Category: Medical Ethics


The Kitchen Shrink: A Psychiatrist’s Reflections on Healing in a Changing World by Dora Calott Wang, M.D.

Have you ever wondered what it is like to be a psychiatrist? To know the intimate thoughts and struggles that go on in the minds of those who are charged with the restoration of health and well-being? The Kitchen Shrink might be the book for you.

The Kitchen Shrink is a beautifully written memoir by Dr. Dora Wang detailing her life as a psychiatrist, wife, and mother and her experience of the shift that has occurred in medicine over the past twenty years.  Dr. Wang is an incredibly gifted writer and storyteller.  Unfortunately, the story she has to share is not as beautiful: there has been a paradigm shift away from patient-centered, “cradle-to-grave” medicine to a more business-centered, insurance driven model that focuses, not on quality, but rather on efficiencies–where the patient has been removed from the center of attention and remade as a “cog” in the health care machine.  I found myself wanting to share my patient-care stories with Dr. Wang as I read her poignant and all-too-familiar accounts.  While I know that her story is both emotionally-wrenching and true, I am left to wonder who, outside of physicians and those interested in health care reform, will find and read this book. While Dr. Wang does not suggest any specific health care reform options, she does a wonderful job of illuminating many of the problems with our current state of health care while reminding us of medicine’s noble history as the healing art.  Through the intimacy shared in her writing, Dr. Wang feels like a kindred-spirit in the quest for balance, happiness, and contentment.  I look forward to reading more from her in the future.

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No! Saliva tests to measure the levels of Serotonin, estrogen, progesterone, melatonin, testosterone, or DHEA are almost never legitimate, are expensive, and do not provide any clinically meaningful information to health care practitioners.  These tests are usually marketed with various supplements to control imbalances of these hormones; a serious conflict of interest.  Some well-intentioned patients have purchased and completed such tests thinking that it might provide their healthcare provider with “important information.”

Saliva testing is not a reliable method of assessing levels of any hormone except Cortisol (which must be done under very specific conditions and only for certain conditions). There is no physiologic reason to measure most salivary hormone levels and no generally published ranges of normal levels of hormones measured in saliva. Hormones are typically measured in blood, which makes physiologic sense; some hormones and their metabolites can usefully be measured in urine, but are not currently a part of any protocol for evaluation or diagnosis of any mental health condition.  Moreover, even if the test results are technically accurate, I’m aware of no science that links salivary hormone assays to non-optimal levels of hormones or neurotransmitters. Nor, even if the tests were entirely legitimate, is there any evidence that the proposed treatments will “optimize” neurotransmitter or hormone levels.

If you are concerned that you may have a mood disorder such as depression or anxiety, concerned about reasons for insomnia, or concerned that you may be approaching menopause, please contact your doctor and have that discussion with him or her. Depression, Anxiety, Insomnia, and all other psychiatric conditions are diagnosed through a “Psychiatric Diagnostic Interview” based on standardized guidelines as put forth by the American Psychiatric Association in the DSM-IV TR (Diagnostic Statistical Manual, 4th Edition, Text Revision).  While certain blood tests may be useful in evaluating for medical conditions that may play a part in certain mental health conditions, such as thyroid conditions, saliva test are not.  Your resources would be better spent investing in yourself through health eating and exercise; you already have all the “important information” any clinician might need: your story.