A tedious sob story.fair warning:may be triggering..but not likely

[Ibid]

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I've just been banned from the Whitaker site www.madinamerica.com

For bold, yes bold misrepresentations and being uncivil....honestly...im never like that...ever..

They need to change the name to www.bedwettingprissy****ingnazisingleissuefanaticalblindedbybigotedmyopiczealotry.com

👎

 

[billypilgrim37]

url]www.bedwettingprissy****ingnazisingleissuefanaticalblindedbybigotedmyopiczealotry.com[/url]

but they would just use a tinyurl and take all the fun out of it.

That website always freaked me out. The layout can only be imbibed if you're manic. I can't get to the content because the lay out makes me feel like I'm trudging into a pit from which I could never get out.

 

[splik]

what did you get banned for? I used to blog on there but was annoyed that they kept reformatting my articles! and i did get attacked by a few people who thought i was some sort of evil psychiatrist lol.

 

[vistaril]

I've just been banned from the Whitaker site www.madinamerica.com

For bold, yes bold misrepresentations and being uncivil....honestly...im never like that...ever..

They need to change the name to www.bedwettingprissy****ingnazisingleissuefanaticalblindedbybigotedmyopiczealotry.com

👎

I obviously am a Whitaker supporter overall(although I don't agree with everything he says).....his basic premise is correct imo.

That said, the site sort of loses focus because(to bring in everyone) it has a combination of anti-psychiatry people, psychiatric 'survivors', and people who think more like me. Trying to appease/include all those viewpoints makes for problems.

 

[F0nzie]

I obviously am a Whitaker supporter overall(although I don't agree with everything he says).....his basic premise is correct imo.

can you explain?

 

[F0nzie]

For bold, yes bold misrepresentations and being uncivil....honestly...im never like that...ever..

Those jerks... You're always welcome here 🙂

 

[vistaril]

can you explain?

1) We use psychotropic medications far too often in general
2) Psychotropic medications are less effective than many are being led to believe
3) Even in cases where there is some benefit from using psychotropic medication, in many cases the benefit is not large enough to outweigh the negatives

 

[F0nzie]

1) We use psychotropic medications far too often in general
2) Psychotropic medications are less effective than many are being led to believe
3) Even in cases where there is some benefit from using psychotropic medication, in many cases the benefit is not large enough to outweigh the negatives

I have felt this way at times when receiving patients on catastrophic med regimens.

I feel fortunate that my residency training has focused extensively on the risks and the benefits of medications. I am also glad that I have common sense.

We've all gone though extensive medical training to get the privilege to prescribe psychotropics when necessary... yet we still manage to screw it up.

Where do you think the problem lies? And how can we fix it?

 

[vistaril]

I have felt this way at times when receiving patients on catastrophic med regimens.

I feel fortunate that my residency training has focused extensively on the risks and the benefits of medications. I am also glad that I have common sense.

We've all gone though extensive medical training to get the privilege to prescribe psychotropics when necessary... yet we still manage to screw it up.

Where do you think the problem lies? And how can we fix it?

1) when we recieve a pt on a catastrophic med regimen that is 'stable'(whatever that means), we tend to be told not to rock the boat and start cutting back. The pt also has the crazy idea that it was increasing the Lamictal from 250 to 300 and adding that middle of the day 50mg spacer dose of seroquel that is keeping her sanity intact. So when their naturally fluctuating mood and anxiety hits a valley, you are going to be pushed to add something. After all they don't want you to take something away because the last time someone haphazardly slung crap at the wall it was thought to stuck, so in their eyes removing that previous garbage is the opposite of what needs to be done......so you either add another half of milligram of klonopin or the pt goes to another psych provider to fix her. And by the time she gets in there, she is naturally doing a little better that day(ie 'stable') and so the new provider looks at the massive and haphazard polypharm and says "well if it ain't broke don't fix it" and the cycle starts anew.....there is no fix for this part of the problem in something that resembles our current system.

2) you're familar with how we get paid. We get paid to tinker with people's medications. That's just reality. We can also get paid to provide regular psychotherapy to patients, but psychologists can do this. And so can lpcs/lcsws. And usually as good as us(and in many cases better). And they get paid anywhere from 65k(therapist) to maybe 80-115k/year(psychologist). And since we don't want to make these sorts of salaries(after all why the hell should we be paid much more than these people when we can't point to better results), we tinker with someone's seroquel dosing rather than deal with the real problem. There is no fix for this part of the problem.

3) I don't think it really matters what programs teach with respect to this. People are going to go out and do what they are going to do. My program mostly has outpt attendings who preach reasonable rx'ing, but I know many of our graduates go out and do what everyone else does. This happens everywhere(at least in the real world outside of academic centers). I know this because I can read lists showing what the most sold/filled drugs are.....In 2010 Americans spent 4.4 billion dollars on seroquel. That makes it #6 in the US. But wait, abilify was #5 at 4.6 billion!! It is an absolute travesty that these two drugs rank #5 and 6 in this category. And most of that is done by psychiatrists. There is absolutely no way we can defend that. When I looked it up I was beyond the point of being embarassed. Honestly, if non-psychiatrists were aware of that(most probably aren't) they should never listen to or care about what a psychiatrist recommends....simply because it's not always easy to tell who is practicing this sort of psychiatry. And with 9 BILLION dollars between these two drugs, it's not like it's just a few bad apples out there. There is no fix for this part of the problem.

Well.....let me take part of that back. There is a rather obvious fix which would be psychiatrists moving away from being people paid primarily to tinker with meds. But because there is no alternative that has near equal reimbursement(at least for most all these current practitioners), that is not going to realistically happen(at least not willingly)

 

[heyjack70]

1) when we recieve a pt on a catastrophic med regimen that is 'stable'(whatever that means), we tend to be told not to rock the boat and start cutting back. The pt also has the crazy idea that it was increasing the Lamictal from 250 to 300 and adding that middle of the day 50mg spacer dose of seroquel that is keeping her sanity intact. So when their naturally fluctuating mood and anxiety hits a valley, you are going to be pushed to add something. After all they don't want you to take something away because the last time someone haphazardly slung crap at the wall it was thought to stuck, so in their eyes removing that previous garbage is the opposite of what needs to be done......so you either add another half of milligram of klonopin or the pt goes to another psych provider to fix her. And by the time she gets in there, she is naturally doing a little better that day(ie 'stable') and so the new provider looks at the massive and haphazard polypharm and says "well if it ain't broke don't fix it" and the cycle starts anew.....there is no fix for this part of the problem in something that resembles our current system.

2) you're familar with how we get paid. We get paid to tinker with people's medications. That's just reality. We can also get paid to provide regular psychotherapy to patients, but psychologists can do this. And so can lpcs/lcsws. And usually as good as us(and in many cases better). And they get paid anywhere from 65k(therapist) to maybe 80-115k/year(psychologist). And since we don't want to make these sorts of salaries(after all why the hell should we be paid much more than these people when we can't point to better results), we tinker with someone's seroquel dosing rather than deal with the real problem. There is no fix for this part of the problem.

3) I don't think it really matters what programs teach with respect to this. People are going to go out and do what they are going to do. My program mostly has outpt attendings who preach reasonable rx'ing, but I know many of our graduates go out and do what everyone else does. This happens everywhere(at least in the real world outside of academic centers). I know this because I can read lists showing what the most sold/filled drugs are.....In 2010 Americans spent 4.4 billion dollars on seroquel. That makes it #6 in the US. But wait, abilify was #5 at 4.6 billion!! It is an absolute travesty that these two drugs rank #5 and 6 in this category. And most of that is done by psychiatrists. There is absolutely no way we can defend that. When I looked it up I was beyond the point of being embarassed. Honestly, if non-psychiatrists were aware of that(most probably aren't) they should never listen to or care about what a psychiatrist recommends....simply because it's not always easy to tell who is practicing this sort of psychiatry. And with 9 BILLION dollars between these two drugs, it's not like it's just a few bad apples out there. There is no fix for this part of the problem.

Well.....let me take part of that back. There is a rather obvious fix which would be psychiatrists moving away from being people paid primarily to tinker with meds. But because there is no alternative that has near equal reimbursement(at least for most all these current practitioners), that is not going to realistically happen(at least not willingly)

I think one way to fix this problem; and I perceive it as a problem, as much as you do I think (though I'm not sure insurance co's, or the general public thinks it's a problem), is to pay more for combined treatment. I think most of the time, throwing a pill is easier than, and pays better than, a 60 minute therapy plus med visit. And paying a social worker is cheaper than paying a psychiatrist for therapy. But my hope is that in the long run combined treatment would actually be cheaper. I mean if we could get paid well to do psychotherapy plus meds, would it prevent another rx for an atypical in a "bipolar II" patient that is really just having Axis II and IV problems? And would good therapy decrease hospitalizations (a huge money saver)?

I've seen split treatment suck repeatedly in community mental health. I'm not sure it works much better in the world of private insurance either. I think this is because nobody will pay for the communication between a therapist and psychiatrist, and without that incentive you have the potential to get a bad psychiatrist chasing symptoms with pills, and (my experience) a crappy social worker doing crappy therapy, and nobody talking to each other that much. I think I can provide better therapy than a social worker, and if I can be the one managing meds I've got a much better perspective on what's actually going on with the patient because I'm seeing them regularly for therapy.

I think this works even if it's not weekly therapy. Even with a 60 minute monthly visit, or even less frequently, you can get a lot better understanding of what's going on with a patient, have better rapport, and are less likely to do something stupid like continuing a crazy med regimen or throwing on another dose of Klonopin when what the patient really needs is to work on what's underlying the symptoms.

I'm a bit cynical about mid-level therapists, or even psychologists doing therapy actually. I often ask about modalities and get the response, "I do sort of eclectic therapy." And what does that mean...? I've had patients with anxiety disorders never even hear about CBT concepts, or looking for root causes of their anxiety, or working on dynamic stuff. I mean do something at least resembling actual therapy. The therapist notes are talking about what did you do last week, are you looking for a job, how are things in your relationship. It's like, come on...there is evidence based treatment for anxiety disorders; at most you're doing supportive therapy, but really you're just shooting the sh#t with the patient for an hour every week.

So long story short, I think psychiatrists can be good psychotherapists and paying for combined treatment would actually save money. Split treatment relies heavily on communication between psychiatrist and therapist and I don't think that happens very much. And a lot of the psychotherapy happening is really junky. There's probably a study out there about this.

 

[vistaril]

I think one way to fix this problem; and I perceive it as a problem, as much as you do I think (though I'm not sure insurance co's, or the general public thinks it's a problem), is to pay more for combined treatment. I think most of the time, throwing a pill is easier than, and pays better than, a 60 minute therapy plus med visit. And paying a social worker is cheaper than paying a psychiatrist for therapy. But my hope is that in the long run combined treatment would actually be cheaper. I mean if we could get paid well to do psychotherapy plus meds, would it prevent another rx for an atypical in a "bipolar II" patient that is really just having Axis II and IV problems? And would good therapy decrease hospitalizations (a huge money saver)?

I've seen split treatment suck repeatedly in community mental health. I'm not sure it works much better in the world of private insurance either. I think this is because nobody will pay for the communication between a therapist and psychiatrist, and without that incentive you have the potential to get a bad psychiatrist chasing symptoms with pills, and (my experience) a crappy social worker doing crappy therapy, and nobody talking to each other that much. I think I can provide better therapy than a social worker, and if I can be the one managing meds I've got a much better perspective on what's actually going on with the patient because I'm seeing them regularly for therapy.

I think this works even if it's not weekly therapy. Even with a 60 minute monthly visit, or even less frequently, you can get a lot better understanding of what's going on with a patient, have better rapport, and are less likely to do something stupid like continuing a crazy med regimen or throwing on another dose of Klonopin when what the patient really needs is to work on what's underlying the symptoms.

I'm a bit cynical about mid-level therapists, or even psychologists doing therapy actually. I often ask about modalities and get the response, "I do sort of eclectic therapy." And what does that mean...? I've had patients with anxiety disorders never even hear about CBT concepts, or looking for root causes of their anxiety, or working on dynamic stuff. I mean do something at least resembling actual therapy. The therapist notes are talking about what did you do last week, are you looking for a job, how are things in your relationship. It's like, come on...there is evidence based treatment for anxiety disorders; at most you're doing supportive therapy, but really you're just shooting the sh#t with the patient for an hour every week.

So long story short, I think psychiatrists can be good psychotherapists and paying for combined treatment would actually save money. Split treatment relies heavily on communication between psychiatrist and therapist and I don't think that happens very much. And a lot of the psychotherapy happening is really junky. There's probably a study out there about this.

the problem is a cbt course is done weekly in some cases....you obviously don't need to see the pt for med mgt anywhere close to that frequency. So for the majority of those visits, combined treatment is really not an option.

 

[Ibid]

but they would just use a tinyurl and take all the fun out of it.

That website always freaked me out. The layout can only be imbibed if you're manic. I can't get to the content because the lay out makes me feel like I'm trudging into a pit from which I could never get out.

It takes some doing to take the fun out of mental health...its so inherently fun its incredible how many people manage it...

what did you get banned for? I used to blog on there but was annoyed that they kept reformatting my articles! and i did get attacked by a few people who thought i was some sort of evil psychiatrist lol.

For a lot of people evil is the only sort...

Not quite sure it all happen so fast....one moment i'm minding my own business making a point (2000 words or less) so obscure you need a Phd in English Lit and an electron microscope to find it and the next moment i'm sitting in the no mans land equivalent of cyberspace wondering what just happened....

I obviously am a Whitaker supporter overall(although I don't agree with everything he says).....his basic premise is correct imo.

That said, the site sort of loses focus because(to bring in everyone) it has a combination of anti-psychiatry people, psychiatric 'survivors', and people who think more like me. Trying to appease/include all those viewpoints makes for problems.

Yes, it's muddleinAmerica.

Those jerks... You're always welcome here 🙂

I'll get the next round of drinks 🙂

 

[nancysinatra]

In 2010 Americans spent 4.4 billion dollars on seroquel. That makes it #6 in the US. But wait, abilify was #5 at 4.6 billion!! ... And with 9 BILLION dollars between these two drugs, it's not like it's just a few bad apples out there.

Is that more or less than we spent on NASA? How about education?

Wouldn't a lot of depressed people in this world feel at least momentarily uplifted if humanity could make it to Mars in our lifetime? And here we are spending our money on Seroquel??? Am I the only bothered by this?

 

[heyjack70]

Is that more or less than we spent on NASA? How about education?

Wouldn't a lot of depressed people in this world feel at least momentarily uplifted if humanity could make it to Mars in our lifetime? And here we are spending our money on Seroquel??? Am I the only bothered by this?

I'm mostly bothered by the fact that anti-psychiatry people (or anti-medicine people) think we get some sort of huge $$ kickback by prescribing expensive drugs. And it's totally not true at all.

 

[notdeadyet]

I'm mostly bothered by the fact that anti-psychiatry people (or anti-medicine people) think we get some sort of huge $$ kickback by prescribing expensive drugs. And it's totally not true at all.

Well, it's not true anymore. It wasn't in the very distant past that psychiatrists did indeed get incentives from pharma tied to how much of a product they pushed.