esteem.
Should
you become so depressed that you experience feelings of worthlessness,
you may begin to engage in unconscious self-destructive actions which
you yourself may not understand. Such actions may include abuse of
chemical depressants such as alcohol, tranquilizers and sleeping pills.
You could develop accident-prone behavior, exhibited ultimately in
gambling with death to see if God, fate or another human being will
save you. Too frequently, when in that condition, some people
miscalculate and actually lose their lives. Similar problems occur with
the use of stimulants in an attempt to combat depression. Stimulants
may include simple and socially acceptable substances such as caffeine,
diet and asthma drugs, as well as narcotics such as cocaine,
amphetamines and others. However, when the stimulant wears off, the
depression returns, only stronger.
So what can you do if you or
a loved one becomes depressed? You get help from a qualified
professional who will listen to you. When Sir William Osler was
teaching medicine to American physicians, he counseled them to “Listen
to the patient…he’ll give you the diagnosis.” These days a patient’s
chief complaint is often that his or her doctor doesn’t really devote
the time and attention needed to understand the dynamics involved. With
today’s managed care system, it may seem more time-efficient to
schedule a brief visit, write a prescription for a tranquilizer, give a
pat on the back and ask the patient to call if there is a problem.
However, we now know that giving benzodiazapines (Valium-type drugs) to
depressed patients may cause the very problem they'll call about,
because it may push them deeper into depression. That violates the
medical principle of “Primum no nocere” taught in every medical school.
It means “First, do no harm.” So, the extra time spent in listening
carefully to a patient often results in that patient then listening
carefully to the doctor’s recommendations and following them.
If
no improvement occurs, you may be a candidate for antidepressant
medication and/or office psychotherapy with a psychiatrist, clinical
psychologist or licensed mental health counselor. Of those, only the
psychiatrist can prescribe medication. There are now more than 30
antidepressants, each with its own target-system response and
side-effects profile, including negative and positive interactions with
other drugs that you may be taking for other medical conditions. With
some pharmaceuticals, you may need to have your serum levels monitored
by lab tests during therapy, as well as have periodic blood, kidney, or
liver functions or electrocardiogram checks.
Several types and
schools of psychotherapy are effective in relieving depression, but
common to all is a positive and emotional learning experience between
patient and therapist. Many studies have shown that the combination of
therapy and medication are more effective than either one alone. Also,
recent research at the Universities of Florida and Wisconsin has
confirmed the long-suspected preventive and antidepressant value of
regular exercise.
If the foregoing measures fail or
self-destructive impulses or behaviors persist, then you may request
referral for an inpatient evaluation and possible short-term, voluntary
hospitalization. Advantages of a comprehensive inpatient milieu program
includes close supervision (one to one if necessary) and daily
psychotherapy visits in addition to ancillary therapy modalities such
as family, group, occupational, music, art, movement, relaxation, etc.
Classes
in communications and coping skills and computer-assisted self-analysis
are also available for patients who are motivated to overcome their
depression. Should these measures be ineffective, a rather archaic
treatment option (which I personally oppose and do not perform) is
electro-convulsive therapy (ECT) for carefully selected patients. A
newer method currently under research study is transcranial
neuromagnetic resonance(TNR).
For those seriously dangerous to
themselves or others, and unwilling to seek treatment, Florida law
provides for a 72 hour period of involuntary observation prior to a
court hearing which determines the need for future commitment and
involuntary treatment under the terms of the “Baker Act.” Details are
available through the Mental Health Division at your county courthouse.
Perhaps
some of the ideas mentioned here may serve as guidelines to help you
decide how to deal with your depression or that of a loved one. When
you feel as if you’re having trouble solving your own problems, do not
hesitate to ask for help. Depression, if untreated, can be fatal.
Here are some questions you may want to ask your doctor about your depression:
1) What is my diagnosis? 2) What else might it be? (differential diagnosis) 3) What is your treatment plan? 4) What are the other treatment options? 5) How long before I can expect to notice improvement? 6) Are blood tests required, and what are the normal ranges? (Request copies of test results for your files.) 7) What is my prognosis (expected outcome)? 8) How long should I expect to be in treatment?
Views on Managed Care Organizations
By Fred Miley, M.D.
News and Views on Managed Care
On March 14 I had the pleasure of attending the Managed Care Workshop sponsored
in Tampa by the APA and FPS, with support from Glaxo Wellcome. While
unable to attend simultaneous sessions, I listened carefully to ideas
presented by Robert K. Schreter, M.D., private practitioner and
Assistant Professor of Psychiatry at Johns Hopkins.
During his
two talks he made several points relevant to those of us in private
practice. Because Managed Care Organizations (MCOs) have shifted many
of our therapy patients to psychologists and social workers,
psychiatrists must learn to do more than just write prescriptions. In
fact, most psychotropics are written by non-psychiatrists. As MCO
profits continue to decline, their methods of cost containment "will
become more Draconian." The largest MCO is now Magellan.
The following paradigm shifts are well underway, all with an emphasis on parsimony:
· Hospital systems to "health care systems"
· Acute hospitalization to "continuum of care"
· Individual care to "population care"
· A commodity service to a "value added service"
· Market share of admissions to "covered lives"
· Full beds to "appropriate level of care"
Practice
modes are also shifting from solo to single specialty group, then to
multispecialty behavioral group, to multispecialty medical group, to
HMO. Dr. Schreter noted that Connecticut has a contract with a 700
member Independent Practice Association (IPA) to provide $25 million
worth of care to all "non-indemnity" (uninsured) patients in that
state. Of the 60 million uninsured people in the entire U.S., 40
percent are children. Dr. Schreter now believes that "independent
physicians in solo practice are poorly positioned to survive."
However,
his workshop oriented toward solo practitioners expanded on his
December 1995 article in Psychiatric Services (Vol. 46, no. 12),
"Earning a living: a blueprint for psychiatrists." His recommendations
included:
· Adapt to the primary care model and maintain a
private practice in niche markets with a mix of payer types, such as
private pay, forensic, child custody, nursing homes, EAPs,
return-to-work programs, outpatient detox, education for specific
diagnostic groups, underserved areas, etc.
· Join a network and
develop new continuum-type services and new applications for existing
services. You can also sell MCOs "a piece of your time" only.
· Cultivate the image of decision maker as the only mental health provider with medical training.
·
Develop a collegial relationship with case managers, giving accessible,
solution-oriented, cost-effective care to restore patients’ prior level
of GAF.
Because MCOs have depressed the incomes of practicing,
academic and institutional psychiatrists, whereas corporate clinical
and administrative salaries have increased, some psychiatrists may
choose to join the latter. Other survival tactics are to join a group
practice and to engage in political activism.
He quotes New
England Journal editor Arnold Relman, M.D.’s concern about the ethical
conflict of interest faced by physicians in the "medical-industrial
complex." Dr. Schreter sees two choices:
1) Adhere to your
mission as a physician, "aloof from competition in the marketplace",
leaving "health care to the MBAs and venture capitalists," thus
becoming an ethical, but uninfluential, employee, or
2) Form organizations to bid for MCO contracts, but be alert "when fiscal management endangers clinical management."
Let
me suggest a third option: Go ahead and risk competition in today’s
marketplace, using your own talents and capital, as an ethical,
self-employed practitioner whose voluntary patients want a personal
therapeutic alliance with as much confidentiality as can be preserved.
I contend that ethical competition improves quality of products and
services, not administrative fiat, threats or CQI committees.
I
fully agree with Dr. Schreter’s final statements, "Survival in
psychiatry is no simple matter. Economic survival is one thing. To
survive as ethical professionals with a primary responsibility to
patients is quite another." I do believe that if the latter is done
especially well, with some management skills and perseverance, the
former should take care of itself.
From Florida Psychiatric Society's newsletter, "Transference", 6/98.
Communication "Secrets"
By Fred Miley, M.D.
1. Nobody ever wins in a family conflict.
All participants are losers, but what exactly do they lose? Usually
it’s their temper, control of their voice volume, respect for the other
person and oneself, objectivity and focus on the real issue. Even if
you think you have overwhelmed your opponent with your superior logic,
there will probably be a payback later. Then you feel you have to
retaliate, and so on. Even winners of legal conflicts may pay a high
financial price, and victors in military battles may lose many lives.
It’s much less costly to negotiate a compromise where no one gets
everything they want, but each gets something they can both live with.
2. Avoid “universal quantifiers” or all-inclusive adverbs.
Words
such as “always” and “never” can, with practice, be replaced with
“often” or “frequently,” and “rarely” or “not very often.” This avoids
unnecessary escalation of verbal conflicts. For example, if she says,
“You always leave your clothes on the floor,” he replies, “That’s a
lie. Last Tuesday I had them all picked up.” Then she says, “So, you’re
calling me a liar…” etc., etc. (I actually had a patient who solved her
clothes-on-the floor problem by neatly folding them and putting them
back in her husband’s drawer. After about a month he asked, “Are you
using some new kind of soap or something?” Her great answer was, “I
just figured if they’re not in the hamper, they must be clean.”
Needless to say his behavior changed.) However, the whole exchange
described above could have been avoided by avoiding the adverb “always.”
3. An argument is not necessarily a bad thing if it remains civilized.
Philosophers
and scientists conduct very high level arguments and counter-arguments
in their monthly professional journals, arguments that may go on for
years. One side of an argument presumes certain basic premises,
followed by logical steps that result in one or more conclusions which
may or may not be warranted. The counter-argument follows the same
procedure. Opponents or dissenters don’t just call one another names,
but check their basic premises and the flow of their logic. Attorneys
and debaters function this way also, presenting evidence-based
arguments for a certain position, allowing a counter-argument, which is
followed by rebuttals, rejoinders, direct and indirect
cross-examination, etc. In the courtroom the judge keeps the arguments
civilized and weighs the strengths of each position. In a personal
conflict, resolution is more likely if both sides take turns listening
in a calm environment. Prior to future arguments, work to establish
rules that promote respect and fairness.
4. Avoid using an ad hominem (“against the person”) argument.
Personal
attacks and name-calling ignore the issue and incite anger and
defensiveness. Examples might be “You’re just like your father,”
“You’re so stupid,” “Ten years ago you did this,” “You must have
defective genes,” etc. It is an unnecessary and hurtful detour away
from the real issues and can doom a relationship between co-workers,
parent and child, friends, lovers or spouses.
5. Get curious, not furious.
If
you honestly disagree with someone, ask yourself how he or she could
have arrived at such a different conclusion from yours. Is there
something they know about the situation that you don’t? Or do you know
something about it that they don’t? An example is what I call the
“Parable of the Kleenex box.” I draw an X on one end of a rectangular
Kleenex box (not a cube shaped one) and hold it between two people who
have communication problems. I then ask each how many Xs they see. The
one without the written X will say “One,” because Kleenex is spelled
with only one “x.” The other will say “two,” and they often begin
arguing about how Kleenex is spelled, sometimes to the point of
name-calling. The flash of mutual insight comes when the box is rotated
180 degrees and they realize they were both correct according to the
information and perspectives they had. Moral: Don’t assume that someone
viewing the same situation has the same information you do. Once you
share the unknown information with the other, you still may not agree
totally because you each bring your own personal life experience to the
situation, but you can both come closer to the truth or the objective
reality. Learn good listening skills and reflect what you understand
the other party’s views to be. Perhaps you made a faulty assumption or
the other person expressed his or her views incompletely. Once they
have been restated more clearly, an all-out confrontation may be
avoided entirely.
6. Agree on a sanctuary area at home.
Unfortunately,
many couples find themselves in their bedrooms when they begin the
“long, meaningful discussions,” which may deteriorate into arguments.
Thus, they develop a negative emotional association to a place that
should be related to relaxation, fun and romance. Instead, that
“playroom” might be considered a protected place where no hassles
occur. The sanctuary might be a bathroom or even a porch, so long as it
is respected by both parties. During the Latin American revolutions,
people could be safe in a church, knowing that no one would consider
standing in the doorway and shooting into it. Even the “Highlanders” in
a popular television series could not fight on holy ground. Apply the
same assurance at home. No one may shout insults or accusations from
the hallway. Instead, try having those tense discussions while walking
outside together. If anyone loses control, a neighbor is likely to call
the police. Or go to a quiet restaurant, where people who are loud or
disruptive are thrown out. If anger management is a problem for you or
another, make rules that help keep your disagreements civil. You are
much more likely to arrive at solutions that both parties will respect.
7. Learn the power of apology.
Knowing
that one person is rarely always right, be prepared to acknowledge your
errors in judgment or unkind remarks with a sincere apology for the way
you made the other person feel. Even when your harsh remark was
directed at another, it can make your spouse or friend feel
uncomfortable and embarrassed. Rather than seek excuses for the attack,
be gracious in your apology. You will earn each other’s trust and
respect by not insisting on having your way or criticizing alternative
ways.
8. Use indirection rather than confrontation.
Avoid
a head-on collision by using an oblique angle to deflect your
opponents’ negative energy. Don’t tell someone what they “need” to do
or how they “ought” to think. Instead, say, “I wonder how it would be
if you…” or even better “if we…” Just fill in the blank. Curiosity is
contagious, and, when you hear someone wonder, you visualize that
possibility and also begin to wonder. Right now, in fact, I wonder how
your relationships would improve if you tried these communication
techniques. See? Now you’re wondering, too…
houghts on Dependence vs. Independence
By Fred Miley, M.D.
An
important goal of therapy is to increase an individual’s
self-sufficiency or healthy independence and to reduce that person’s
neurotic dependency on other people, institutions, drugs or other
dangerous substances.
Distressing symptoms and behaviors may
develop in highly dependent persons. These include helplessness,
hopelessness, passivity, indecision and a sense that fate is against
them. On the other hand, there’s an unhealthy kind of independence
caused by traumatic experiences which can interfere with the
individual’s functioning and even prevent proper care. They tend to
withdraw from life to avoid ever being hurt again and may experience
social isolation, apathy, help rejecting behaviors and paranoid fears.
The
psychological term “ambivalence” implies mixed feelings toward the same
subject and certainly applies to the issue of dependency. For example,
one may fear dependence due to the inherent loss of freedom, choice and
mobility, but also fear independence and its attendant
responsibilities. Similarly, one may fear failure because of shame and
embarrassment, possibly even monetary loss and the ability to provide
for a family, yet may also fear success because of the pressure of
future expectations to perform, to have others’ livelihoods depend upon
them, and to lead in the spotlight.
Chemical dependence is a
major psychiatric problem in today’s world and unfortunately drives
much criminal behavior related to non-prescription drug abuse. However,
almost all the prescribed medications used for major mental illnesses
such as severe depression, psychosis, schizophrenia and bipolar
disorder do not cause chemical dependency. The ones that can are the
minor tranquilizers and sleeping pills, especially benzodiazepines and
barbiturates. Fortunately, there are now a number of non-addictive
options available. Some ambivalence toward taking prescribed drugs is
normal and patients should be encouraged to question and understand the
purpose and proper use of any medication they take.
A
diagnosis of “dependent personality” does not indicate a major mental
illness, rather “a pervasive and excessive need to be taken care of
that leads to submissive and clinging behavior."” It can lead to a
hostile-dependent relationship in which the dependent person resents
the real or perceived debt owed the provider and blames that person for
enabling the dependence. It’s like getting a bank loan for a new car
and then cursing the banker and the bank every time you drive it or
make a loan payment.
Another type of dependence is
“co-dependency” which is the need to be needed in order to feel useful
or loved. This kind of relationship requires a compulsive rescuer and a
chronic victim. The danger is that once the “victim” is “rescued,” the
rescuer tries to put the rescued person back down to the place where
they started in order to have the satisfaction of being the “hero”
again because that’s the original basis for their relationship. Both
parties think they are getting something they want or need, yet each
feels some resentment toward the other. So, carefully consider the
risks to both the giver and the receiver before making someone your
“project” or allowing someone else to make you theirs.
Depending
on third parties may create many risks, whether it’s a spouse,
relative, institution, government agency, insurance company,
politician, astrologer, palm reader, lawyer or even a doctor. The
higher one’s dependency is, the fewer one’s options are. The most
dependent people have the least amount of control over their own lives.
Strong dependence and low sense of control often result in high stress
levels and frustration, low self-esteem and depression.
Yet, no
man, or woman, is an island, totally independent of others. Nor would
most want to be. The healthiest type of dependence therefore is
“inter-dependence” in which all parties assist one another, with
division of labor and mutual respect and support. This form of
inter-dependence requires people to understand and appreciate others’
needs and to remain willing to meet those needs, with the trust that
their own will also be met.
While some individuals know one
another well enough to anticipate each other’s needs, none should be
expected to be “mind readers.” Each party expresses true needs but is
not compelled to “test” others by making unrealistic demands. No one
“keeps score” of who has done more for the other, but each one secretly
feels that he or she has the best end of the bargain. Clearly, this
type of interaction--whether in the family or workplace, or between
personal partners or professional colleagues--requires awareness,
honesty and effort. It requires a level of maturity. Some would call it
work.
Remember that while the U.S. independence was declared
on July 4th, true independence did not in fact exist until much later
after great struggles and sacrifices had been made. Yet, would anyone
say that these struggles and sacrifices were not worthwhile?
Indeed,
while healthy inter-dependent relationships may require a significant
investment of time and perseverance, the rewards are many and lasting.
Family Reunion at Homecoming Weekend (12/00 Transference article)
By Fred Miley, M.D.
From
October 5th to 8th, 2000 I had the great pleasure of attending in Fort
Lauderdale the very well organized first meeting of the recently
reintegrated Florida Psychiatric Society. Since a breakup in 1971, it
had existed as two discrete District branches, the Florida Psychiatric
Society (FPS) and the South Florida Psychiatric Society (SFPS). The
separation had not arisen because of a North vs. South psychiatric
civil war. Rather, sincere and strongly held differences of opinions,
which no longer exist, led to that separation a generation ago. Having
belonged to both groups, I never really considered that separation
permanent and maintained an attachment to South Florida, where I had
done my psychiatry residency at Jackson Memorial in Miami and had
conducted my practice for nearly ten years. During that time, the U. of
Miami’s psychiatry department chairs were John Caldwell and Jim Sussex,
both excellent role models for residents in training. My wife and
I stayed in contact with Miami friends while our daughter attended
medical school and residency there. In fact, while rotating through
psychiatry, the younger Dr. Miley met a patient who said, “Oh, I had
another Dr. Miley once.” So things often come full circle after a
generation goes by. Now that the FPS is again one, the circle has
closed, thanks in large part to SFPS members like the late Tom
Buchanan, as well as Ron Shellow, Ray Good and Jim Goodman, who often
attended meetings of both societies to preserve communications. Having
had the good fortune to train under some of those mentors, I now
appreciate their lifetime commitment to the medical profession and
their chosen specialty. Dan Castellanos, current FPS president,
facilitated the transition with tact and efficiency. David Gross, Bob
Fernandez, Carey Merritt and president-elect Wade Myers all devoted
many hours to merger negotiations and arrangements. We owe a debt to
all those on the reintegration task forces and the Florida Psychiatry
committee, and to Phil Cushman who developed and maintains a unifying
FPS website. Also to the societies’ executive directors and good
friends, Margo Adams and Dodi Shellow, and their staffs who handled all
the challenges, paperwork and data management demanded by the merger.
Those committees and individuals overcame resistance, difficulties and
disinterest and benefited all of us. Together again, the FPS can
promote through educational programs, political involvement and
community outreach our mission to “continuously improve the ability of
its members to provide quality treatment for persons with mental
illness.” Returning to South Florida after 20 years to meet again
with old friends and colleagues in our renewed Society was indeed a
hopeful homecoming. At this time our profession is under siege by
insurance and managed care companies, governmental restrictions, plus
compliance, liability and confidentiality concerns. However, now almost
1,100 Florida psychiatrists can speak to those issues through their
Council members with one voice. It’s good to be home again.
