Clear Liquid Diet

[Majesty]

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When is it appropriate to order a clear liquid diet as a psychiatrist?

 

[Doc Samson]

When is it appropriate to order a clear liquid diet as a psychiatrist?

Tough to say... any of the medical scenarios that would require a clear liquid diet would typically make the patient inappropriate for an inpatient psychiatry unit.

 

[michaelrack]

A patient with GI symptoms that would not typically require medical hospitalization. For example, a relatively healthy adult recovering from a diarrheal episode that normally would be treated as an outpatient

 

[kugel]

When is it appropriate to order a clear liquid diet as a psychiatrist?

What are you getting at here?
The question seems tendencious.

 

[Majesty]

Fecal smearing. Oh yeah, it happened.

 

[whopper]

It's uncommon to rare, but sometimes a psychiatrist will have to change a diet out of the norm for psychiatric reasons.

In residency, I typically was in a situation where the diet needed to be modified at least every few weeks. What then happened was there was an attending who did not know what the diet options were. Their attitude was why learn the options when they rarely had to make changes. They saw it as solely IM's responsibility.

So as a first year, and I wanting to get the attending to check off of everything, the attending usually didn't know what was going on with the diet and ordered an IM consult. Them the IM doctor came in, became upset that they were consulted just for diet and took it out on me. I told them they needed to take it up with the psychiatric attending because it was he or she, not me that ordered the consult. Then the psychiatric attending blew them off. Then the IM doctor wouldn't do any changes because they were ignored. The the nurse is upset because she wanted the diet changed and takes it out on the resident. Nurses usually are immune to resident complaints because they're out of the teaching hiearchy.

I decided to just handle diet myself after PGY-1 and tell the attending what I was going to do instead of leaving it up to the attending, who often didn't know what to do. The attending often just said "yes" and that was fine with me.

 

[nancysinatra]

It's uncommon to rare, but sometimes a psychiatrist will have to change a diet out of the norm for psychiatric reasons.

In residency, I typically was in a situation where the diet needed to be modified at least every few weeks. What then happened was there was an attending who did not know what the diet options were. Their attitude was why learn the options when they rarely had to make changes. They saw it as solely IM's responsibility.

So as a first year, and I wanting to get the attending to check off of everything, the attending usually didn't know what was going on with the diet and ordered an IM consult. Them the IM doctor came in, became upset that they were consulted just for diet and took it out on me. I told them they needed to take it up with the psychiatric attending because it was he or she, not me that ordered the consult. Then the psychiatric attending blew them off. Then the IM doctor wouldn't do any changes because they were ignored. The the nurse is upset because she wanted the diet changed and takes it out on the resident. Nurses usually are immune to resident complaints because they're out of the teaching hiearchy.

I decided to just handle diet myself after PGY-1 and tell the attending what I was going to do instead of leaving it up to the attending, who often didn't know what to do. The attending often just said "yes" and that was fine with me.

That is the worst reason for a consult I have ever heard. And I thought I had heard some bad ones... However, I like the response of the IM attending not making any changes because they were blown off. Wish I could walk away every time someone blows me off...

 

[Manicsleep]

When is it appropriate to order a clear liquid diet as a psychiatrist?

Fecal smearing. Oh yeah, it happened.

I have seen that happen for safety reasons although never have gotten the opportunity myself. I hope I never get the 'opportunity' either.

Dangerous/suicidal patient covering the windows/camera in a seclusion/safety room?

 

[whopper]

Wish I could walk away every time someone blows me off...

Attendings could get away with it, at least in that hospital where I did residency.

I didn't blame the medical attendings. To be given a consult because the staff wants the patient on finger food only because that patient is using plastic utensils as shanks is ridiculous. I told the attending, and the attending just waved his hand and said something to the effect of "I'm not dealing with a diet change. Thats internal medicine."

IMHO it was really just an attending trying to blow off responsibility to others. That IM doc IMHO was completely justified in walking away from the consult. Only problem I had with it was I was a resident and just following orders. The nurse should've taken it out on the psychiatry attending but knew she couldn't do that so took the next best target--the resident. Residency was a good way to learn about managing a unit not because some of the attendings were good managers but because they were some of the worst.

But I am digressing from the point of the thread.

 

[nancysinatra]

"I'm not dealing with a diet change. Thats internal medicine."

Isn't that nutrition?

So this is even more off topic, but say a certain attending or unit gets a bad reputation for routinely calling lots of bogus consults, won't that eventually reach the head of the department that they keep calling? In this case, if your attending would call medicine over a diet change, is there anything he WOULDN'T call medicine over? So wouldn't medicine get tired of it and raise some kind of department level complaint against psychiatry?

I would seriously like to write a book just about all the forms of bad behavior in the medical profession. Bogus consults alone would be a whole volume. I bet at one point in history, that attending of yours was interviewing for residencies, and he probably told interviewers how much he cared about "the whole person" and how that made him want to go into psychiatry--and now here is years later turfing diet changes to medicine. Seriously, when will it stop?

 

[Manicsleep]

I agree with nancy.

You go to medical school, you should know how to change a diet. I cover an inpatient unit 1 week a month and I do my own physicals and write all the orders. It really isn't that hard.

Before our group took over they used to have NPs do it. We got the contract and also more money. The NPs were actually citing patient safety.

 

[whopper]

So this is even more off topic, but say a certain attending or unit gets a bad reputation for routinely calling lots of bogus consults, won't that eventually reach the head of the department that they keep calling? In this case, if your attending would call medicine over a diet change, is there anything he WOULDN'T call medicine over? So wouldn't medicine get tired of it and raise some kind of department level complaint against psychiatry?

That's exactly what happened. The psychiatrists all agreed to follow the IM doctor's requests during the meeting.

Then next day, it was business as usual. All the psychiatrists did the same exact thing they did before.

This is what happens when you have a shortage of psychiatrists. When you have a lame one in the department and it's hard to replace him, you're stuck.

I didn't work as an attending where I did residency, but the head of the IM hospitalists kept telling me he wanted me working there because I was the only psychiatrist that seemingly knew not to order an IM consult when someone had a one time BP of 124/83 and thinking it was HTN. When I first started, this hospitalist was my teaching professor. By the time I graduated, we were friends because we had a lot of talks over this issue in the attending lounge while watching a football game. Everytime he brought up his complaints with the psychiatry attendings it fell on deaf ears.

(The above was actually a very in-depth drama...wow it could've been a season on some medical show.)

When I was the chief resident, on more than one occasion, I actually stuck it to some of the attendings "Why are you doing this? The texts say you can't diagnose HTN unless 3 readings were done and they have to be higher than this reading." Reason why I did that was because residents were getting yelled by the IM doctor for the IM consult that the psychiatry attending ordered. The dept head had no problem with that because she had to deal with the same bull for years. She actually supported me and insulated me against attendings not too happy with me challenging their complacency. The nurse managers loved it too because they too were frustrated over that bull.

In the end it didn't get me anywhere other than to let off a lot of steam. The attendings didn't change their ways. Any of the improvements I made in that area helped the symptoms but not the root cause. I was, for example, able to tell residents to not do consults they thought were bull so long as we could find a technicality. (e.g. the Edinburgh scales were done in the maternity ward. Whenever they had a patient that didn't speak English, the nurse still gave them the English test. When the nurse discovered that the patient didn't speak, English, they'd direct the patient to say she was suicidal so a psychiatry resident would have to administer the test in the foreign language. The nurses hated using the translator. What I did was I told the Ob department that we would not do any of the psychiatry consults for (+) Edinburgh tests if the person didn't speak English and a translator wasn't used. That alone cut down the consults by 2-3/day.) If a resident was asked to do one and the above happened, they would simply write down "please do the Edinburgh test in the patient's native language then reconsult us."

The attendings didn't care because it wasn't their time wasted and they usually had residents do that anyway. By the time I was in my last few months of residency, a new department head took over and gave many of the attendings an ultimatim. "I know where I can find new psychiatrists, so follow the rules or you're out." I don't know exactly what happened after I graduated but I did hear plenty of the attendings were doing better jobs after I left.

 

[Majesty]

You guys are buzzkills.
I got to order a clear liquid diet for psyhiatric reasons.

AND THIS IS WHAT THE CONVERSATION EVOLVES INTO???!! (narcissictic injury).

It was pure, it was magical, it was...ruined by SDN.

 

[nancysinatra]

You guys are buzzkills.
I got to order a clear liquid diet for psyhiatric reasons.

AND THIS IS WHAT THE CONVERSATION EVOLVES INTO???!! (narcissictic injury).

It was pure, it was magical, it was...ruined by SDN.

No! It's just circumstantiality, or tangentiality--though not sure which since sometimes the threads come back around, and you never know when!

Hey, it was cool that you got to order a clear liquid diet! What you should do is start a "Firsts In Psychiatry" thread and post it there. Then other people can post their firsts in psychiatry after yours. I have one or two, I think. It would be a thread to keep going over time.