GP working in adult mental health

[DRZIVAR]

Hello friends I am a newly licensed GP physician who got a job opportunity in rural Georgia to practice medicine in an Adult Mental Health facility. I am new to this field and it has its own challenges. I wanted to see if anyone has the same experience dealing with patients who have been diagnosed with schizophrenia, Bipolar disorders or depression which is majority of what I see here. I want to give patients benefit of the doubt and treat them however I am becoming skeptical if patients are telling me stories that needs to be heard for them to be diagnosed with schizophrenia specially. Diagnosing patients with that obviously is subjective as you have to listen to a patient and if they say they are hallucinating or delusional then it diagnosis has to be made and medications started. Obviously this is the battle in psychiatry where diagnosis modalities are not really there such as xrays and blood tests. I just wanted to see if some other colleagues have been in the same boat and what advise is out there for a new GP here to protect physician and treat patients accordingly.

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[OldPsychDoc]

Sounds as though you're essentially needing to practice psychiatry without the benefit of four year's extensive, specialized training in it. I'd suggest doing what you can to rectify that -- find out if there are some good psych CME events near you--maybe from Emory or one of the S. Carolina programs. (I'm far away from you, but our organization does regular "Psychiatry Update" CME conferences aimed at primary care docs. Hopefully something similar is accessible to you.)
I would also advise you to persistently petition your superiors and request additional training--reminding them that it might be a liability for them if you're practicing beyond the scope of your knowledge.
Thanks for stepping up to the front lines, though.

 

[hamstergang]

Hello friends I am a newly licensed GP physician who got a job opportunity in rural Georgia to practice medicine in an Adult Mental Health facility. I am new to this field and it has its own challenges. I wanted to see if anyone has the same experience dealing with patients who have been diagnosed with schizophrenia, Bipolar disorders or depression

Of course we have experience with those patients as this is a forum for psychiatry residents. On the other hand, you've been through 2 programs (in FM?) but only have a year of credit, and haven't been in clinical medicine for 5 years, right? How can you possibly do this job competently and safely? I know you probably don't have another choice to stay in medicine, but I feel bad for your patients.

 

[notdeadyet]

Hello friends I am a newly licensed GP physician who got a job opportunity in rural Georgia to practice medicine in an Adult Mental Health facility.

Out of curiosity, do you mean that you are someone who completed an internship but did not do a residency?

EDIT: Sorry, replied prior to seeing hamstergang's post...

 

[smalltownpsych]

Hello friends I am a newly licensed GP physician who got a job opportunity in rural Georgia to practice medicine in an Adult Mental Health facility. I am new to this field and it has its own challenges. I wanted to see if anyone has the same experience dealing with patients who have been diagnosed with schizophrenia, Bipolar disorders or depression which is majority of what I see here. I want to give patients benefit of the doubt and treat them however I am becoming skeptical if patients are telling me stories that needs to be heard for them to be diagnosed with schizophrenia specially. Diagnosing patients with that obviously is subjective as you have to listen to a patient and if they say they are hallucinating or delusional then it diagnosis has to be made and medications started. Obviously this is the battle in psychiatry where diagnosis modalities are not really there such as xrays and blood tests. I just wanted to see if some other colleagues have been in the same boat and what advise is out there for a new GP here to protect physician and treat patients accordingly.

Appropriate diagnosis is essential to having the best treatment plan. Without supervised clinical training, you will be severely handicapped in this area. If you have a solid psychologist on staff, that might be someone to talk to about cases as we tend to get a lot of experience and training in diagnostic interviewing, assessment, and case conceptualizing. If they are using a bunch of LPCs as the therapists then probably not much help there as diagnosis is a weak spot of their training. Whatever happens, you don't want to end up diagnosing by unwanted or obnoxious personality traits like the rest of the untrained people in the field. My best advice is to rely on the diagnostic criteria from the DSM5. It has its limitations, of course, but that is the best place to start and help you stay grounded in science. Also, focusing on the physiological signs and symptoms as opposed to the psychological can help. Looking at their movement and affect and emotional reactivity. In my own differentials, I spend a lot of time assessing sleep patterns.

 

[DRZIVAR]

Of course we have experience with those patients as this is a forum for psychiatry residents. On the other hand, you've been through 2 programs (in FM?) but only have a year of credit, and haven't been in clinical medicine for 5 years, right? How can you possibly do this job competently and safely? I know you probably don't have another choice to stay in medicine, but I feel bad for your patients.

 

[sunlioness]

Hello friends I am a newly licensed GP physician who got a job opportunity in rural Georgia to practice medicine in an Adult Mental Health facility. I am new to this field and it has its own challenges. I wanted to see if anyone has the same experience dealing with patients who have been diagnosed with schizophrenia, Bipolar disorders or depression which is majority of what I see here. I want to give patients benefit of the doubt and treat them however I am becoming skeptical if patients are telling me stories that needs to be heard for them to be diagnosed with schizophrenia specially. Diagnosing patients with that obviously is subjective as you have to listen to a patient and if they say they are hallucinating or delusional then it diagnosis has to be made and medications started. Obviously this is the battle in psychiatry where diagnosis modalities are not really there such as xrays and blood tests. I just wanted to see if some other colleagues have been in the same boat and what advise is out there for a new GP here to protect physician and treat patients accordingly.

People tend not to tell you they're delusional.

What they tend to tell you is that the mob is targeting their family and the police aren't responsive.

Or that their apartment is infested, the neighbors are releasing toxins through the air vents, and the landlord is in on it and wants to evict them instead of addressing the problem.

Things of this nature.

Oh, and they will also tell you, "I'M NOT CRAZY!! This is really happening!"


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[DRZIVAR]

Sounds as though you're essentially needing to practice psychiatry without the benefit of four year's extensive, specialized training in it. I'd suggest doing what you can to rectify that -- find out if there are some good psych CME events near you--maybe from Emory or one of the S. Carolina programs. (I'm far away from you, but our organization does regular "Psychiatry Update" CME conferences aimed at primary care docs. Hopefully something similar is accessible to you.)
I would also advise you to persistently petition your superiors and request additional training--reminding them that it might be a liability for them if you're practicing beyond the scope of your knowledge.
Thanks for stepping up to the front lines, though.

I want to thank you for your most positive and helpful answer. I am trying to get some CMEs and go to some events as the program here will fund and support me. I am however having difficulties finding any that is basic enough for me or useful. I am going to one at Carter Center in Atlanta this weekend but do you know of any way I can search for upcoming events and seminars or a website I can check periodically for these events?

 

[sunlioness]

I don't envy your situation.

I'd be really really overwhelmed.


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