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Is it ok to take a mental health day off from residency?

NVO

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      Hey for all you worrying that your program will kick you out for taking too many mental health days you can always get kicked out of residency and go open up a private practice charging 300 bucks an hour.

      Dang look at all the students she has to do her work!
       

      BoardingDoc

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        Hey for all you worrying that your program will kick you out for taking too many mental health days you can always get kicked out of residency and go open up a private practice charging 300 bucks an hour.
        ROFL, she lists herself as one of "Medscape's physicians of the year for 2016."

        This is the link for medscape which describes her as one of the two docs who is "neither the best nor the worst" because her lawsuit was still pending at that time.
        Medscape: Medscape Access (click forward one slide to see her).
         
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        Wordead

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          I think Item 3 is the most egregious and is enough to get even a model resident in huge trouble, let alone one that's already struggling.



          I think what some of you are missing in this case is the egregiousness of some of her actions as it pertains to psychiatry and her painful lack of insight into her own deficiencies. If you read the entire testimony, you will find that this resident was remediated multiple times. Over and over again, she made the same mistakes and even worse, she had no insight into the fact that they WERE mistakes, which is really career damaging in psychiatry. I'm not just talking about missing grand rounds. If you read the documents, there were multiple errors that she made and multiple times when she was reportedly less than honest about things and when confronted she had no idea that what she did was wrong. That's a problem, especially in a field where you're entrusted with helping patients gain insight into their own behaviors.

          If you want more detail on this case, check out Operman's post with the attached documents in this thread (and by the way, when the story first came out, I was outraged that she was terminated and believed that her program had targeted her on purpose, but in reading the documents, it's clear that isn't what happened).


          This resident would have been terminated with or without time off.

          In my 5 years of residency I've restrained like, a million agitated patients so Im a little confused - why's it so bad for a psych resident to do that?
           

          rokshana

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            In my 5 years of residency I've restrained like, a million agitated patients so Im a little confused - why's it so bad for a psych resident to do that?
            Really? I have ordered restraints plenty of times but have only helped once (as an intern that happened to be in the room) when 4 nurses were trying to tie the pts restraints...is it common that residents get called to restrain pts?
             

            Merely

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              Really? I have ordered restraints plenty of times but have only helped once (as an intern that happened to be in the room) when 4 nurses were trying to tie the pts restraints...is it common that residents get called to restrain pts?

              No residents don’t restrain patients lol
               

              dpmd

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                In my 5 years of residency I've restrained like, a million agitated patients so Im a little confused - why's it so bad for a psych resident to do that?
                Restraining a medically confused patient is a totally different thing than restraining a psych patient, legally speaking. So comparing what they do to those times that we grab grandma's arm and tie a soft restraint around it because it came undone or the less legal but still relatively easy taping down the forehead (or c collar) of a uncooperative drunk trauma patient while you get some imaging is not equivalent. I have been the one to start tying someone down also, but it is for medical reasons and they have all been lying down. Not the same as taking down a mentally disturbed individual and putting them in leathers.
                 

                Wordead

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                  You have? Are you trained to put your hands on patients for a physical restraint? Solo?

                  No I never did it solo I suppose more as an extra pair of hands to hold someone down and put the restraints on - like one person on each arm. But yeah Ive done it. Am I trained? No I suppose Ive never done a module on it.

                  But whys that such a no no? Like I feel Im missing something big like it's a huge violation of something but I cant quite grasp it.
                   

                  Mass Effect

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                    No I never did it solo I suppose more as an extra pair of hands to hold someone down and put the restraints on - like one person on each arm. But yeah Ive done it. Am I trained? No I suppose Ive never done a module on it.

                    But whys that such a no no? Like I feel Im missing something big like it's a huge violation of something but I cant quite grasp it.

                    Are you a psych resident? I'm going to guess no. As stated above, it's entirely different restraining psych patients for several reasons, including safety and the law. And you never, ever, ever, ever, ever, ever do it alone.
                     

                    calvnandhobbs68

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                      No I never did it solo I suppose more as an extra pair of hands to hold someone down and put the restraints on - like one person on each arm. But yeah Ive done it. Am I trained? No I suppose Ive never done a module on it.

                      But whys that such a no no? Like I feel Im missing something big like it's a huge violation of something but I cant quite grasp it.

                      So no you're violating joint commission standards and you and the hospital could get in quite a bit of trouble if anyone found out you had been doing this and had never been trained on safe restraints and physical holds. This doesn't matter if it's a psychiatric patient or a non-psychiatric patient, this generally applies to all restraints. It's also a requirement of CMS conditions of participation, which ultimately can result in termination of federal funding...so if it's you or that, they'll dump your ass real fast.

                      Joint Commission Standard
                      Standard PC.03.05.17: The [organization] trains staff to safely implement the use of restraint or seclusion.

                      Joint Commission Element of Performance
                      1. The hospital trains staff on the use of restraint and seclusion, and assesses their competence, at the following intervals:
                      – At orientation
                      – Before participating in the use of restraint and seclusion
                      – On a periodic basis thereafter
                      2. Based on the population served, staff education, training, and demonstrated knowledge focus on the following:
                      – Strategies to identify staff and patient behaviors, events, and environmental factors that may trigger circumstances that require the use of restraint or seclusion
                      – Use of nonphysical intervention skills
                      – Methods for choosing the least restrictive intervention based on an assessment of the patient’s medical or behavioral status or condition
                      – Safe application and use of all types of restraint or seclusion used in the hospital, including training in how to recognize and respond to signs of physical and psychological distress (for example, positional asphyxia)
                      – Clinical identification of specific behavioral changes that indicate that restraint or seclusion is no longer necessary
                      – Monitoring the physical and psychological well-being of the patient who is restrained or secluded, including, but not limited to, respiratory and circulatory status, skin integrity, vital signs, and any special requirements specified by hospital policy associated with the in-person evaluation conducted within one hour of initiation of restraint or seclusion
                      – Use of first-aid techniques and certification in the use of cardiopulmonary resuscitation, including required periodic recertification (See also PC.03.05.07, EP 1)
                      3. Individuals providing staff training in restraint or seclusion have education, training, and experience in the techniques used to address patient behaviors that necessitate the use of restraint or seclusion.
                      4. The hospital documents in staff records that restraint and seclusion training and demonstration of competence were completed.
                       

                      Wordead

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                        So no you're violating joint commission standards and you and the hospital could get in quite a bit of trouble if anyone found out you had been doing this and had never been trained on safe restraints and physical holds. This doesn't matter if it's a psychiatric patient or a non-psychiatric patient, this generally applies to all restraints. It's also a requirement of CMS conditions of participation, which ultimately can result in termination of federal funding...so if it's you or that, they'll dump your ass real fast.

                        Joint Commission Standard
                        Standard PC.03.05.17: The [organization] trains staff to safely implement the use of restraint or seclusion.

                        Joint Commission Element of Performance
                        1. The hospital trains staff on the use of restraint and seclusion, and assesses their competence, at the following intervals:
                        – At orientation
                        – Before participating in the use of restraint and seclusion
                        – On a periodic basis thereafter
                        2. Based on the population served, staff education, training, and demonstrated knowledge focus on the following:
                        – Strategies to identify staff and patient behaviors, events, and environmental factors that may trigger circumstances that require the use of restraint or seclusion
                        – Use of nonphysical intervention skills
                        – Methods for choosing the least restrictive intervention based on an assessment of the patient’s medical or behavioral status or condition
                        – Safe application and use of all types of restraint or seclusion used in the hospital, including training in how to recognize and respond to signs of physical and psychological distress (for example, positional asphyxia)
                        – Clinical identification of specific behavioral changes that indicate that restraint or seclusion is no longer necessary
                        – Monitoring the physical and psychological well-being of the patient who is restrained or secluded, including, but not limited to, respiratory and circulatory status, skin integrity, vital signs, and any special requirements specified by hospital policy associated with the in-person evaluation conducted within one hour of initiation of restraint or seclusion
                        – Use of first-aid techniques and certification in the use of cardiopulmonary resuscitation, including required periodic recertification (See also PC.03.05.07, EP 1)
                        3. Individuals providing staff training in restraint or seclusion have education, training, and experience in the techniques used to address patient behaviors that necessitate the use of restraint or seclusion.
                        4. The hospital documents in staff records that restraint and seclusion training and demonstration of competence were completed.

                        Huh. Well, good to know. Wont be doing that again.
                         
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                        Mass Effect

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                          So no you're violating joint commission standards and you and the hospital could get in quite a bit of trouble if anyone found out you had been doing this and had never been trained on safe restraints and physical holds. This doesn't matter if it's a psychiatric patient or a non-psychiatric patient, this generally applies to all restraints. It's also a requirement of CMS conditions of participation, which ultimately can result in termination of federal funding...so if it's you or that, they'll dump your ass real fast.

                          Joint Commission Standard
                          Standard PC.03.05.17: The [organization] trains staff to safely implement the use of restraint or seclusion.

                          Joint Commission Element of Performance
                          1. The hospital trains staff on the use of restraint and seclusion, and assesses their competence, at the following intervals:
                          – At orientation
                          – Before participating in the use of restraint and seclusion
                          – On a periodic basis thereafter
                          2. Based on the population served, staff education, training, and demonstrated knowledge focus on the following:
                          – Strategies to identify staff and patient behaviors, events, and environmental factors that may trigger circumstances that require the use of restraint or seclusion
                          – Use of nonphysical intervention skills
                          – Methods for choosing the least restrictive intervention based on an assessment of the patient’s medical or behavioral status or condition
                          – Safe application and use of all types of restraint or seclusion used in the hospital, including training in how to recognize and respond to signs of physical and psychological distress (for example, positional asphyxia)
                          – Clinical identification of specific behavioral changes that indicate that restraint or seclusion is no longer necessary
                          – Monitoring the physical and psychological well-being of the patient who is restrained or secluded, including, but not limited to, respiratory and circulatory status, skin integrity, vital signs, and any special requirements specified by hospital policy associated with the in-person evaluation conducted within one hour of initiation of restraint or seclusion
                          – Use of first-aid techniques and certification in the use of cardiopulmonary resuscitation, including required periodic recertification (See also PC.03.05.07, EP 1)
                          3. Individuals providing staff training in restraint or seclusion have education, training, and experience in the techniques used to address patient behaviors that necessitate the use of restraint or seclusion.
                          4. The hospital documents in staff records that restraint and seclusion training and demonstration of competence were completed.

                          We were also told there were legal/DMH regulations that applied to restraining psych patients without training as well.
                           

                          dpmd

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                            As far as non psych restraints there was a training module on it that was part of the periodic training stuff we were supposed to do I think maybe online or whatever or maybe they sent a PowerPoint as an email during residency. They called the online training moodles and there were supposedly a lot of them we were supposed to do but I know I didn't do a single one without any repercussions. That may be different now though since it was a new thing when I went through. They might check now.
                             

                            neoexile

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                              I have worked since I was 15 yrs old. I have never missed a day at work in my life. I would never call in sick for residency. That is just how it was 20 yrs ago. I can't remember anytime when someone called in sick. When you call in sick, someone is doing the work for you and I just don't feel that this is right unless something really bad happened.

                              I agree with this. It is NOT fair to burden others with YOUR problems.
                               

                              Mass Effect

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                                I agree with this. It is NOT fair to burden others with YOUR problems.

                                You're a physician and no one has ever informed you that life is not always fair? You cover for them the same way they will cover for you when you call in sick.

                                Really? Could we not have let this thread die a natural death?

                                That question should be directed to Neoexile.
                                 
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                                siliso

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                                  If you’re not in physical or mental shape to be a competent physician today, you have a professional obligation to be self-aware enough to recognize that and not go to work. I haven’t found myself in that situation often, and it stinks when it inconveniences others, but it does happen to the best of us and we’re better if we acknowledge it.
                                  There’s probably mental equivalents to the sniffles (you can tough either one out and still perform at capacity) and mental equivalents to sepsis from pneumonia (call jeopardy and go to the hospital), and some things in between.
                                   
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                                  siliso

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                                    Some incapacitating issues, whether it’s viral gastroenteritis or acute stress reaction, don’t need more than a day or two of rest and supportive care to get reset and back in action. Others will need longer time with more professional medical assistance. It’s still our professional responsibility to recognize when we’re incapacitated, NOT to go to work incapacitated (doing so is unsafe for patients), and to seek care/take care of the problematic condition appropriately.
                                     
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                                    calvnandhobbs68

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                                      honestly, considering this is a forum and you don't know about me and what I have struggled with... you are completely wrong. My point is that take 1 day off won't remedy something that really needs to be addressed/ won't be fixed with a day off

                                      1567051550237.jpeg
                                       
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