Demise of the DSM

[9point75]

Is anyone else excited for the train wreck that may or may not be the DSM 5? Okay, so it probably won't be as bad as some of the backseat drivers are making it out to be, but still...

I love that they plan on collapsing Axis I, II, and III all into one field.
I wish they would erase Axis IV and V... they are completely worthless

I also wish that they would only permit Psychiatrists to have access and to use the diagnoses from the DSM. This would not be completely unheard of, Psychologists do this with all of their testing materials. Since when do physicians farm out the art of diagnosing patients to non-medical personel?

While I'm at it, why can't we just stop this DO craziness? It's not the civil war anymore and osteopathic manipulation is not exactly modern evidence based medicine. I propose we just turn all the DO schools into MD schools.

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[393656]

The only sure changes are elimination of the GAF concept and replace with another way to documentent disabling effects of a mental disorder, replacement of categorical approach to diagnosis with dimensional/spectrum disorder approach, signifigant overhaul to personality disorders which is a total farse and much too complicated.

Whether they get rid of axis 1, 2 and 3 is not 100 percent but a possibility. It doesnt really matter what axis you put it on to me. You write it down so who cares what axis its on. This makes less sense to people who do not use dsm4 correctly using axis 3-how many people do you know that uses this correctly to ONLY write down medical illnesses that are effecting their mental disorder or treatment of their mental disorder in some fashion. Most people slap down the entire past medical history on axis 3 which is totally incorrect. Glaucoma, diversticulitis, cancers may or may not be contributing to ones mental symptoms but often are not and get slapped down there. Given its kind of a useless category when you use it in such, if people cannot use the current setup correctly then dropping the whole setup alltogether is not going to change much.

I think the major think they neglected with dsm5 is efficiency for diagnosis. In todays day and age you have to be realistic and they did that with a dimensional model but they did not account for the lack of time current day providers have to evaluate, diagnosis and treat a patient. A 200 step personality disorder evaluation system is only going to make it less and less useful as people will not use it. Simplicity ironically would lead to more accurate data compared to overlydetailed approach.

Personally I would have 2 lines-diagnosis and psychosocial stressors. Diagnosis is anything causing some type of dysfunction in their lives whether its personality or "axis 1" Psychosocial is all the contributing "axis 4" stuff. The rest to be honest does not have much utility in understand the patient. If a medical disorder was causing signifigant stress it could go on the psychosocial stressors such as "dealing with cancer or chemo, dealing with chf"

That would eliminate the uneeded and wrongly used procedure of slapping down every medical problem in the axis.

 

[digitlnoize]

Is anyone else excited for the train wreck that may or may not be the DSM 5? Okay, so it probably won't be as bad as some of the backseat drivers are making it out to be, but still...

I love that they plan on collapsing Axis I, II, and III all into one field.
I wish they would erase Axis IV and V... they are completely worthless

I also wish that they would only permit Psychiatrists to have access and to use the diagnoses from the DSM. This would not be completely unheard of, Psychologists do this with all of their testing materials. Since when do physicians farm out the art of diagnosing patients to non-medical personel?

While I'm at it, why can't we just stop this DO craziness? It's not the civil war anymore and osteopathic manipulation is not exactly modern evidence based medicine. I propose we just turn all the DO schools into MD schools.

I've never liked the whole Axis system. It seems very far removed from the rest of medicine's A/P problem list.

Good luck getting the DO schools to change. There have been a number of DO's pushing for a change, most specifically, eliminating at least parts of OMM from our board exam, the COMLEX. Currently, we're tested on DO craziness like cranial, although it's only a couple of questions, still...

Still (see what I did there? DO humor...), I wouldn't say there is no evidence for "OMM" treatment. There is more than enough evidence for the "muscle energy" techniques for MSK problems, some pretty good evidence for headaches and LBP, and a lot of improving evidence-based research being done in other areas. That being said, I don't think it should be tested on our boards, or taught as gospel, until it's proven.

All that being said, have I had back/neck pain from studying too long during med school? Yeah. Do I beg my classmates to crack me? Yep. Does it help? A lot. A least temporarily, until I screw myself up again or time passes. Do I do it to patients? Hell no. I'm not that comfortable with my meager training...although I'll do some very simple gentle stuff.

I am perfectly capable of accepting that there are two sets of initials. After all, DDS's and DMD's do it just fine. I do think we should modify the DO initials to make it less confusing to the public. MD-O seems like a nice compromise, and would make the "O" (osteopathic) certification available to those MD's who want it, which does happen. There's an MD in my town who does nothing but osteopathic manipulation, charges cash, and does quite well. He's actually the only "DO" in town that does that much manipulation, so he gets tons of referrals.

If I could tell every MD one thing to learn about "OMM," (I use the quotes because these techniques are used by tons of practitioners under various names from PT, to Massage, to Dentists (i.e. TMJ), to chiropractors, etc)...anyways, I would say everyone should learn how to do an OA (or occipital, aka suboccipital) release for headaches. Easy, harmless, and many times will help within minutes. Also, easy enough to teach to patient's spouses to do at home.

 

[393656]

Just wondering why you needed to spell out all your medical school rotations in your sig?

 

[digitlnoize]

Just wondering why you needed to spell out all your medical school rotations in your sig?

I'm a copycat. Many others do it, but I kind of liked the idea of expressing my frustrations and joys with smileys. I'm probably going to change it soon...it is rather annoying, isn't it?

 

[Suedehead]

I'm a copycat. Many others do it, but I kind of liked the idea of expressing my frustrations and joys with smileys. I'm probably going to change it soon...it is rather annoying, isn't it?

not annoying. fun.

 

[zenman]

Whether they get rid of axis 1, 2 and 3 is not 100 percent but a possibility. It doesnt really matter what axis you put it on to me. You write it down so who cares what axis its on. This makes less sense to people who do not use dsm4 correctly using axis 3-how many people do you know that uses this correctly to ONLY write down medical illnesses that are effecting their mental disorder or treatment of their mental disorder in some fashion. Most people slap down the entire past medical history on axis 3 which is totally incorrect.

I actually like this and I'll tell you why. I started in a community mental health clinic recently and it's a great help when the previous provider provides Axis III with every dx and even meds so I can check for interactions and halfway have a clue what's going on. I have no time to cruise though their chart because I have patients stacked on top of each other waiting to be seen and that last med check note might be the only history I have. Sucks, but it's fact.

 

[nitemagi]

I prefer Axis III to only include relevant medical conditions to their current psychiatric problem. I don't really care if they had an appy 15 years ago or a hangnail. All too often I see people list every known medical condition ever. Not really useful, IMO.

 

[masterofmonkeys]

While I'm at it, why can't we just stop this DO craziness? It's not the civil war anymore and osteopathic manipulation is not exactly modern evidence based medicine. I propose we just turn all the DO schools into MD schools.

As a former theoretical scientist, do you know what I call the overuse of the phrase 'evidence-based'? 'lack of thought'. Evidence based is an excuse to fail to use proper theory formulation and critical thinking skills.

Do you remember how much training you got in kinesiology, functional movement analysis, exercise physiology, biomechanical finite element analysis, etc? Oh, none? Like most MDs? So what gives you the ability to judge ANY therapeutic modality for MSK? LOL.

I routinely use OM techniques in my other life as well as targeted exercise modalities (using a framework totally different from that of PT) as a strength coach. In anywhere from 1 session to 4 weeks I often get comments like 'I can't believe after an MRI and 3 specialists they couldn't figure out what was wrong and you not only figured it out but fixed it that quickly' or 'I can't believe I almost got a 40k surgery for this'.

I don't have a lot of clinical trials backing my methodologies. I do have huge sustained success rates. I also have years spent going through the lit and developing a true understanding for what's going on with the MSK system, something that most MD's lack, and have no knowledge that they lack.

Sincerely,
Masterofmonkeys, MD.

 

[9point75]

Next I'll start hearing about how accupuncture, chiropractic, homeopathy really really really work too.

 

[notdeadyet]

Good luck getting the DO schools to change.

Folks seem to equate the DO degree with DO = MD + OMM. There's truth in that, but there's a lot more truth to the idea of DO = MD - LCME. Even if DO schools were cool with converting to conferring MD degrees (a huge if), the much bigger hurdle will be getting DO schools in compliance with LCME requirements before they'd be able to do so.

Facilities, admission standards, student services, teaching faculty, program management, etc. would all have to pass LCME reqs first, which many DO schools would struggle with and possibly find prohibitively expensive to get in compliance with. The DO schools that have no home hospital and have students largely piecing together third year rotations at various hospitals would have a particularly tough time getting the ability to confer the MD degree without a major overhaul that I'd bet they'd be very reluctant to make.

The DO degree isn't going anywhere without a near revolution (and windfall) on the part of the osteopathic programs and the AOA. I wouldn't hold my breath.

 

[9point75]

That's very insightful and I agree with you, but we definitely need to consolidate the DO into the MD degree somehow. It devalues the title of physician to the lay public when it is fractured this way.

 

[Majesty]

While I'm at it, why can't we just stop this DO craziness? It's not the civil war anymore and osteopathic manipulation is not exactly modern evidence based medicine. I propose we just turn all the DO schools into MD schools.

Also, MD schools now offer manipulation.
Agree 100%.
When foreign grads are being seen as MDs, this becomes absurd. They have no LCME in the carribean or mexico or india and we are able to judge those students based on their clinical abilities as well as test scores and give them an MD. I have seen very good DOs and IMGs as well as some poor MDs. In my slightly biased opinion, I think MDs are better trained but I think the residency has a lot of input into the final product and that is irrespective of school...unless they wont let DOs or IMGs in.

 

[notdeadyet]

That's very insightful and I agree with you, but we definitely need to consolidate the DO into the MD degree somehow. It devalues the title of physician to the lay public when it is fractured this way.

Interesting. This flies counter to what I've heard from most DOs. They've said that the most it comes up is "What's a DO?" or "Are you a doctor?" which requires a 15 second clarification that resolves things. That seems annoying to have to do, but I'd guess no moreso than explaining to patients that yes, psychiatrists are physicians.

Anyway, the ball is largely in the court of the DO schools and the AOA. If an osteopathic school changed their facilities, structure, and programs and got themselves compliant with LCME requirements, then agreed to a painful scrutiny and carte blanche agreement to implement whatever changes were requested and finally agreed to operate under LCME oversight without any AOA allegiance, the LCME would be willing to take them on. But those are some pretty long odds.

The DO converting to an MD degree would be great for many DOs who would rather hold MD degrees (though this is not all osteopaths, I'm sure). It might be of marginal benefit to the handful of patients who remain confused after a quick explanation. It wouldn't affect MDs at all.

The big problem is this: what's in it for the AOA or DO schools, who need to be onboard to make the change? The AOA would become irrelevant, so they'd obviously be against the change. Most DO schools would have to spend millions of dollars getting their programs in compliance and doing some painful restructuring, and for what benefit? Do any DO schools have open seats each year?

And do most of the top DO programs want to go from being top of their field to being considered average-at-best when in direct competition with their better funded MD counterparts? And what about many of the below-the-mean DO programs who will likely be unable to implement the changes needed by the LCME? They'll remain DO and will have exacerbated the problem caused by having the DO degree in the first place.

And are MD programs pushing for this? No MD program I know of wants more medical schools under LCME control, as it just makes for smaller pieces of pie. Every sane MD program in existence pushes for increasing class sizes to help with physician shortages, as this directly benefits them, whereas adding schools does not.

The main benefit I see from converting the DO degree to MD degree is for osteopaths who would rather have MD degrees. I can't see most of their DO schools wanting this, I can't see the AOA wanting this, and I can't see the MD schools wanting this. I don't see it happening.

 

[393656]

This may be the most useless thread ever due to the fact we have two TOTALLY seperate conversations going on in the same thread. I have to scroll through posts on one topic to get to the topic of the thread.

In regards to axis 3, there are lots of things that would be "helpful" that you could do by modulating the axis system to make it useful for your particular situation but the ENTIRE POINT of a dsm is to standardize things and make it consistent. If you are not doing that than you are really disregarding the only utility the dsm has which is some degree of reliability.

If a provider who actually follows dsm rules looks at axis 3 and sees a list of all medications but then is perplexed that he must have missed something as he cannot figure out how his kidney stone last year is relating to his mental health at this point. Was he traumatized? did he start to have an anxiety disorder? Or likely someone slapped it down erroneously and now its a confusing mess with no inter-provider reliability or utility.

So while modifying the dsm rules to make things convenient is nice for you, it is absolutely awful for the system as a whole.

And yes that guys sig is annoying.

And finally MD does NOT equal DO in anyway. They have their manipulation that we do not have. They also are currently in business ONLY because they present an option to people who otherwise would not have obtained entrance into medical school, another option with lesser criteria for the purposes of money generation and UNCESSARY generation of more doctors.

To call it anything else in this day and age is ridiculous. Back in the day when they were a completely seperate ideaology that had little to do with allopathic medicine, than a utility of them existed. Now a la carribean MD schools, the only reason to go to one is if you dont get into an MD school. What utility does that bring?

 

[Manicsleep]

I also wish that they would only permit Psychiatrists to have access and to use the diagnoses from the DSM. This would not be completely unheard of, Psychologists do this with all of their testing materials. Since when do physicians farm out the art of diagnosing patients to non-medical personel?

Psychologists...at least some militant ones...want to move away from the DSM and start their own version. This was a major point at their last ApA convention. As far as their proprietary testing, you don't have to use them or accept them. If they aren't acceptable for psychiatrists to administer, they aren't acceptable in the medical field. This is why psychiatrists should know their psychometric testing. I only allow testing that is psychiatry friendly. I think psychologists have been picking a lot of fights and psychiatrists are finally starting to 'get it' and we are going to see the outcomes in this decade.
I employ psychologists and they are not allowed to use the tests that stipulate only psychologists can administer them. If they don't like it, they can find another job and I can find another psychologist (its not that hard these days and its getting easier).

 

[Manicsleep]

MD and DO are largely similar in most ways.
MDs can learn manipulation if they want and DOs don't really practice manipulation. Where is the real difference other than quality of schools. Also, how many MDs are not really US MDs. Even then, nobody can say that all US DO schools are worse than MD schools, although this is largely the case.

In California, there was a time where you paid a fee and became an MD if you held a DO. Not sure why this can't be done again and on a permanent basis.

 

[digitlnoize]

This may be the most useless thread ever due to the fact we have two TOTALLY seperate conversations going on in the same thread. I have to scroll through posts on one topic to get to the topic of the thread.

If you want to blame someone, blame the OP. The tread itself was started with 2 topics...

And yes that guys sig is annoying.

Well...too bad.

And finally MD does NOT equal DO in anyway. They have their manipulation that we do not have. They also are currently in business ONLY because they present an option to people who otherwise would not have obtained entrance into medical school, another option with lesser criteria for the purposes of money generation and UNCESSARY generation of more doctors.

"Uncessary" generation of more doctors? Last I heard, there was a huge shortage of physicians, especially in psychiatry and primary care. Plus, if you had spent any amount of time on SDN, you would know that many (if not most) people choose DO school for reasons OTHER than backup.

I have many students in my class who applied DO only with excellent MCAT scores and GPAs. One of my close friends only applied to one school, despite great credentials.

I applied to MD and DO schools, and the DO school I am at was #3 on our "rank" list. You are correct in assuming I didn't get into my first 2 MD choices, but #1 was ultra competitive (and being a non-trad, I had too many bad grades from my time prior to med school to make up for), and #2 was in a city my family and I really didn't like, so it's better we wound up where we did. In fact, once I got my acceptance, I pulled all my lower ranked applications, MD and DO.

I picked this school for the small town location (great for raising my daughter), low tuition, good job market for wife, low cost of living, weather, schools for my daughter, the school's PBL program, the flexibility in clinical rotation scheduling, and last, but not least, the 100% health insurance coverage (which saved us >$10,000 when I had my arrhythmia ablated last year).

To call it anything else in this day and age is ridiculous. Back in the day when they were a completely seperate ideaology that had little to do with allopathic medicine, than a utility of them existed. Now a la carribean MD schools, the only reason to go to one is if you dont get into an MD school. What utility does that bring?

I think I just gave more than enough reasons why someone would choose DO school over MD school. Other people have other reasons: Close to home, they want to learn manipulation, family hx of DO's, etc.

Don't be so closed minded. Please. As a token of good faith, I'll even disable my sig just for you Wallstreet.

 

[393656]

Give me a break. I am so tired of people not being realistic and honest with themselves.

Anyone who says they chose DO school over MD is lying or delusions unless they had some family tie, some specific location they needed to be (ie near spouse, family) or had extreme interest in OMM pursuit.

Evidenced by you ranking 2 MD schools above the DO school, your rankings speak for themselves. You must not have been that "stellar" by the way.

Its not the quality of the DO school necessarily but the quality of the applicants is lower stastically. Now this is what bothers me when people argue this as you can look up the stats and stats do not lie. Lower gpa and mcat scores across the board for every DO school than MD school.

99 percent of the time the 3rd and 4th year in DO school is a total joke compared to MD hospital based rotations amongst residents and academic institutions. Every DO I encoutered had cush rotations in private offices or hospitals that were not at all representative of what an MD does.

And sorry but there is no shortage of physicians out there. There is a shortage of them who want to get paid 85k and go into family med so you can pump out another million docs and it wont change the shortage in FP. So the answer is not to flood the market with lower quality doctors with big debt burden who will also try to steer away from the market that they were intended to fill in the first place.

 

[st2205]

My first choice was anywhere in Texas (MD or DO) over absolutely anything outside Texas (MD or DO). Did not get accepted anywhere in Texas (not a resident and have no ties to the state).

As stated earlier, stats for psych are way below average (lowest according to USMLE) all across the board. What was it you were aiming for when you inevitably had to settle on psych?

 

[Suedehead]

Anyone who says they chose DO school over MD is lying or delusions unless they had some family tie, some specific location they needed to be (ie near spouse, family) or had extreme interest in OMM pursuit.

again, very black and white. I'm seeing a pattern here, wallstreet. do you exaggerate for effect or are you really this concrete? your generalizations are generally accurate, but, man - stereotyping is lazy thinking.

 

[digitlnoize]

Give me a break. I am so tired of people not being realistic and honest with themselves.

Anyone who says they chose DO school over MD is lying or delusions unless they had some family tie, some specific location they needed to be (ie near spouse, family) or had extreme interest in OMM pursuit.

Evidenced by you ranking 2 MD schools above the DO school, your rankings speak for themselves. You must not have been that "stellar" by the way.

I ranked the 2 MD schools higher because #1 was in my home town, and I thought #2 was a great program. The third MD school in my state (1h) from home was ranked much lower than my DO school. I applied widely to ~20 MD schools, but withdrew my applications after my early acceptance to my DO school.

I never said I was a stellar applicant. I had a pretty high science GPA (3.75) because I had never taken any science classes before my return to school. I didn't do extremely well on the MCAT (28R) because I suck at math, having been out of it for so long, and sucked up the physics section.

Still, I have a great work ethic, having held a couple of great jobs for a long time in the "real world." I got high A's in organic chemistry, TA'd the class the following year, giving bi-weekly lectures to >100 students, and was an ER scribe for 2 years. I've taught guitar and drum lessons for year, and organized multiple benefit concerts to raise money for various charities, including $5000 for Make A Wish, and $2000 for my local firefighters.

Some of my classmates were "stellar" applicants. I know people who had MCATs over 35, >3.8 GPAs, Master's degrees. One classmate of mine had a freaking children's hospital built in her hometown through fundraising efforts that she started, ran, and organized.

I'm not sure why you have a problem with the idea that it's possible someone *could* have ranked a DO school higher than an MD school? It doesn't make your degree any less valid...

Its not the quality of the DO school necessarily but the quality of the applicants is lower stastically. Now this is what bothers me when people argue this as you can look up the stats and stats do not lie. Lower gpa and mcat scores across the board for every DO school than MD school.

Sure. Be careful with stats posted on school websites though. They're often old and out of date. I know my own school's website hasn't updated their stats in 3 years, even though the mean MCAT score is now >30, the website still says 26.

99 percent of the time the 3rd and 4th year in DO school is a total joke compared to MD hospital based rotations amongst residents and academic institutions. Every DO I encoutered had cush rotations in private offices or hospitals that were not at all representative of what an MD does.

I've actually found the opposite. My MD school friends I talk to are very jealous of how much I get to do on my rotations, where they just get to watch the resident do everything. I'm not in academic hospitals true, but most of my experiences have been inpatient (sometimes with some clinic work, as in OBGYN where we were delivering babies, doing surgery, then seeing office patients). Since it's just me and the attending, I get to do a lot more. I scrub and first assist on every surgery. I handle my own panel of patients that I present, then round on with the attending. My psych rotation was at the highest acuity inpatient facility in the state. My hours are far from cush, I'm typing this now between surgeries, and I've been at work since 5am this morning.

And sorry but there is no shortage of physicians out there. There is a shortage of them who want to get paid 85k and go into family med so you can pump out another million docs and it wont change the shortage in FP. So the answer is not to flood the market with lower quality doctors with big debt burden who will also try to steer away from the market that they were intended to fill in the first place.

I seriously do not understand this statement. Aren't you a psychiatrist?

There are exactly 2 child psychiatrists in my town, both of whom have waiting lists over 1 year long. According to the AAMC Specialty Data Report, >55% of practicing psychiatrists are 55 or older, and there are 6000 patients per practicing psychiatrist, and over 40,000 per practicing C&A psychiatrist. The number of 1st year psych residents did increase by 11% from 2002 to 2007 (from ~1100 to ~1300). At that rate, we won't even replace 1/2 of the 21,000 psychiatrists 55 or older by the time they retire in 10 years.

Also, no FM grads are getting 85k. Go over on the FM board and look, the new grads are getting great offers, usually >$180k per year + benefits.

 

[393656]

I ranked the 2 MD schools higher because #1 was in my home town, and I thought #2 was a great program. The third MD school in my state (1h) from home was ranked much lower than my DO school. I applied widely to ~20 MD schools, but withdrew my applications after my early acceptance to my DO school.

I never said I was a stellar applicant. I had a pretty high science GPA (3.75) because I had never taken any science classes before my return to school. I didn't do extremely well on the MCAT (28R) because I suck at math, having been out of it for so long, and sucked up the physics section.

Still, I have a great work ethic, having held a couple of great jobs for a long time in the "real world." I got high A's in organic chemistry, TA'd the class the following year, giving bi-weekly lectures to >100 students, and was an ER scribe for 2 years. I've taught guitar and drum lessons for year, and organized multiple benefit concerts to raise money for various charities, including $5000 for Make A Wish, and $2000 for my local firefighters.

Some of my classmates were "stellar" applicants. I know people who had MCATs over 35, >3.8 GPAs, Master's degrees. One classmate of mine had a freaking children's hospital built in her hometown through fundraising efforts that she started, ran, and organized.

I'm not sure why you have a problem with the idea that it's possible someone *could* have ranked a DO school higher than an MD school? It doesn't make your degree any less valid...



Sure. Be careful with stats posted on school websites though. They're often old and out of date. I know my own school's website hasn't updated their stats in 3 years, even though the mean MCAT score is now >30, the website still says 26.



I've actually found the opposite. My MD school friends I talk to are very jealous of how much I get to do on my rotations, where they just get to watch the resident do everything. I'm not in academic hospitals true, but most of my experiences have been inpatient (sometimes with some clinic work, as in OBGYN where we were delivering babies, doing surgery, then seeing office patients). Since it's just me and the attending, I get to do a lot more. I scrub and first assist on every surgery. I handle my own panel of patients that I present, then round on with the attending. My psych rotation was at the highest acuity inpatient facility in the state. My hours are far from cush, I'm typing this now between surgeries, and I've been at work since 5am this morning.



I seriously do not understand this statement. Aren't you a psychiatrist?

There are exactly 2 child psychiatrists in my town, both of whom have waiting lists over 1 year long. According to the AAMC Specialty Data Report, >55% of practicing psychiatrists are 55 or older, and there are 6000 patients per practicing psychiatrist, and over 40,000 per practicing C&A psychiatrist. The number of 1st year psych residents did increase by 11% from 2002 to 2007 (from ~1100 to ~1300). At that rate, we won't even replace 1/2 of the 21,000 psychiatrists 55 or older by the time they retire in 10 years.

Also, no FM grads are getting 85k. Go over on the FM board and look, the new grads are getting great offers, usually >$180k per year + benefits.

I will not argue with someone who is barely into medical school. Go troll the allo forum. If you want to think a DO is equal to an MD than by all means congrats. Fortunately all lay people know better and value an MD still making still worthwhile to defend the difference. Many slackers I knew skated into DO schools (same goes for caribean which is really unfortunate as they are worse). Best of luck to you.

 

[digitlnoize]

I will not argue with someone who is barely into medical school.

Phew! Safe! In all seriousness, good, now the thread can get back to a discussion about the DSM. I should add, in my defense, that I'm about to start 4th year, which I don't think is "barely into" med school. More like "almost done."

If you want to think a DO is equal to an MD than by all means congrats. Fortunately all lay people know better and value an MD still making still worthwhile to defend the difference.

I get the jist of this, but your grammar was a bit confusing here. I guess an MD still making still worthwhile to defend the difference is a still good is point...still.

I have actually found that most lay-people (and most docs) have no idea who is an MD and who is a DO. If you don't go digging in the chart for their initials, you often have no idea. Most hospitals seem confused about the whole system too, putting MD after the names of many DOs on staff, on websites and such. My entire argument for changing DO to MDO (but keeping it under AOA rule) is to make it less confusing for lay-people.

Many slackers I knew skated into DO schools (same goes for caribean which is really unfortunate as they are worse). Best of luck to you.

I guess that means that all DO and Caribean students are slackers. Including the guy in my class who got a 274/99 on his USMLE. Such a total slacker. And, you're right, it's totally easy to "skate" into DO school. I mean, at my school, 4,821 slackers had applied (as of late Jan.) for 150 spots. Applications will continue rolling in until April. The 3% who get accepted must be the biggest slackers of them all.

 

[st2205]

I will not argue with someone who is barely into medical school. Go troll the allo forum. If you want to think a DO is equal to an MD than by all means congrats. Fortunately all lay people know better and value an MD still making still worthwhile to defend the difference. Many slackers I knew skated into DO schools (same goes for caribean which is really unfortunate as they are worse). Best of luck to you.

So again, what was it about your medical school preformance that was so bad that you had to match psych? You sound like a pretty smart chap and psych is notorious for having to fill spots with really bad IMGs like Whopper who weren't able to get into USMD schools or people like OPD who are so old that not even FP will take them.

 

[erg923]

I employ psychologists and they are not allowed to use the tests that stipulate only psychologists can administer them. If they don't like it, they can find another job and I can find another psychologist (its not that hard these days and its getting easier).

Granted I don't work for you, but I have never met a psychologist that would agree to have his/her test battery dictated or limited by the referring psychiatrist?! Frankly, I've never encounter a psychiatrist with enough gall to attempt to dictate a separate profession's practice methods. I think I can easily see some ethical problems with a psychologists who agrees to do assessment cases with this limitation in place. I really think you need to reconsider this stipulation, as I am not sure whom its really benefitting?

Moreover, If you don't trust them to know how to put together their own battery (so much so that you have to approve it before hand), then why on earth would you hire them do assessments in the first place? If they are not competent to do this very basic (and very important) first-step of the process, then I think you could argue that they aren't very competent in intellectual/cognitive/psychometric assessment, no? Thus, why would subject your patients to them and their services?

 

[Manicsleep]

Granted I don't work for you, but I have never met a psychologist that would agree to have his/her test battery dictated or limited by the referring psychiatrist?! Frankly, I've never encounter a psychiatrist with enough gall to attempt to dictate a separate profession's practice methods. I think I can easily see some ethical problems with a psychologists who agrees to do assessment cases with this limitation in place. I really think you need to reconsider this stipulation, as I am not sure whom its really benefitting?

Moreover, If you don't trust them to know how to put together their own battery (so much so that you have to approve it before hand), then why on earth would you hire them do assessments in the first place? If they are not competent to do this very basic (and very important) first-step of the process, then I think you could argue that they aren't very competent in intellectual/cognitive/psychometric assessment, no? Thus, why would subject your patients to them and their services?

I am glad you brought up basic and important first steps.

When psychologists create tests that are exclusive to psychologists or bar psychiatrists but are supposed to be used in a clinical setting it is not helpful to anyone. If I can't administer a test and I can't interpret it, I am not going to use it or allow it to be used. Why you can't understand that and why you have never met psychologists who can understand that is beyond me. I have met plenty of psychologists who grasp this simple concept very well. Basic and important things to learn as a psychology student, its a good thing you are not done yet but its unfortunate you are learning them on SDN.

Are you familiar with formularies? Think of this like a psychometric test formulary. The great thing is that its not like medications and there really is no "non formulary" psych test that is absolutely needed. It's an amazing system. Expect this kind of thing to increase as it is working wonderfully.

 

[Manicsleep]

So again, what was it about your medical school preformance that was so bad that you had to match psych? You sound like a pretty smart chap and psych is notorious for having to fill spots with really bad IMGs like Whopper who weren't able to get into USMD schools or people like OPD who are so old that not even FP will take them.

 

[erg923]

I suppose its because I've never met a psychiatrist who was interested in such a thing....My encounters with psychiatrists thus far (with the exception of SDN) have always been a "you do your job, I'll do mine" and we'll work together kinda thing. Ive never experienced any other way. Then again, I have no experience in PP clinical settings and have never had the experience of having psychiatrist have authority over me or my work. Im used to working with them in team settings, but not having them as direct supervisors or bosses. Even still, the psychologists who I do know who are directly "under" psychiatrists within a clinic or practice certainly haven't had them attempt to micromanage their work like that. Its just a very foreign concept that, to me, seems like it would violate my professional autonomy. There is just no way I could tolerate such restrictions on my work.

In the academic medical settings I have worked, neuropsychologists are treated mostly as an allied health consulting service. We do the assessment and the medical doc takes the input via a report we send. Sometimes the suggestions are utilized, sometimes not. No biggie, doesn't hurt my feelings. BUT, I have never known a psychiatrist (or neurologist) who is interested (or thought it necessary) to essentially double check my work. Again, if you feel adding that step is really necessary, then I would be worried about the quality of psychologists you are hiring for these evaluations. If you can't trust the accuracy and integrity of these people's work product (without feeling like you have to add your own 2 cents to their eval, or double check it), then why have you hired them in the first place?

This comes off as being much about "control" over employeees who you view as "under" you (rather than interdiciplinary professional peers) than any clinically relevant issue. This is well within your "right" as an employer of course, I just dont think it sounds like a very amicable or professional work enviroment for a doctoral-level professional.

 

[Therapist4Chnge]

As far as their proprietary testing, you don't have to use them or accept them. If they aren't acceptable for psychiatrists to administer, they aren't acceptable in the medical field. This is why psychiatrists should know their psychometric testing. I only allow testing that is psychiatry friendly. I think psychologists have been picking a lot of fights and psychiatrists are finally starting to 'get it' and we are going to see the outcomes in this decade.

The fact that you even wrote this shows your complete lack of understanding of the tennants of neuropsychological assessment, and complete lack of respect for the field.

There are very good reasons why certain assessments would not be acceptable for psychiatrists to administer: Lack of training on the assessment, poor understanding of how they do what they do (implications and limitations of certain types of assessments), lack of understanding about how different types of validity play a role in intepretation and making sense of conflicting results, etc.

Most anyone can be taught to administer the assessment (it happens every day), but interpretation of the data is a completely different skill set. Just because you don't understand an assessment or are not allowed to administer an assessment, does not invalidate the assessment. Limiting a professional's ability to practice is not only short-sighted but quite possibly unethical.

I employ psychologists and they are not allowed to use the tests that stipulate only psychologists can administer them. If they don't like it, they can find another job and I can find another psychologist (its not that hard these days and its getting easier).

If someone agrees to work for you, then it's your call, but understand that your position is yet another reason why many professionals prefer not to work with psychiatrists. Arrogance is an ugly color on any professional.

So again, what was it about your medical school preformance that was so bad that you had to match psych? You sound like a pretty smart chap and psych is notorious for having to fill spots with really bad IMGs like Whopper who weren't able to get into USMD schools or people like OPD who are so old that not even FP will take them.

I'm not sure your beef with Whopper, but he is consistantly one of the most knowledgeable posters on here.

When psychologists create tests that are exclusive to psychologists or bar psychiatrists but are supposed to be used in a clinical setting it is not helpful to anyone. If I can't administer a test and I can't interpret it, I am not going to use it or allow it to be used.

It protects the patient against professionals attempting to practice outside of their scope. It also helps ensure that the interpretation is done by a qualified clinician, and not someone who believes that they can give/interpret any assessment under the sun. Do no harm, right?

 

[sideways]

Goddamn medicine is nothing but a bunch of insecure narcissists. It's all about title and proving to the world how amazing you are. I know I'm not saying anything revelatory here. But this thread really tips the hand.

 

[sideways]

I'm not sure your beef with Whopper, but he is consistantly one of the most knowledgeable posters on here.

I believe that's sarcasm.

 

[Manicsleep]

The fact that you even wrote this shows your complete lack of understanding of the tennants of neuropsychological assessment, and complete lack of respect for the field.

There are very good reasons why certain assessments would not be acceptable for psychiatrists to administer: Lack of training on the assessment, poor understanding of how they do what they do (implications and limitations of certain types of assessments), lack of understanding about how different types of validity play a role in intepretation and making sense of conflicting results, etc.

Most anyone can be taught to administer the assessment (it happens every day), but interpretation of the data is a completely different skill set. Just because you don't understand an assessment or are not allowed to administer an assessment, does not invalidate the assessment. Limiting a professional's ability to practice is not only short-sighted but quite possibly unethical.

So those psychological tests that say a psychologist may administer but a psychiatrist can't are somehow aware which psychologists can interpret the data? The tests don't say only those trained in administration and interpretation etc...they make distinctions based on profession. Sorry, but there is a hierarchy there. Yours is lower.

I think its you who lacks understanding or you are just blinded by your single minded agenda.
If someone can't interpret a test, they should know their limits. I am technically allowed to do surgery, I don't because I know my limits. I do however have the ability to interpret psychometric tests as my program trained us in administration and interpretation of this data and I have kept up with my training and learned more. Conversely, many psychologists have no idea about neuropsych testing, yet these tests don't bar them. I think you are being a little hypocritical but thats nothing new. You have a clear agenda, its not in the favor of psychiatrists and it can be pointed out from your previous posts.

RE: Tennants: I think you mean tenets. You are a very wise PhD 'real doctor' or whatever...so you may have just misspelled tenant but I think you meant tenet. Don't use big words if you don't know what they mean. It works great with patients. K.I.S.S.

If someone agrees to work for you, then it's your call, but understand that your position is yet another reason why many professionals prefer not to work with psychiatrists. Arrogance is an ugly color on any professional.

Skill however is a fabulous color. I'm sorry you couldn't get some of that smashing MD color or the dashing DO. I am sorry you had to settle for psychologist and angry about it. It is why many physicians are choosing to hire social workers who are just as skilled instead of psychologists whose ego won't let them realize their PhD or PsyD means nothing in the clinical world. Arrogance is an ugly color but ignorance and incompetence are horrible additions to arrogance.

 

[Ibid]

I think its you who lacks understanding or you are just blinded by your single minded agenda.

I don’t want to be awkward but you have missed out the apostrophe there mate. Its is possessive. It’s is the contraction.
p.s. Don't go over my postings, it will take the rest of your life as I am illiterate.

 

[Doc Samson]

And...... the MD/DO and iatry/ology flame war is over. Return to the original topic or the lock looms.

 

[Majesty]

Is anyone else excited for the train wreck that may or may not be the DSM 5? Okay, so it probably won't be as bad as some of the backseat drivers are making it out to be, but still...

I love that they plan on collapsing Axis I, II, and III all into one field.
I wish they would erase Axis IV and V... they are completely worthless.

I think the DSM 5 will have value. These things arent supposed to tell us what to do. Dammit Jim, I'm a Doctor not a statistical manual based provider!

I also wish that they would only permit Psychiatrists to have access and to use the diagnoses from the DSM. This would not be completely unheard of, Psychologists do this with all of their testing materials. Since when do physicians farm out the art of diagnosing patients to non-medical personel?

We do it all the time. X-ray techs, ultrasound techs, respiratory techs. We use accessory personnel in health care all the time. So we use psychologists? Big deal, there is only one person on top and the professional as well as the lay population knows who the real Doctor is in the medical setting.

While I'm at it, why can't we just stop this DO craziness? It's not the civil war anymore and osteopathic manipulation is not exactly modern evidence based medicine. I propose we just turn all the DO schools into MD schools

The osteopathic head honchos would lose everything. My thinking is that the average DO probably would benefit from this change. We would benefit too because their would be a more unified physician body.

 

[deleted75966]

I do however have the ability to interpret psychometric tests as my program trained us in administration and interpretation of this data and I have kept up with my training and learned more

Heh. Oh, and in keeping with your insistence on correcting typos and grammar, I thought you might like to know it's, "THESE data."

Arrogance is an ugly color but ignorance and incompetence are horrible additions to arrogance.

Irony's ugly roar echoes across the interwebs. . .

As an aside, I cannot imagine working with or for someone that holds your opinions. It's bizarre to me to even think about clinical work in this manner. I have no idea which tests are legally interpretable by whom (I quite frankly thought there was no such limits on physician, being that the AMA is all powerful in the healthcare arena). I also don't care to an extent. I'm not a fan of the "have my nurse do it," or "hey, here's this computer program that generates numbers and stuff," method. But, if a neurologist or psychiatrist is doing a clinical evaluation and comes up with, or uses, a test (correctly) to test a hypothesis that is based on sound reasoning, and doesn't purport to be doing a neuropsychological evaluation, great!! I see this occasionally in neurology reports, never seen it in a psychiatry report. But, psychiatrist researchers, I know often use neuropsychological tests (e.g., fMRI studies of the Iowa Gambling Test in patients with borderline personality disorder, which was actually developed by neurologists and neuropsychologists). I, btw, also use neurological tests in my evaluations when hypothesis testing. When I include these in my reports, the neurologists do not question their use, they understand the context in which I used them and why. I'd do the same with psychiatric tests except I don't think such a thing exists

 

[deleted75966]

So we use psychologists? Big deal, there is only one person on top and the professional as well as the lay population knows who the real Doctor is in the medical setting.

Why is this even part of your thought process? When it comes down to it, aren't all specialists used this way? So, is the only "real doctor" the primary care physician, chiropractor or nurse practitioner? Why the need to even bother trying to establish a hierarchy in this context? What is the relevance?

 

[Majesty]

And finally MD does NOT equal DO in anyway. They have their manipulation that we do not have. They also are currently in business ONLY because they present an option to people who otherwise would not have obtained entrance into medical school, another option with lesser criteria for the purposes of money generation and UNCESSARY generation of more doctors.

I don't know. I don't think I have met DOs that were generally worse than MDs although we really didn't have DOs in residency. For a while our family physican was a DO and she was a concierge doctor who was really on top of her game. I think your residency is more important that medical school and we have a shortage of doctors. Its the over production of noctors that we should be more concerned about.

 

[Majesty]

Why is this even part of your thought process? When it comes down to it, aren't all specialists used this way? So, is the only "real doctor" the primary care physician, chiropractor or nurse practitioner. Why the need to even bother trying to establish a hierarchy in this context? What is the relevance?

The hierarchy is important and actually vital. Someone needs to be in charge even when there is a team approach and that someone is the Physician. Its too bad you don't understand that. Not understanding that is dangerous to patient care. I would never want to work with someone like you and I am glad that the psychologists and neuropsychologists that I supervise don't have this severe lack of understanding.

 

[deleted75966]

The hierarchy is important and actually vital. Someone needs to be in charge even when there is a team approach and that someone is the Physician. Its too bad you don't understand that. Not understanding that is dangerous to patient care. I would never want to work with someone like you and I am glad that the psychologists and neuropsychologists that I supervise don't have this severe lack of understanding.

Of course, that depends on where/context. In many contexts, there is no physician involved. But, in the cases when a physician is involved, I am in charge of my domain as is any specialist. The level of interaction will depend on the level of physician (e.g., a green primary care physician versus an experienced neuropsychiatrist). In a sense, I suppose you could say that the physician is in charge of overseeing the patient's medical care, or, at least, the patient's neurological/psychiatric care; that's very different than saying that the physician is in charge or on a higher level in some fashion than others on treatment teams. I can prescribe treatments or refer to rehab (let's say in the case of a stroke patient) and my assessment formulation is reported in whole (not interpreted by the physician). Without a doubt, there would be open communication in such a team. The physician does not command me and I am under no obligation to agree with or yield judgment in my domain of expertise to a physician. I give my own feedback to patients as does the physician. I see the situation as hierarchy-irrelevant. And, functionally that is the case, we are independent practitioners (physician and psychologist). I imagine that the psychologists/neuropsychologists that you think you supervise would find that notion amusing and probably insulting. My assigned faculty mentor is an MD (likely because I am the only neuropsychologist in my department), but he doesn't "supervise" my clinical work. Being in academia, he mentors/"supervises" my research development and my choices with regards of what responsibilities I contemplate taking in the context of achieving tenure (e.g., Should I open a clinic is this speciality group? I have an idea for a grant on XX topic, what do you think?). The idea of a physician supervising psychological work is kind of stupid (like manic's boast of dictating which tests are used; that's just plain unethical, luckily he's in psychiatry and the malpractice lawsuits are relatively hard to prosecute.) and, as such, does not happen in the hospital at which I work. This is a collaborative environment.

Now, in an inpatient unit, when you have the attending, residents, and nurses rounding, clearly the attending is in charge and it would be dangerous to varying levels of severity for that not to be the case (confuse medical orders, who is called in what circumstance, etc. . .).

 

[digitlnoize]

The osteopathic head honchos would lose everything. My thinking is that the average DO probably would benefit from this change. We would benefit too because their would be a more unified physician body.

This is why I'm in favor of the MD-O designation (or something similar.)

It would allow the "osteopathic" head honchos to retain their separate but equal stuff, but would help unify doctors, and open OMM more to the few MD's that want it, while easily showing who has certification in manipulation stuff. It'll never happen though...

I hope this DSM-V crap gets going soon. I'd hate to start learning DSM-IV during residency, then have to change. I'm probably going to get a year or two with IV, then two years with V the way things are looking though...sigh...

 

[Therapist4Chnge]

The idea of a physician supervising psychological work is kind of stupid (like manic's boast of dictating which tests are used; that's just plain unethical, luckily he's in psychiatry and the malpractice lawsuits are relatively hard to prosecute.) and, as such, does not happen in the hospital at which I work. This is a collaborative environment.

I'm also in academic medicine, and I've experienced the same thing. We get consults from neuro-surg, neurology, oncology, and similar...and I have yet to have a physician even attempt to suggest what I use for my evaluation. They trust me to do my evaluation and provide recommendations. There is no undercutting or posturing, though maybe that is because everyone I work with is comfortable in their role and they understand the value in what each team member contributes. We also rarely have the need to consult Psychiatry, so maybe that helps.

 

[Majesty]

I think we have discussed the psychiatry supervising psychologists before. Look it up.

I supervise them, my colleagues supervise them. I order psychometric tests. None of the psychologists or social workers get worked up. Get over it.

This is why I'm in favor of the MD-O designation (or something similar.)

It would allow the "osteopathic" head honchos to retain their separate but equal stuff, but would help unify doctors, and open OMM more to the few MD's that want it, while easily showing who has certification in manipulation stuff. It'll never happen though...

I hope this DSM-V crap gets going soon. I'd hate to start learning DSM-IV during residency, then have to change. I'm probably going to get a year or two with IV, then two years with V the way things are looking though...sigh...

It will never be MD-O unless the MDs stay MDs. and the DOs become MD-Os. FYI, there is an acronym like that at state hospitals in california for really sick forensic patients. I think its mentally disabled offenders or something. They aren't teaching the DSM5 at all right now? I would think that would be important for residents. I wonder how the last transition went. I have pretty much spent my entire education/career in the DSM-IV era. It does create a little knot in the stomach when I think about learning all that again. But i am sure it will re-energize the field as well. Wonder how many people will be retiring just about that time.

 

[PETRAN]

I'd do the same with psychiatric tests except I don't think such a thing exists

psychiatrist don't need tests, psychiatrist cures humanity. Thats the case in soviet russia

 

[Ibid]

FYI, there is an acronym like that at state hospitals in california for really sick forensic patients. I think its mentally disabled offenders or something.

http://www.cps.gov.uk/legal/l_to_o/mentally_disordered_offenders/

Narrow point but not just CA. (not that anyone would get confused imo)

 

[digitlnoize]

It will never be MD-O unless the MDs stay MDs. and the DOs become MD-Os. FYI, there is an acronym like that at state hospitals in california for really sick forensic patients. I think its mentally disabled offenders or something.

That's what I meant. MD's can stay MD's, unless they want to do an OMM fellowship or certification, in which case, they'd get the O. DO's would become MDO's. DOM has also been tossed around, but I don't like that as much, because it has less meaning in the public's eye, I think. MD-O covers all the bases, and let's the people doing manipulation stay separate. Again though, it'll never happen...especially since DO's are so much different than MD's in that we "treat the whole person, not just the sx..."

They aren't teaching the DSM5 at all right now? I would think that would be important for residents. I wonder how the last transition went. I have pretty much spent my entire education/career in the DSM-IV era. It does create a little knot in the stomach when I think about learning all that again. But i am sure it will re-energize the field as well. Wonder how many people will be retiring just about that time.

Not sure about residents, but my rotations have all been DSM-IV based, and my test was too apparently. I think they have to since the V isn't actually approved yet.

55% of practicing psychiatrists are > 55yo. So...I'd say a lot might retire soon...hurray for us young folk!

 

[deleted75966]

I think we have discussed the psychiatry supervising psychologists before. Look it up.

I'm sure you have.

I supervise them, my colleagues supervise them. I order psychometric tests. None of the psychologists or social workers get worked up. Get over it.

I think you either misperceive how those psychologists view your request for specific tests or your working with some pretty hard-up psychologists with few other options. For example, if I suggest in an eval that a patient may benefit from a specific medication and the physician or nurse practitioner prescribes it, they are not following my command, they are following my suggestion. This difference is important. If a neurologist or psychiatrist requests a specific test and I deem it appropriate, I'll give it. Why wouldn't I? Similarly, if I have a case and I want clarification on an issue that I think a specific physician might have a solid opinion on, I'll ask. They will also ask for my expertise. Again, it is collaboration, not supervision. You're on a hell of an ego trip if you think otherwise. FMG? I ask because perhaps your problem is a simple cultural misunderstanding.

 

[Doc Samson]

And we're done... so many things wrong with this thread, I don't even know where to start. Now run along and play nice.