how to build a practice SUPER fast (joke)

[Fan_of_Meehl]

I get plenty of peopled pissed at me for saying that they actually don't have ADHD and feeling alert on stimulants is not diagnostic. Some people have also carved out identities as being "bipolar" when they are clearly not. Fortunately one patient was receptive to being treated as unipolar treatment resistant depression and he got so much better after decades of him barking up the wrong tree.

You're so right. How could I forget ADHD or, the diagnosis de jour these days at VA, TBI--generally, a history of a mild concussion years ago (which the patient and family believe explains all of the dysfunctional behavior and psychiatric symptoms the person has exhibited since that time). I think it's time to 'bring back the stigma' of mental illness.

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[dl2dp2]

Most have been receptive to my explanations though. The thing is, I think even well educated patients, unless you work in medicine, it is hard to tell what is good medicine and what is not (e.g. most don't know how appraise the medical literature or have great knowledge of the pharmacology). Patients primarily know and have to work off, their own personal experiences with the medications.

I agree with that and I don't think these are necessarily contradictory. I've seen numerous well off patients receiving very poor care--because they fell into a trap--spent a ton of money on non-evidence based approach, and come running to me after various episodes of problematic outcomes--very common in substance abuse treatment. I'm simply describing that some marketing strategies can be very effective and sustainable in the long run, whereas others may be successful in the short run, but eventually it'll run afoul.

Opioid use disorder is a very good example. For many years, some of the leading (read most expensive) inpatient treatment programs in the country (Betty Ford, Serenity Malibu) advocated for a detox and drug free treatment program, even after decades of very strong scientific evidence that shows that medication maintenance is absolutely necessary for the vast majority of patients. This battle continues to be ongoing, and the Feds are starting to crack down on what essentially amounts of malpractice. Many overdose events are likely attributable to this practice, including several celebrity overdoses immediately proceeding inpatient stays.

Nevertheless, many of these facilities continue to attract well-off clients due to their existing reputation and connection.

You CAN be wealthy and make a lot of money by practicing bad medicine with good marketing. But I'm advocating that you make a lot of money by practicing GOOD medicine, which in the end is in greater need---I think a lot of people in the community are confused and see that two things are mutually exclusive, but I think in a world where snake oil is everywhere, having a practice of modesty and honesty that is strongly informed by science will get you much farther in the long run.

 

[randomdoc1]

I agree with that and I don't think these are necessarily contradictory. I've seen numerous well off patients receiving very poor care--because they fell into a trap--spent a ton of money on non-evidence based approach, and come running to me after various episodes of problematic outcomes--very common in substance abuse treatment. I'm simply describing that some marketing strategies can be very effective and sustainable in the long run, whereas others may be successful in the short run, but eventually it'll run afoul.

Opioid use disorder is a very good example. For many years, some of the leading (read most expensive) inpatient treatment programs in the country (Betty Ford, Serenity Malibu) advocated for a detox and drug free treatment program, even after decades of very strong scientific evidence that shows that medication maintenance is absolutely necessary for the vast majority of patients. This battle continues to be ongoing, and the Feds are starting to crack down on what essentially amounts of malpractice. Many overdose events are likely attributable to this practice, including several celebrity overdoses immediately proceeding inpatient stays.

Nevertheless, many of these facilities continue to attract well-off clients due to their existing reputation and connection.

You CAN be wealthy and make a lot of money by practicing bad medicine with good marketing. But I'm advocating that you make a lot of money by practicing GOOD medicine, which in the end is in greater need---I think a lot of people in the community are confused and see that two things are mutually exclusive, but I think in a world where snake oil is everywhere, having a practice of modesty and honesty that is strongly informed by science will get you much farther in the long run.

Well said sluox. What I also don't understand is why some providers feel such a pressure to appease people. While benzos and stims can be very effective at keeping coming back, doing a non-evidence based approach imo will create a provider greater headache because it will eventually not turn out well and then you just have a mess to try to clean up. As you've seen in earlier posts, I've been able to successfully build a practice and stick to an evidence based model which I am extremely excited about. I feel like if more providers just stood their ground and became comfortable with saying no, overall the outcomes of patients would be much better and there would be less of a consumer based mentality in medicine. Although we want the patients to be happy with their results, it's not the same as ordering a burger. That and, I have seen some patients who have consulted with two or more psychiatrists prior to seeing me after other providers have said they are not comfortable with just giving them benzo monotherapy. After I tell these patients I agree with their recommendations, they finally seem to start to get it and there is more buy in for the evidence based model and patients become willing to change. More psychiatric providers need to band together to holding our ground!