For those times when you just need to vent a bit

[Doctor Bagel]

This thread has almost given me a sense of guilt about the fact I'm given a full 30 min for followups in my VA clinic... then I have a week like I had this week. The acuity in my outpatient clinic is off the charts. I'm honestly wondering who is going to snap first... and when they do will it be self-directed violence, or a wife that gets attacked/killed.

I actually feel bad about posting that. It is true that the attendings at my VA did not have schedules that looked particularly busy, but yes, the VA is full of its own hardships. And also full of lots of good doctors.

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[sunlioness]

Can you use vacation to take a day off each week. If you can, take every Wednesday off. That way each day is either the first day back or your last day before time off.

I might run that up the flagpole and see if anyone salutes. Alternately, I think a six hour day would also help a lot. It kinda amounts to the same either way. Either a 32 or 30 hour workweek. I'm not sure if I have the vacation/sick/personal time to cover it. But even if I didn't, it'd be worth the salary cut.

 

[WingedOx]

He's gonna have to get Xanax on the street and he'll have to go to a bad neighborhood for that. And he might get beat up, robbed, or murdered. Do you want that on your conscience, doc?

I had a vet tell me that in residency in a similar situation to yours. Fortunately back then, the suicide thing wasn't in the news as much.

I remember when a bunch of my non medical friends were posting stuff on social media. One of those "share if you agree!" things saying vets should be allowed to see private docs if the VA wait was too long. And I'm like, do out know how many orders of magnitude longer wait it is to see a private psychiatrist?! I was scheduling four months out for a new eval at the time.

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Yeah, I had the exact same thing back in residency told to me about someone's xanax. Not a vet, just a guy who had no insight into the fact that he was taking 10 mg of the stuff per day was a problem. At least from him I know which McDonalds in the city people buy the stuff from.

The media stuff is bad at my place too. We've had this "whistleblower" who's been making claims for the past couple years about wait times, mistreatment, whatever, that all inevitably get investigated, and dismissed when they're shown to be BS. Of course the facts in the cases are considered protected information, but the initial claims all get repeated ad nauseum in the media. So of course our most paranoid or most personality disordered patients all bring them up anytime they don't get what they want.

Also, if I hear one more "The VA just wants to take my guns away..."

 

[WisNeuro]

I remember when a bunch of my non medical friends were posting stuff on social media. One of those "share if you agree!" things saying vets should be allowed to see private docs if the VA wait was too long. And I'm like, do out know how many orders of magnitude longer wait it is to see a private psychiatrist?! I was scheduling four months out for a new eval at the time.

When I was at a private hospital doing neuropsych, our wait list was 4-6 months. At this VA, we are at 3-6 weeks. Sure, go ahead and go see how the private sector works out for wait lists for specialty services.

 

[thoffen]

He's gonna have to get Xanax on the street and he'll have to go to a bad neighborhood for that. And he might get beat up, robbed, or murdered. Do you want that on your conscience, doc?

Hah. Had a patient last year come in requesting Adderall (which unfortunately other providers there had given him in the past), stating, rather correctly I believe, that if he didn't get his Adderall he would just end up in jail. That might have been fine evidence for ADHD, except his evidence of this was court paperwork with the charges of "diversion of controlled substance".

 

[Shikima]

Thankfully I have a good team of therapists (one of the reasons I'm happy here so far) and we're all usually in agreement that me trying to manage these people from just my MedMon clinic is a seriously bad idea, but the patients don't want to show up for therapy, don't want to commit to an IOP or higher level of care, refuse to be admitted, etc. Plus, the splitting and other cluster B bull**** out of these rural vets is off the charts.

Despite this, the line "this is why so many of us kill ourselves!" has been thrown around like candy at a parade any time we do or say something they don't like, despite their frequent non-adherence. One of my therapists yesterday got told that "I'm going to report you to Senator ____ and Fox News!" after we called our second safety check on him in a month after he screamed into the phone that he was suicidal and refused to answer his phone after that.

I've got a guy in his early 30s coming in as my last patient this afternoon who is already loaded up on opiates because of chronic back pain. Still refuses to go to the vet center for therapy, then spends the whole half hour frustrated at me because I won't start him on xanax. "So what are vets who are in pain and anxious supposed to do!? Are you supposed to just let us suffer!?"

Happens in PP too. ;-(

 

[sunlioness]

So, I can't get out any earlier. But I can use PTO time to take weds off, but not until May 18 because that's when my schedule opens up. I'm not sure why I need to be here if my schedule is opened up. But whatever. The fact that I have repeatedly said I'm burned out doesn't seem to register. My numbers don't justify being burned out. And if I cared more, I'd feel better.

Yesterday I saw a patient in her 70s who hadn't been seen by a doc here in over a year. I'd never seen her before and she was on my schedule for fifteen minutes. She was a bit late. She was a very poor historian and didn't seem to entirely know why she was there. But eventually she told a story about how she's on Xanax 1mg QID and Restoril 30mg at HS prescribed by her primary. He cut her off a bit ago and she was a mess. He apparently realized he was "wrong", apologized, and restarted the meds. The patient states that she guesses she's here in case he ever does that again, she'll just get them filled here.

In the course of the visit, she mentioned that she's struggling with her memory and she falls a lot.

What did I do about it?

Nothing.

I did nothing. :-(

Hey, that was nice. As I was typing this just now a random patient I don't know stood in my doorway and cackled at me.

Charming.


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[smalltownpsych]

So, I can't get out any earlier. But I can use PTO time to take weds off, but not until May 18 because that's when my schedule opens up. I'm not sure why I need to be here if my schedule is opened up. But whatever. The fact that I have repeatedly said I'm burned out doesn't seem to register. My numbers don't justify being burned out. And if I cared more, I'd feel better.

Yesterday I saw a patient in her 70s who hadn't been seen by a doc here in over a year. I'd never seen her before and she was on my schedule for fifteen minutes. She was a bit late. She was a very poor historian and didn't seem to entirely know why she was there. But eventually she told a story about how she's on Xanax 1mg QID and Restoril 30mg at HS prescribed by her primary. He cut her off a bit ago and she was a mess. He apparently realized he was "wrong", apologized, and restarted the meds. The patient states that she guesses she's here in case he ever does that again, she'll just get them filled here.

In the course of the visit, she mentioned that she's struggling with her memory and she falls a lot.

What did I do about it?

Nothing.

I did nothing. :-(

Hey, that was nice. As I was typing this just now a random patient I don't know stood in my doorway and cackled at me.

Charming.


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Aha! That's the solution. You just need to get better at doing nothing. If you hadn't been trying to help your patients, you wouldn't have become so burned out. It is amazingly clear how the system is set up to ensure sub-standard care.

 

[erg923]

So, I can't get out any earlier. But I can use PTO time to take weds off, but not until May 18 because that's when my schedule opens up. I'm not sure why I need to be here if my schedule is opened up. But whatever. The fact that I have repeatedly said I'm burned out doesn't seem to register. My numbers don't justify being burned out. And if I cared more, I'd feel better.

Yesterday I saw a patient in her 70s who hadn't been seen by a doc here in over a year. I'd never seen her before and she was on my schedule for fifteen minutes. She was a bit late. She was a very poor historian and didn't seem to entirely know why she was there. But eventually she told a story about how she's on Xanax 1mg QID and Restoril 30mg at HS prescribed by her primary. He cut her off a bit ago and she was a mess. He apparently realized he was "wrong", apologized, and restarted the meds. The patient states that she guesses she's here in case he ever does that again, she'll just get them filled here.

In the course of the visit, she mentioned that she's struggling with her memory and she falls a lot.

What did I do about it?

Nothing.

I did nothing. :-(

Hey, that was nice. As I was typing this just now a random patient I don't know stood in my doorway and cackled at me.

Charming.


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This place sounds like the twilight zone. What do your supervisors/medical director think about the outcomes of the patients they are serving. Who tracks this?

 

[smalltownpsych]

This place sounds like the twilight zone. What do your supervisors/medical director think about the outcomes of the patients they are serving. Who tracks this?

Methinks you may have spent too much time in a government healthcare organization that actually has some accountability.

 

[sunlioness]

The only thing I know for sure that they track is doctors' utilization and whether the notes are time stamped.

My next intake is here. I read the initial assessment. The only thing that helps him is Xanax, so that'll make things easier.

Sigh.

I really don't want to get yelled at or get into an argument today. I really don't. But I'm not giving Xanny to a guy who drinks to fall asleep every night. I haven't sunk quite that low yet.

Edited: though apparently I've sunk low enough to refer to it as "Xanny".


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[smalltownpsych]

The only thing I know for sure that they track is doctors' utilization and whether the notes are time stamped.

My next intake is here. I read the initial assessment. The only thing that helps him is Xanax, so that'll make things easier.

Sigh.

I really don't want to get yelled at or get into an argument today. I really don't. But I'm not giving Xanny to a guy who drinks to fall asleep every night. I haven't sunk quite that low yet.

Edited: though apparently I've sunk low enough to refer to it as "Xanny".


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Yup. All they care about is that you are generating revenue and no one cares about patient outcomes in community mental health. From what I have seen, they don't even track patients who commit suicide, not to mention any other marker of patient outcome such as rehospitalization, incarceration, employment.

 

[WingedOx]

Yup. All they care about is that you are generating revenue and no one cares about patient outcomes in community mental health. From what I have seen, they don't even track patients who commit suicide, not to mention any other marker of patient outcome such as rehospitalization, incarceration, employment.

It's not like places actually give you the resources to do anything about those metrics though.

 

[smalltownpsych]

It's not like places actually give you the resources to do anything about those metrics though.

From what I have seen, it is less about resources and more about unhealthy system dynamics. One of those problematic dynamics is constantly claiming that lack of resources is the problem. That is how "they" justify treating the employees like crap and paying them crap wages which leads to patients being treated like crap which leads to crappy outcomes.

 

[WingedOx]

From what I have seen, it is less about resources and more about unhealthy system dynamics. One of those problematic dynamics is constantly claiming that lack of resources is the problem. That is how "they" justify treating the employees like crap and paying them crap wages which leads to patients being treated like crap which leads to crappy outcomes.

Depends on who they're trying to blame. It's not my fault that I can't keep someone from being incarcerated unless I can access wraparound services for them. At my current job I can. I have my doubts about where @sunlioness is at, particularly since my impression of it is that her hospital is basically running on medicaid alone (I correctly guessed where she was a few months ago)

 

[smalltownpsych]

Depends on who they're trying to blame. It's not my fault that I can't keep someone from being incarcerated unless I can access wraparound services for them. At my current job I can. I have my doubts about where @sunlioness is at, particularly since my impression of it is that her hospital is basically running on medicaid alone (I correctly guessed where she was a few months ago)

Aha! "who they're trying to blame" another common unhealthy dynamic in these systems. Just having a bit of fun with this and not implying in any way that you are demonstrating these dynamics. I have always been interested in system dynamics though and it seems that CMHs are some of the best examples to study. I also find it fascinating how school systems can so effectively stamp out the human drive to learn at such an early age.

 

[thoffen]

Edited: though apparently I've sunk low enough to refer to it as "Xanny".

So long as the dose is in "bars", then I'm cool with that.

 

[sunlioness]

It was! Two bars twice a day is what he needed. He's a big guy, you see.

But today is my birthday. And I'm off until Monday and going to visit old college friends.

Life is good.


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[birchswing]

@sunlioness Happy birthday!

Not responding to anyone in particular but about the VA: I don't completely get the VA.

So, when you're in the military, you get military healthcare through military facilities, right?

If you serve a normal term, you can retire and get insurance you can use anywhere after retirement, right?

Is the VA then just for people who were in the military but not long enough to retire?

If so, it seems weird to have a separate system. We already have so many. The military has its own already (I think it's called Tricare). And then we have Medicaid (the availability of which depends on your state), and we have Medicare.

People seem to not like socialized medicine. But it seems like we not only have it, but we have a lot of socialized systems. I hear how the VA is failing. Is there a reason not to transition vets into one of the existing socialized systems that isn't failing? For example, Medicare seems to be fairly well liked and there seem to be a lot of providers.

 

[splik]

the VA is a healthcare system not an insurance system. The VA will sometimes take active duty veterans in emergency situations, if they can't take the patient for some reason (for example they don't have the space or don't offer the service, or aren't able to provide the needed care in a timely manner etc). Many veterans treated at the VA are in the reserves. The VA treats veterans - basically anyone who was discharged from the military with anything other than an dishonorable discharge. You have tricare. Older veterans, or veterans with ESRD or on SSDI will have medicare and often choose to receive some or all of their care through the VA. The VA will bill insurance companies including medicare if patients have insurance. Veterans may have to pay some costs if they are not receive service-connected disabilities, and sometimes they may only be eligible for care for specific problems. For example I treated a patient who could only receive treatment for PTSD through the VA (this is quite unusual) though. Also veterans with service connected disabilities might prefer to get their care through the VA as they don't have to pay for stuff, whereas if they went elsewhere or used their medicare they would have to pay for prescriptions etc. Many veterans have a positive institutional transference and feel comfortable at the VA. Many of the employees at the VA are veterans themselves. I was surprised how many times I would be asked if I was a veteran but it was because patients knew often the healthcare providers there are. the VA has a lot of problems but it isn't failing - it is just that the care of veterans is so politically charged that the organization is often prone to the whims and fancies of the moment, and congress reacts with legislation to non-problems etc. Personally I think the VA is a better than Medicare though they are not the same, I don't really think of medicare as socialized healthcare at all, whereas the VA is one of the purest forms of socialized medicine anywhere in the world. There are obviously veterans who really do not like the VA and will go elsewhere. I have treated a few patients with PTSD outside of the VA (one had been raped and found it too traumatizing to be in the VA's mental health clinic, another was paranoid, and another was referred through the VA as he needed specialized care not available at the local VA).

 

[WisNeuro]

What splik said. Also, the VA is not "failing." At least by any measurable standard. Actually, when you look at clinical outcomes research (which, admittedly, all of healthcare does a terrible job at) they actually outperform the private sector.

 

[Shikima]

What splik said. Also, the VA is not "failing." At least by any measurable standard. Actually, when you look at clinical outcomes research (which, admittedly, all of healthcare does a terrible job at) they actually outperform the private sector.

Based on which metric?

The one metric that I'm interested in which cannot be measured is the quality of outcomes and sustained remission.

 

[WisNeuro]

Based on which metric?

The one metric that I'm interested in which cannot be measured is the quality of outcomes and sustained remission.

Various metrics, some meta-analyses have to do with risk and mortality following various surgical procedures, mostly cardiac and orthopedic. Lots pf data on preventative medical services. Better rates of controlling inappropriate medication prescription in the elderly. Better outcomes for nursing home settings in the VA compared to private. The mental health literature is lacking in general in this country. What little exists focuses mainly on antidepressant medications and schizophrenia care.

 

[notdeadyet]

A few points of clarification:

Many veterans treated at the VA are in the reserves.

The only reservists eligible for VA care are those who have deployed.

The VA treats veterans - basically anyone who was discharged from the military with anything other than an dishonorable discharge.

This is mostly semantics, but I want to clarify because it propagates a myth: being an honorably discharged veteran does not qualify you for VA services.

All veterans of active duty are eligible for VA care for a couple years after conclusion of service. But beyond that, veterans are only eligible if they have injuries or illnesses that started or were exacerbated by their military service.

I mention this because folks seem to assume that anyone who served can get VA care which isn't the case.

Veterans may have to pay some costs if they are not receive service-connected disabilities, and sometimes they may only be eligible for care for specific problems. For example I treated a patient who could only receive treatment for PTSD through the VA (this is quite unusual) though.

Veterans with a low service connection are sometimes eligible only for the condition they are service connected for.

This used to be quite common, but less so with the gaming of the service connection system that's gotten a lot more widespread.

 

[smalltownpsych]

Based on which metric?

The one metric that I'm interested in which cannot be measured is the quality of outcomes and sustained remission.

The one VA that I worked at (I know, if you've seen one VA, then you've seen one VA) had a broad range of solid mental health services that far exceeded what I have seen at various community mental health settings. As far as outcome goes it's hard to compare when most of what I saw the VA offering barely exists outside of that setting. What I saw at the VA was excellent programs and services being coordinated and psychologists playing a leading role in that. We should compare some of this stuff though because I think it would speak to the efficacy of psychologists in these roles.

 

[Shikima]

The one VA that I worked at (I know, if you've seen one VA, then you've seen one VA) had a broad range of solid mental health services that far exceeded what I have seen at various community mental health settings. As far as outcome goes it's hard to compare when most of what I saw the VA offering barely exists outside of that setting. What I saw at the VA was excellent programs and services being coordinated and psychologists playing a leading role in that. We should compare some of this stuff though because I think it would speak to the efficacy of psychologists in these roles.

I don't think any one would disagree. The VA does a good enough job with wrap around services and is attempting to improve them constantly. CMH could learn a thing or two from them. PP is far too individualized.

 

[JKinSC]

All veterans of active duty are eligible for VA care for a couple years after conclusion of service. But beyond that, veterans are only eligible if they have injuries or illnesses that started or were exacerbated by their military service.

I mention this because folks seem to assume that anyone who served can get VA care which isn't the case.

I did want to chime in on this one; it's not necessarily quite so cut and dry, as far as active duty vets go. I got out ~100 years ago, with no disability, and have been using the VA for primary care since starting med school. I have had to fill out paperwork showing that I had no money for 4 years (means testing), but aside from time spent filling out forms and such, it has cost me nothing.

 

[WingedOx]

I tell my patients "the first mistake that anyone can make when dealing with the VA benefits office is assuming what they do makes any sense".

 

[WingedOx]

Oh wonderful. Brand new intake coming to me from the private sector on QID xanax + adderall.

 

[vistaril]

Excellent thread going on here......I've made no secret about the fact that my ideal job would be a VA job. Unless you have the sweetest possible setup possible, I don't think it's possible to beat most VA jobs. In terms of workload, schedule, salary(when considering the workload and benefits!!!!). In most cases, I don't think it's even possible for other jobs to come close. From the VAs I've seen, one is literally getting 3+ times as much compensation per patient(or alternatively 4-5x as much compensation if done in terms of per clinical minute since VA appts tend to be scheduled or 30 min followups) when everything(student loan assistance, benefits, vacation, etc) is considered.

One problem is that there is a lot of variability in VA salaries from one system to another. But even at the very lowest ends of VA pay(165-170ish I believe now), it's still a good deal. At 230-240 or whatever(plus all the other goodies), it's the best deal by far.

The problem is some people are geographically limited. I need to be in a very specific area, and the job market here is not ideal. I'm not really working much right now in mental health(about 10-12 hrs per week only) because I simply refuse to take a lot of these 'bad' jobs. I realize I could start my own practice, but the numbers there don't seem very appealing to me. And quite frankly even if they did the nature of the work doesn't either. If I'm going to do outpt I'd much rather do outpatient for the VA than in private practice.

So the re business is where most of my time goes, and it certainly isn't doing well. I'm putting a lot of hours into it and i am interested in it and the possibilities there, but haven't made any money doing it yet. We'll see but I don't anticipate that turning around this year. I'll do well on one and then the gains I made there have to be put towards an equal loss on another.

 

[vistaril]

Oh wonderful. Brand new intake coming to me from the private sector on QID xanax + adderall.

that certainly sounds like the real world in the private sector....what you have to remember is that if that provider switched places with you(and was working in the VA system) he almost certainly would have never written that(or that much depending on the VA) in the first place. Thats just the way it works. It doesn't neccessarily make VA psychs better or more responsible- in most cases they know there bread is just buttered in a different way. And so they respond accordingly.

I've done private practice non-SMI outpt and I'm hoping to get a VA job....and I can tell you without a doubt that my prescribing habits will be *very* different at the VA as compared to outpt pp. And nothing else(in terms of my knowledge, training, etc) will have changed. Thats just the way it is.

 

[notdeadyet]

I've done private practice non-SMI outpt and I'm hoping to get a VA job....and I can tell you without a doubt that my prescribing habits will be *very* different at the VA as compared to outpt pp. And nothing else(in terms of my knowledge, training, etc) will have changed. Thats just the way it is.

So you're saying that how you approach your prescription of controlled substances is based on whether or not you are financially incented to prescribe inappropriately?

 

[clausewitz2]

So you're saying that how you approach your prescription of controlled substances is based on whether or not you are financially incented to prescribe inappropriately?

Surely that's why everyone else does...

 

[birchswing]

Surely that's why everyone else does...

You should never discount the tragic effects of ignorance.

 

[WingedOx]

Dear PCP, did you seriously start my 81 year old patient on TID xanax?

 

[sunlioness]

Today there was some sort of fist fight type thing going on in the hallway. I think it was patient on patient? I couldn't really tell from my vantage point. Which was behind a locked door peeking out a window from behind blinds.


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[thoffen]

Dear PCP, did you seriously start my 81 year old patient on TID xanax?

Yeah. Seriously. Half-life is too short. Need to bump it to QID.

 

[sunlioness]

Case manager: this patient you saw one time a while ago is on dialysis and they say her psych meds are making her blood pressure drop during her treatments. They say you need to adjust them.

*peeks at chart. Patient is on Zoloft 50mg.*

Me: No.

Case manager: what should I tell them?

Me: to manage her hypotension.

Damn, I'm getting bitchy. At least I left the f-bomb I was thinking out.


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[sunlioness]

Both brintellix and trintellix make me think of Skrillex. And that makes me want to dance.


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[vistaril]

So you're saying that how you approach your prescription of controlled substances is based on whether or not you are financially incented to prescribe inappropriately?

no, the differences in the setting are broader than just that.

 

[WingedOx]

Both brintellix and trintellix make me think of Skrillex. And that makes me want to dance.


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I'm just playing the new Radiohead song on a loop in my office.

 

[WisNeuro]

Dear PCP, did you seriously start my 81 year old patient on TID xanax?

Welcome to my world when I get patients transferred in from outside PCP's and providers are wondering why they have an increase in memory difficulties and balance problems.

 

[WingedOx]

Welcome to my world when I get patients transferred in from outside PCP's and providers are wondering why they have an increase in memory difficulties and balance problems.

probably 70% of the stresses of my job as a psychiatrist are related to patients taking or asking for controlled substances.

I was thinking about why it's been such a problem where I'm at now on the drive home. I was trying to work through my countertransferences and asking "why does it seem like my white patients are so much needier than the others?" I work right on the border of where city meets suburbia so I have a pretty diverse mix of urban/suburban/rural and black/white/hispanic, and I don't have the same patients screaming at me and playing the victim card who live on the city side of the line despite way higher levels of poverty on that side. Then I remembered what it was like when I was working in the center of the city. All my patients back then knew where to score what I was prescribing if I wasn't giving it to them. Hell, I pass a McDonalds about half way down my commute every day that has been known for years as a place to buy benzos. For my suburban/rural patients if the patients want something, they're pretty much only able to get it from me. There's no alternative if I tell them, "this benzo/opiate combination isn't a good idea, and it isn't helping your anxiety anyway, so it's time for a taper". At my last job they could just buy some from people selling in the hospital lobby.

 

[MacDonaldTriad]

Maybe it isn’t so surprising that your suburban Caucasian patients are less connected to the drug subculture as compared to you more urban customers. I have been tempted to add a socialization training / orientation mixer to our list of services. That way they can exchange ideas like; “look, it is meth at the Jack in the Box, the heroine is at the car wash. Jeezzz, where have you been?” It might take the pressure off you to break out the script pad.

 

[WingedOx]

Dude comes in as an intake who's manic as all hell, not sleeping, so circumstantial that my appointment takes an additional half hour and I still didn't get close to doing all the usual screening questions. Previous psychiatrist RIP. He's asking for someone to continue his previous 20 mg QID methylphenidate prescription, that his wonderful previous psychiatrist "who was a total genius and a leader in the field of psychiatry" had him on.

I look up the previous psychiatrist. He's a former AOA true believer who's published a nice chunk of whackadoodle studies about OMM in psychotic and affective disorders.

 

[sunlioness]

Dude comes in as an intake who's manic as all hell, not sleeping, so circumstantial that my appointment takes an additional half hour and I still didn't get close to doing all the usual screening questions. Previous psychiatrist RIP. He's asking for someone to continue his previous 20 mg QID methylphenidate prescription, that his wonderful previous psychiatrist "who was a total genius and a leader in the field of psychiatry" had him on.

I look up the previous psychiatrist. He's a former AOA true believer who's published a nice chunk of whackadoodle studies about OMM in psychotic and affective disorders.

Posts like this are why SDN needs a "Wow" button like Facebook has.

 

[Ceke2002]

Dude comes in as an intake who's manic as all hell, not sleeping, so circumstantial that my appointment takes an additional half hour and I still didn't get close to doing all the usual screening questions. Previous psychiatrist RIP. He's asking for someone to continue his previous 20 mg QID methylphenidate prescription, that his wonderful previous psychiatrist "who was a total genius and a leader in the field of psychiatry" had him on.

I look up the previous psychiatrist. He's a former AOA true believer who's published a nice chunk of whackadoodle studies about OMM in psychotic and affective disorders.

Methylphenidate to treat mania? Okay I'm not a Doctor and even I'm sitting here going I mean as far as I know prescribing a stimulant for mania isn't the same as prescribing a stimulant for something like ADHD.

 

[MLT2MT2DO]

Dude comes in as an intake who's manic as all hell, not sleeping, so circumstantial that my appointment takes an additional half hour and I still didn't get close to doing all the usual screening questions. Previous psychiatrist RIP. He's asking for someone to continue his previous 20 mg QID methylphenidate prescription, that his wonderful previous psychiatrist "who was a total genius and a leader in the field of psychiatry" had him on.

I look up the previous psychiatrist. He's a former AOA true believer who's published a nice chunk of whackadoodle studies about OMM in psychotic and affective disorders.

Buttholes like this are the ones that hold AOA leadership positions and continue to make the degree feel like a substandard product. The further I seperate myself from these jokers the more i feel like a "real" professional.



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[clausewitz2]

Maybe it isn’t so surprising that your suburban Caucasian patients are less connected to the drug subculture as compared to you more urban customers. I have been tempted to add a socialization training / orientation mixer to our list of services. That way they can exchange ideas like; “look, it is meth at the Jack in the Box, the heroine is at the car wash. Jeezzz, where have you been?” It might take the pressure off you to break out the script pad.

Sounds like a free overnight in the county lockup might do the job nicely.

 

[WingedOx]

Buttholes like this are the ones that hold AOA leadership positions and continue to make the degree feel like a substandard product. The further I seperate myself from these jokers the more i feel like a "real" professional.

Turns out he was a former vice executive of the AOA, and former dean of a rather prominent DO school back in the '80s too. Also a big published advocate for increasing AOA postgraduate training because having DOs in ACGME residencies "dilutes the osteopathic profession and takes away our uniqueness".

Methylphenidate to treat mania? Okay I'm not a Doctor and even I'm sitting here going I mean as far as I know prescribing a stimulant for mania isn't the same as prescribing a stimulant for something like ADHD.

The patient claimed that it was for "ADHD", though he's never actually had symptoms of inattention. He did say it made him feel "great" and allow him to work 16 hour days though...