Psychiatrist working as a veterinarian or a dentist in an inpatient setting - your thoughts?

[nancysinatra]

So, I am currently working at a highly troubled forensic institution somewhere in the US and its territories. A large part of my job involves managing a unit exclusively devoted to cluster B personality disorders, although this was not the original design of the unit. Most of the patients are officially "diagnosed" with schizophrenia, schizoaffective disorder, bipolar disorder, depression, OCD, anxiety, PTSD, learning disability, mild MR, autism, substance abuse, and, often, a sensory processing disorder. Some even have diabetes, obesity, back pain, and a "history of trauma." Others suffer from multiple personality disorder, which, if you multiply that by all the diagnoses they carry, it gets complicated and results in a lot of meds. Almost all of them are on every single psych med, at the highest dose. It's weird because even with these doses we see no results. I mean, like, none. One day it dawned on me that many were just antisocial.

In this population, there are a lot of assaults, as in, every 15 minutes, and I, the on-call provider, am asked to do something. Sometimes, the patients won't even talk to me!!! In fact, they totally refuse to "contract for safety" at times. This is really worrisome since contracting for safety is an extremely effective way of preventing violence among the inpatient antisocial population, especially when the government has decided that restraint and seclusion are inhumane. Without this contract in place, I am forced to make decisions without their input. I sort of wonder if this is how veterinarians feel.

I also have one patient who adamantly refuses to follow the recommendations of our in-house dentist - he wants pain meds whereas the dentist recommends a root canal. The poor dentist is not used to "difficult patients" and I found myself trying to facilitate communication. To no avail - they both got completely flustered. Which left me realizing that dentists probably don't get much training in DBT.

I think maybe I will just do the root canal myself.

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[Baller MD]

You mentioned in a past post that you enjoyed your psych rotation in med school. Why don't you just work at a place similar to that?

 

[slappy]

There's a fine line between being funny, and trying too hard. This is nowhere close to that line.

 

[nancysinatra]

There's a fine line between being funny, and trying too hard. This is nowhere close to that line.

There's a fine line between having some tact and being a jerk. As is typical of this forum, you are nowhere close to one of these.

Goodbye SDN. Posted here for over ten years and not a thing to show for it. And by the way I was telling the truth about my job, not trying to be funny. That's actually how my current job is. But I think we all know what side of people comes out on the internet. I'm never coming back here.

 

[TexasPhysician]

I pulled a tooth on a medical mission trip once. I need to join the OP when I want to put my practice to work!

Sounds exciting!

 

[Frazier]

You mentioned in a past post that you enjoyed your psych rotation in med school. Why don't you just work at a place similar to that?

IIRC, he noted in an old post that the people (attendings/residents) during his psych rotation are what drew him to the field.

In other words, the faculty/staff on IM/Surg/etc were so unlikable at his med school, he defaulted to psych largely due to the staff not being insufferable on that service [not so much out of passion for the work/pathology].

I can 100% understand how this lent itself to the dissatisfaction that's been evident now for years' worth of posts.

 

[EMDO2018]

Are you a psych patient who has hog tied the real psychiatrist and hacked his computer?

 

[OldPsychDoc]

I only know Nancy through this forum, but I'll affirm that though her posts are usually influenced more by a need to vent than an intent to convey subtleties of daily practice, I will vouch for Nancy being authentic, as is the uncommon practice situation she finds herself in.

(In other words, give her a break.)

 

[michaelrack]

"In this population, there are a lot of assaults, as in, every 15 minutes, and I, the on-call provider, am asked to do something."
I think what they are asking you to do
is give haldol 5 and ativan 2.
(not that that is the course you should pursue)

 

[F0nzie]

I like Nancy's posts because she says what she has on her mind.

Consider private practice Nancy. Patients will call you because they want help. By default they will have enough cognitive capacity to work with you and make joint decisions. You can make them accountable and they will either stick with you or leave. Someone else will want their time slot anyways. 1 day a week as an adjunct to your line of work. I promise it will make a difference.

 

[mojetter]

I found it funny...

Have you considered Lithium?

 

[PikminOC]

There's a fine line between having some tact and being a jerk. As is typical of this forum, you are nowhere close to one of these.

Goodbye SDN. Posted here for over ten years and not a thing to show for it. And by the way I was telling the truth about my job, not trying to be funny. That's actually how my current job is. But I think we all know what side of people comes out on the internet. I'm never coming back here.

Nancy, do not leave. I was very happy to see that you posted here.
I worked in a facility where we had violent patients as well.
We never contracted for safety though.

 

[PikminOC]

IIRC, he noted in an old post that the people (attendings/residents) during his psych rotation are what drew him to the field.

In other words, the faculty/staff on IM/Surg/etc were so unlikable at his med school, he defaulted to psych largely due to the staff not being insufferable on that service [not so much out of passion for the work/pathology].

I can 100% understand how this lent itself to the dissatisfaction that's been evident now for years' worth of posts.

Frazier, I like your new avatar.

 

[johnhoedack]

Nancy I've barely posted here but vhave lurked over the years. I just wanted to add that I've genuinely appreciated your contributions to this forum. I'm waiting to match into psych now (4th year med student) and I like your style. I can say that we share a similar mentality and it your posts actually helped convince me to do psych.

 

[PikminOC]

If you need a break, please PM those of us you really like you!

 

[Opira]

Goodbye SDN. I'm never coming back here.

Awesome. Now if vistaril also leaves, this place would be so bereft of negative energy. One can only hope.

 

[OldPsychDoc]

Awesome. Now if vistaril also leaves, this place would be so bereft of negative energy. One can only hope.

There will always be someone to fill the void.

(One might nominate a relatively non-prolific poster who returns to this group after an 8 month absence only to contribute 5 posts with a decidedly negative tone toward other posters and their personal decision-making process, for example. )