surftheiop

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Sorry if this is a dumb question, but something I was wondering about. I know all these questions and more will be answered in the next couple of years of medschool, but the internet provides answers so much faster!

In general do "normal" practicing psychiatrists do any sort of physical exams? I feel like I've seen several psychiatrists walking around hospital with stethoscopes which made me wonder.

But all of the psychiatrists I've shadowed/worked with were kind of "special cases" in that one was triple boarded peds/psych/C&A so would do some general peds stuff as part of appointments and the other was an academic research psychiatrist so would do part of the physical for research subjects.

Are there certain branches that might have some "hands on" component?
Do psychiatrists maybe do some form of a neurological exam on occasion?
 

masterofmonkeys

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Plenty of psychiatrists do physical exams. It's not unheard of for inpt psychiatrists to do to their own physicals. It's also not uncommon for CL docs to do the same. Good neuro exam skills are of pretty large importance, i'd say, although maybe not on a day to day basis. EPS, especially dystonia and parkinsonism can sometimes be subtle in initial presentation. Wernicke's encephalopathy has raised its ugly head in the EtOH abuse population in psych wards on more than one occasion. NPH in an elderly decompensating schizophrenic. It can also help in some dementias (such as diffuse lewy body dz, Korsakoff's, alzheimer's variants, etc).

Interventional pain is technically a psych subspecialty, and that is of course very hands on...and very competitive especially for psych. This may be one good thing to come out of medicare cuts is that it will no longer be sought after for its earning potential. Assuming I pull it off, I hope to do both procedures and psychotherapy with my patients, and honestly am hoping to do more of the latter than the former.
 

Red Beard

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PES and C/L attendings: I've seen them do cursory physical exams.

Inpatient ward and outpatient general pyschiatrists: Never seen one do a physical. They may do it occasionally, but I've never seen it.
 

digitlnoize

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The inpatient unit I was on had an NP who came in and did physicals on the patients. The psych docs didn't have to, which isn't to say they didn't address medical issues (I.e. Hypothyroidism) because they did.
 
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In general do "normal" practicing psychiatrists do any sort of physical exams? I feel like I've seen several psychiatrists walking around hospital with stethoscopes which made me wonder.

Are there certain branches that might have some "hands on" component?
Do psychiatrists maybe do some form of a neurological exam on occasion?
Yes. AIMs for pts on neuroleptics. Brief, focused cardiac/neuro exams for certain pts. Bread and butter medical stuff.
 

whopper

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This is an issue that has not been formalized and is somewhat grey. Some texts and people of authority in the field are of the opinion that psychiatrists should not do physical examinations because it crosses boundary violations.

That written, in many specific scenarios we need to them. E.g. someone has cuts on their wrist, even in outpatient, I should take a look at them. In emergency and C & L psychiatry, physical exams are very important. Some may argue that the primary care doctor's physical exam should be enough. Bullspit. I've had several patients in emergency psychiatry where once the emergency room doctor found just one mental health issue he dumped the patient to psychiatry and checked off that everything was physically fine in the patient, even if they had broken legs, a visably palpable liver, erythema on the skin (that later turned out to be MRSA) etc. In emergency psychiatry, a physical examination IMHO is a must.

In outpatient, the patients are, for all intents and purposes, medically stable (physically speaking) and medical issues are not acute. In these cases, physical exams may not be needed as often if at all. In outpatient, I'd only do a physical exam if I believed there was something specific I should be looking for. E.g. the person has a history of self-mutilation. In those cases, I'll only inspect what I need to inspect (e.g. the forearms). Many insurance providers will not cover a doctor for nonpsychiatric medical care.

In outpatient, the doctor-patient relationship is more intimate. In that setting, you could have a patient for possibly years, even decades. You may have to see them several times in one week. In these settings, I get the boundary violation philosophy with physical exams. In inpatient it's different. the doctor usually only sees the patient once to a days.
 

Manicsleep

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I (and my colleagues) do a physical exam on every inpatient admission.

There are no therapeutic boundaries there. You are stabilizing them and sending them forward to a PHP, day program or their outpatient psychiatrist. If that outpatient psychiatrist is you, then you just have a colleague do the exam.