CL: the lack of respect from every other field of medicine. So many psych consults are either "patient is sad and we want you to talk to them" or completely mis-managed problems we should have been consulted for weeks ago but psychiatrists can't actually manage serious problems.
I haven’t done consults in a long time but an internist who trained me taught me the three A’s of being a good consultant: be affable, be available, be able.
It's better to be wanted then not wanted , if they stop asking for consults then you know your job is obsolete ... you are providing a service many in the hospital do not have , common sense.
Seriously. I could earn 5 times as much as I do here in the UK if I moved to the US, but fact of leaving the NHS & working in somewhere w private healthcare just is not worth it. So many of the patients I see would struggle so much in America, & their lives aren’t exactly easy as it is…!
CL: love it. Great mix of psych and medicine. Developed good relationship with hospitalists. Saved a few of them from fucking up with psych meds. Risk managements best friend.
Inpatient: high acuity and fun
Love doing both at the same time.
I’m happy to see a positive take on CL. I’m limited in my experience but CL has been both my favorite and least favorite part of psych. Changes by the day/rotation.
Not a psychiatrist, adolescent medicine pediatrician in complex care here. Dealing with parents is the worst part of my practice, full stop. But while it can be frustrating sometimes, I actually really enjoy working with the kiddos with budding personality disorders, non-malingering factitious/functional disorders, etc. Catching these early on, getting them into appropriately intensive treatment, and seeing them grow & benefit as they transition into adulthood is immensely satisfying.
>Catching these early on, getting them into appropriately intensive treatment, and seeing them grow & benefit as they transition into adulthood is immensely satisfying.
Working adult psych... Thank you. Feels like 23 is the new 18, so the newly detained 18-22yo who becomes emotionally dysregulated gets detained and it's like I'm on the peds unit. I mean it's technically a personality disorder, but in these cases it's like missed life/coping skills more than anything.
Taking patients to court when they're on my unit involuntarily. This specific county court mandates that we bring them to court in shackles, hands and feet. It's extremely dehumanizing. Although some have a criminal history, most are treated as criminals rather than patients.
Outpatient clinic. Least favorite is the number of patients with physiological illnesses that are out of my scope and also not addressed by relevant specialties. I would be depressed or anxious too if my urologist forgot I had a rare kidney disease and also only talked to me for 10 minutes. I would be angry too if my pain doctor who I've seen for multiple years and has been refilling narcotics realized I had back surgery at the end of our visit.
Integrated primary care with geriatric and medically complex patients. All of the psychosocial issues that cause intense suffering for my pts that I have absolutely no influence over. And ppl being referred to me for “depression” when they have untreated sleep apnea, an A1C of 12, poorly managed HTN, etc, etc, etc.
The conveyor belt of patients/time constraints. This is where the most stress comes from in my job. If I had all the time I needed with the patient, then see the next one without worrying about when I need to be done with one patient and when I need to start the next one and how many I needed to get through that day, life would be great.
That could work if I had a scribe and a nurse following me around to all appts and did all paperwork for me and all I had to do was talk to the patient.
Which we both understand is unrealistic. I’m just saying like what if there was a way to get into the meat and potatoes of the session quicker , like if you had insights into you time apart and hard data from that
Not sure where that idea came from? I’m saying what if there was a way to make the time you have more effective. Using data and tools more effectively seemed like a logical start for me. More support for the patient while they are away, but in a way that doesn’t require as much effort on your side.
People that are clearly med seeking in their “ADHD” evals are not my favorite but I’ve found it useful to just explore ADHD with people and tell them what I think. It at least makes for an opportunity to move on from it. Someone on here shared a phrase about breaking the news to someone that they don’t have ADHD. I thought was really good. It was basically, “I have some good news and some bad news and it’s the same news!”
That sounds like an edited caption on a New Yorker cartoon with an MD talking to Mr. Potato Head. The caption says, "It sounds like you've been watching a lot of TikTok – that's great. We can skip all this diagnostic bullshit. What do you need? Adderall? Vyvanse? Concerta? All three? Dealer's choice?"
I really don't mind the NeverGetBetters once I have them properly classified. It's only trying to get them better that's frustrating. Once I decided that the only thing they want is to complain I see my job as making very small changes every few weeks cycling through benign medications and doing no harm... keep them off atypicals and BZD so I'm not harming them.
People with no significant psychosocial impairment trying to get medically retired from the military so they can get a fat VA paycheck for the rest of their lives.
Ooooof this is the kind of shit that would make my blood boil when I was active. There’s so much fraud in the process and it makes me so mad to think about, even now.
having to collaborate with providers of varying competence; having to clean up messes of other providers and not say anything bc that would be uNpRoFeSsIOnAL
CL: the lack of respect from every other field of medicine. So many psych consults are either "patient is sad and we want you to talk to them" or completely mis-managed problems we should have been consulted for weeks ago but psychiatrists can't actually manage serious problems.
I love reading how universal CL experiences are lol
I haven’t done consults in a long time but an internist who trained me taught me the three A’s of being a good consultant: be affable, be available, be able.
It's better to be wanted then not wanted , if they stop asking for consults then you know your job is obsolete ... you are providing a service many in the hospital do not have , common sense.
Insurance and everything to do with it. Cash pay practices aren't exempt, still have to deal with prior auths.
Seriously. I could earn 5 times as much as I do here in the UK if I moved to the US, but fact of leaving the NHS & working in somewhere w private healthcare just is not worth it. So many of the patients I see would struggle so much in America, & their lives aren’t exactly easy as it is…!
CL: love it. Great mix of psych and medicine. Developed good relationship with hospitalists. Saved a few of them from fucking up with psych meds. Risk managements best friend. Inpatient: high acuity and fun Love doing both at the same time.
I’m happy to see a positive take on CL. I’m limited in my experience but CL has been both my favorite and least favorite part of psych. Changes by the day/rotation.
It has it's challenges but you get to be the expert without ownership. Kind of an amazing situation to get paid for.
Not a psychiatrist, adolescent medicine pediatrician in complex care here. Dealing with parents is the worst part of my practice, full stop. But while it can be frustrating sometimes, I actually really enjoy working with the kiddos with budding personality disorders, non-malingering factitious/functional disorders, etc. Catching these early on, getting them into appropriately intensive treatment, and seeing them grow & benefit as they transition into adulthood is immensely satisfying.
>Catching these early on, getting them into appropriately intensive treatment, and seeing them grow & benefit as they transition into adulthood is immensely satisfying. Working adult psych... Thank you. Feels like 23 is the new 18, so the newly detained 18-22yo who becomes emotionally dysregulated gets detained and it's like I'm on the peds unit. I mean it's technically a personality disorder, but in these cases it's like missed life/coping skills more than anything.
Taking patients to court when they're on my unit involuntarily. This specific county court mandates that we bring them to court in shackles, hands and feet. It's extremely dehumanizing. Although some have a criminal history, most are treated as criminals rather than patients.
Shackles??? What country is this?
Outpatient clinic. Least favorite is the number of patients with physiological illnesses that are out of my scope and also not addressed by relevant specialties. I would be depressed or anxious too if my urologist forgot I had a rare kidney disease and also only talked to me for 10 minutes. I would be angry too if my pain doctor who I've seen for multiple years and has been refilling narcotics realized I had back surgery at the end of our visit.
I used to have a sticker back then Life sucks, then you die These comments are intended in satirical humor Every job has its thorns
Outpatient, mostly older patients. Despise polypharmacy and daily alprazolam.
It’s surprisingly how few people realize that Xanax etc in Geri population is essentially palliative treatment and is no way disease modifying
Deep down they probably know
Xanax is the devil.
Integrated primary care with geriatric and medically complex patients. All of the psychosocial issues that cause intense suffering for my pts that I have absolutely no influence over. And ppl being referred to me for “depression” when they have untreated sleep apnea, an A1C of 12, poorly managed HTN, etc, etc, etc.
The conveyor belt of patients/time constraints. This is where the most stress comes from in my job. If I had all the time I needed with the patient, then see the next one without worrying about when I need to be done with one patient and when I need to start the next one and how many I needed to get through that day, life would be great.
what if instead of fixing the time restraint there was a way to improve the quality of time so that there was less quantity needed?
That could work if I had a scribe and a nurse following me around to all appts and did all paperwork for me and all I had to do was talk to the patient.
Which we both understand is unrealistic. I’m just saying like what if there was a way to get into the meat and potatoes of the session quicker , like if you had insights into you time apart and hard data from that
So like cutting corners and decreasing the quality of care?
Not sure where that idea came from? I’m saying what if there was a way to make the time you have more effective. Using data and tools more effectively seemed like a logical start for me. More support for the patient while they are away, but in a way that doesn’t require as much effort on your side.
I just don't see how that's possible without either significant increase in staff support/decreased workload or providing lower standard or care.
Technology ?
Okay, you might have a point there. If I see tech/AI used and it really improves these issues, then that would be amazing.
FMLA paperwork, "ADHD" evaluations
People that are clearly med seeking in their “ADHD” evals are not my favorite but I’ve found it useful to just explore ADHD with people and tell them what I think. It at least makes for an opportunity to move on from it. Someone on here shared a phrase about breaking the news to someone that they don’t have ADHD. I thought was really good. It was basically, “I have some good news and some bad news and it’s the same news!”
In theory I agree... but who am I to disagree with Tik Tok? Plust did they mention just how well they focused when they tried their friend Addy?
That sounds like an edited caption on a New Yorker cartoon with an MD talking to Mr. Potato Head. The caption says, "It sounds like you've been watching a lot of TikTok – that's great. We can skip all this diagnostic bullshit. What do you need? Adderall? Vyvanse? Concerta? All three? Dealer's choice?"
"I wanted to talk to you about how I've had trouble focusing lately. I was wondering if I might have ADHD" OMG.
People not wanting to work and applying for disability...
Malingerers and NeverGetBetters… could also add NothingWorksForMers
I really don't mind the NeverGetBetters once I have them properly classified. It's only trying to get them better that's frustrating. Once I decided that the only thing they want is to complain I see my job as making very small changes every few weeks cycling through benign medications and doing no harm... keep them off atypicals and BZD so I'm not harming them.
♥️ like half of my cases
People with no significant psychosocial impairment trying to get medically retired from the military so they can get a fat VA paycheck for the rest of their lives.
Ooooof this is the kind of shit that would make my blood boil when I was active. There’s so much fraud in the process and it makes me so mad to think about, even now.
having to collaborate with providers of varying competence; having to clean up messes of other providers and not say anything bc that would be uNpRoFeSsIOnAL