sideways

Removed
Aug 8, 2009
1,669
11
0
Status
Medical Student
So you're on a plane and someone has a heart attack or something along those lines. The flight attendant yells "is there a doctor on the plane?"

Will a psychiatrist 10 yrs into practice still have the ability to offer anything to the person? Or does the psychiatrist sit there and pray his 7 year old son doesn't yell "my daddy is a doctor!"

It's a serious question I have, and perhaps the only thing making me question psych. It probably shouldn't be an issue for me, but it is.
 

billypilgrim37

Unstuck in Time
10+ Year Member
7+ Year Member
Apr 22, 2007
2,387
115
171
Status
Attending Physician
I'm not sure what a cardiothoracic surgeon could offer other than aspirin, xanax, and chest compressions. I guess they might have a BMV on the plane, but your 7 year old could help you with that. As long as you can still do a trach w/ a BIC pen, you should be set.
 

sluox

15+ Year Member
Jan 4, 2002
1,708
766
381
Status
Attending Physician
Kind of interesting, but this actually happened to me once. As it turns out, it was an acute alcohol intoxication--right along most psychiatrists' alleys, hopefully.

You could ask the same question for radiologists and pathologists, or perhaps a slew of other sub-specialists, like neonatologists, palliative care specialists, radiation oncologists, etc. I'm not sure why this is specifically psychiatry. I'm pretty sure a rad onc would be way less useful than a psych in the EtOH withdrawal scenario.

Also, if this is really a concern for you, you can always get ACLS/BLS certified every 5 years...that way you can be as proficient as a paramedic in emergency situations.
 

OldPsychDoc

Senior Curmudgeon
Moderator Emeritus
10+ Year Member
Dec 2, 2004
6,218
3,778
281
57
Left of Center
Status
Attending Physician
Kind of interesting, but this actually happened to me once. As it turns out, it was an acute alcohol intoxication--right along most psychiatrists' alleys, hopefully.

You could ask the same question for radiologists and pathologists, or perhaps a slew of other sub-specialists, like neonatologists, palliative care specialists, radiation oncologists, etc. I'm not sure why this is specifically psychiatry. I'm pretty sure a rad onc would be way less useful than a psych in the EtOH withdrawal scenario.

Also, if this is really a concern for you, you can always get ACLS/BLS certified every 5 years...that way you can be as proficient as a paramedic in emergency situations.
Yeah, I always think of it in terms of maybe having to deal with an emergent sedation of a terrorist suspect or other disruptive individual. Now THAT I know! (And I'm told the emergency med kits do contain ativan and haldol...)

An attending (Psych) of mine had to respond to one of these calls once for a lightly scalded toddler. (He waited for the third call, too, expecting someone more qualified to volunteer.) He was impressed being asked by the pilot whether they needed to divert and land immediately--but had the mom adminster tylenol from the diaper bag instead.
 

whopper

Former jolly good fellow
15+ Year Member
Feb 8, 2004
6,850
1,609
381
Visit site
Status
Attending Physician
Will a psychiatrist 10 yrs into practice still have the ability to offer anything to the person? Or does the psychiatrist sit there and pray his 7 year old son doesn't yell "my daddy is a doctor!"
Depends on the psychiatrist. I hate saying this, but several doctors I've seen 10 years into practice forget things they're not supposed to forget, psychiatrist or not.

I'm currently in a situation where I work in a group home on my moonlighting gig where I know more internal medicine than the internal medicine doctor. I have for example several patietns with hyperlipidemia for years where the IM doctor did nothing about it. I had to inform the patient of their disorder, and write notes in the chart recommending the IM doctor order a statin. On my own, I informed the patient what was going on, advised them to eat and excercise, but told them that for insurance purposes, the IM doctor was supposed to order the statin.

That's just the tip of the iceberg. I can list several medical problems in my patients I've seen where I detected the problem first, and the IM or PCP doctor pretty much just overlooked it.

If you let yourself forget your medical knowledge, you can forget it in a manner where you may be able to get away with it in day-to-day practice, but I certainly do not advise it. As a medical doctor, you have a duty to your profession and your patients to be better than to simply just given than a psychotropic pill, and bill them.

Medical issues also frequently occur with psychiatric patients. Catatonia can cause rhabdomylosis, metabolic issues, HTN, diabetes, smoking, etc. These are issues I frequently see.
 

carlosc1dbz

10+ Year Member
Jan 29, 2007
306
21
251
Southern California
Status
Attending Physician
So you're on a plane and someone has a heart attack or something along those lines. The flight attendant yells "is there a doctor on the plane?"

Will a psychiatrist 10 yrs into practice still have the ability to offer anything to the person? Or does the psychiatrist sit there and pray his 7 year old son doesn't yell "my daddy is a doctor!"

It's a serious question I have, and perhaps the only thing making me question psych. It probably shouldn't be an issue for me, but it is.
I think it is important for all different types of doctors to practice medicine maybe once a month, just to keep the basic medical information from evaporating. You know that if your family knows your a doctor, or your wife's friends find out, you are going to be bombarded with questions. What are you going to say, well actually I'm a psychologist, or I'm a radiologist. You cannot do that. It sounds terrible. As far as the emergency situations are concerned, I think its important to be able to offer help in those situations, but since everyone is so specialized in their fields I understand how difficult it can be to keep your emergency skills up to par.
 

michaelrack

All In at the wrong time
10+ Year Member
Dec 22, 2007
3,934
1,073
331
Memphis TN
Status
Attending Physician
What are you going to say, well actually I'm a psychologist, or I'm a radiologist. .
If you say you are a psychologist, that should get you off the hook for treating anything medical. A psychiatrist, on the other hand..
 

michaelrack

All In at the wrong time
10+ Year Member
Dec 22, 2007
3,934
1,073
331
Memphis TN
Status
Attending Physician
Or does the psychiatrist sit there and pray his 7 year old son doesn't yell "my daddy is a doctor!"

.
In my case, the internist/psychiatrist sits and prays that his wife, who is a psychiatrist, doesn't yell "my husband is a doctor!" (she has done this before)
 

monelkub

Junior Member
10+ Year Member
5+ Year Member
Jan 26, 2005
21
0
0
Status
I think it is important for all different types of doctors to practice medicine maybe once a month, just to keep the basic medical information from evaporating.
"Practice" is probably the wrong term to use, if you mean actually administering some kind of care. We all want to be holistic and help but when reality sets in, it makes you think twice. I would rather use "read up" or the like because it is a slippery slope, especially with med-mal issues. I am a psychiatry resident and all specialty attendings harp on us to NOT treat family members, do NOT write Rx's for family members or friends. I feel it's ok to look into an ear or throat of your neighbors child but without a full hx, continuity of care, medical record you are playing with fire, your license and all the hard work you have put in. I usually tell them I can check you out but you should call your PCP, go to urgent care, ER, etc.

Regarding "is there a doctor on board", earlier this year I was flying with my wife and they called over head for a doctor. No one responded so I stood up and took a look, turned out to be elderly women who was dizzy, nauseated and fell trying to make it to the bathroom. I did the ABC's and spoke over the radio to the airport with the pilot. Did vitals which were stable and I asked for the medical kit which was very weak, no AED. I started O2 and stayed with her until we landed. Not much I could do but the woman did well and I briefed the EMS when they boarded. When I walked back to my seat two guys mentioned "you did a great job" and I said are you docs and they responded "yup anesthesiologists." They asked me what I did and I said psychiatry and their jaws dropped. My point is regardless of what we do, start with the basics which even techs know, and just being there to help may be therapeutic with the limited resources you may have on a plane.
 

nancysinatra

10+ Year Member
Sep 27, 2007
1,499
343
281
Still walkin'
Status
Attending Physician
I'm not sure what a cardiothoracic surgeon could offer other than aspirin, xanax, and chest compressions. I guess they might have a BMV on the plane, but your 7 year old could help you with that. As long as you can still do a trach w/ a BIC pen, you should be set.
And how to decompress a tension pneumo! 2nd intercostal space, midclavicular line...

My dad's a pathologist, and about 30 years after finishing residency he saved someone's life who was going into anaphylactic shock after they got stung by a bee while riding a bike.

You can also be really gung ho and take ATLS, PALS, etc.
 

OldPsychDoc

Senior Curmudgeon
Moderator Emeritus
10+ Year Member
Dec 2, 2004
6,218
3,778
281
57
Left of Center
Status
Attending Physician
[SAM L JACKSON] Enough is enough!
I have had it with these ############# doctors on this ############# plane!
[/SAM L JACKSON]


sorry...I'll get back to work now...
 

illegallysmooth

Smooth member
10+ Year Member
May 21, 2008
1,506
78
271
Buffalove
Status
Attending Physician
1. I love this thread.
2. There's a funny gal over on pre-pharm on the "PharmD = Dr" thread trying to convince me that pharmacists should be prescribing, not physicians. It made me laugh trying to imagine what she'd do or say in the plane scenario :laugh:
 

surftheiop

10+ Year Member
Dec 4, 2008
1,940
27
0
Status
1. I love this thread.
2. There's a funny gal over on pre-pharm on the "PharmD = Dr" thread trying to convince me that pharmacists should be prescribing, not physicians. It made me laugh trying to imagine what she'd do or say in the plane scenario :laugh:
To be honest I've never quite understood why the model isn't

Doctor diagnoses, Pharmacist prescribes/doses

(Besides the fact it would be more expensive, but doesn't seem like the health care system has ever been too worried about cost over the years)
 

illegallysmooth

Smooth member
10+ Year Member
May 21, 2008
1,506
78
271
Buffalove
Status
Attending Physician
To be honest I've never quite understood why the model isn't

Doctor diagnoses, Pharmacist prescribes/doses
I don't mean to derail the thread, but the pharmacist isn't assessing the patient. I'm only a pre-med, but therapy decisions in most cases should be based on the clinical findings, no? Just because a Dr. diagnosis a pt with X doesn't mean the pharmacist would know the exact type of X, severity of X, what X looks/sounds/feels like - especially in cases when these subtleties might indicate different treatment modalities. I believe, of course, pharmacists should be a part of the health care team and should especially be utilized in difficult or complex cases, but I don't think they should be prescribing.
 

whopper

Former jolly good fellow
15+ Year Member
Feb 8, 2004
6,850
1,609
381
Visit site
Status
Attending Physician
It wasn't till about the first year of residency where I felt comfortable giving out medications to patients in at least guarded medical condition. Even patients who were stable, while I was comfortable, it was a sophomoric type of comfort. It really wasn't till the end of 2nd year where I thought to myself that I was good enough to do 90% of what happens psychiatry on my own, though I needed much more training to be good at what I did.

So for anyone, like a pharmacist, to think they can prescribe......makes me wonder if it's a combination of them seeing other bad doctors practice and gauging themselves off the bad doctor, and them wanting more control.

I've seen so many pharmacists see a script for a medications that don't seem like it's the right one, and it's because the doctor might not be doing the right thing. I have a patient with panic-disorder, and I put her on an SSRI (previous psychiatrists tried Xanax, bupropion, topamax). When he saw the SSRI, the patient told me he said something to the effect of "Finally! You're on the right medication!" She told me the pharmacist and her knew each other, and he knew she had panic-attacks, but was powerless to do much other than just fill out the script.
 
Last edited:

surftheiop

10+ Year Member
Dec 4, 2008
1,940
27
0
Status
It wasn't till about the first year of residency where I felt comfortable giving out medications to patients in at least guarded medical condition. Even patients who were stable, while I was comfortable, it was a sophomoric type of comfort. It really wasn't till the end of 2nd year where I thought to myself that I was good enough to do 90% of what happens psychiatry on my own, though I needed much more training to be good at what I did.

So for anyone, like a pharmacist, to think they can prescribe......makes me wonder if it's a combination of them seeing other bad doctors practice and gauging themselves off the bad doctor, and them wanting more control.

I've seen so many pharmacists see a script for a medications that don't seem like it's the right one, and it's because the doctor might not be doing the right thing. I have a patient with panic-disorder, and I put her on an SSRI (previous psychiatrists tried Xanax, bupropion, topamax). When he saw the SSRI, the patient told me he said something to the effect of "Finally! You're on the right medication!" She told me the pharmacist and her knew each other, and he knew she had panic-attacks, but was powerless to do much other than just fill out the script.


I didn't mean why don't current pharmacists prescribe, I meant why isn't the medical system designed in such a way such that pharmacists would be trained to prescribe/dose?

It seems like if your going to have a system with both pharmacists and physicians where pharmacists are the experts in pharmacology/kinetics/drug interactions, etc., it would be logical for the pharmacists to be trained to handle prescribing in certain cases.
 

HooahDOc

15+ Year Member
Jun 23, 2003
5,777
858
381
Status
Attending Physician
To be honest I've never quite understood why the model isn't

Doctor diagnoses, Pharmacist prescribes/doses

(Besides the fact it would be more expensive, but doesn't seem like the health care system has ever been too worried about cost over the years)
Some hospitals will have pharmacists who double-check prescription orders and dosing behind the physician. If they think there is a mistake, they will contact the prescribing physician for clarification. Some medications are also ordered as, "Pharm to dose".

Also, there are "clinical pharmacists". I'm not really sure what they do but I think they can prescribe in some states.
 

Doc Samson

gamma irradiated
10+ Year Member
Dec 2, 2005
1,963
10
241
Not Boston anymore
Status
Attending Physician
[SAM L JACKSON] Enough is enough!
I have had it with these ############# doctors on this ############# plane!
[/SAM L JACKSON]


sorry...I'll get back to work now...
The overdub of that line for basic cable is:

I have had it with these monkey-fighting snakes on this monday-to-friday plane

I laughed for a long time when I stumbled across that and now use "monkey-fighting" as often as I can.
 

surftheiop

10+ Year Member
Dec 4, 2008
1,940
27
0
Status
The overdub of that line for basic cable is:

I have had it with these monkey-fighting snakes on this monday-to-friday plane

I laughed for a long time when I stumbled across that and now use "monkey-fighting" as often as I can.
OMG I almost died after looking that up
 

235750

Guest
10+ Year Member
Dec 5, 2008
636
4
0
Status
Non-Student
Billy Pilgrim answered your OP straight away.

What could a doctor do in this situation that couldn't be accomplished with someone who took BLS?

Planes have AEDs, any idiot can operate them and do chest compressions/breaths in-between. As a former paramedic I can tell you that running codes is pretty mind numbing work.

All you have to do once out of med school is to keep up on the guidelines for chest compressions/breaths ratio. That keeps changing. Everything else is the same

You can do challenging CMEs and keep up on your general medical knowledge. I knew one psychiatrist who keep his ACLU and ATLS up to date, and he'd do wildlife medicine for his CMEs. Like any specialty it's up to you to stay current
 

sideways

Removed
Aug 8, 2009
1,669
11
0
Status
Medical Student
Billy Pilgrim answered your OP straight away.

What could a doctor do in this situation that couldn't be accomplished with someone who took BLS?

Planes have AEDs, any idiot can operate them and do chest compressions/breaths in-between. As a former paramedic I can tell you that running codes is pretty mind numbing work.

All you have to do once out of med school is to keep up on the guidelines for chest compressions/breaths ratio. That keeps changing. Everything else is the same

You can do challenging CMEs and keep up on your general medical knowledge. I knew one psychiatrist who keep his ACLU and ATLS up to date, and he'd do wildlife medicine for his CMEs. Like any specialty it's up to you to stay current
I ask the question because I was at an airport (not on an airplane) and saw an old man lifeless on the floor. A cluster of cops and paramedics were surrounding him, and at his head, drawing something into a syringe, trying to establish an airway, etc. was some young doc, clearly just a guy waiting for a flight who jumped in to help.

Now, my instant thought was this guy's probably EM, anesthesiology. But, I wondered, would ANY doc, of any specialty, just by the fact that they are a doctor, be the best person to jump in and run that ship? Or would some specialties, like psych, be best to leave it to the first responders.
 

Faebinder

Slow Wave Smurf
10+ Year Member
May 24, 2006
3,507
10
251
Pennsylvania
Status
Attending Physician
In my case, the internist/psychiatrist sits and prays that his wife, who is a psychiatrist, doesn't yell "my husband is a doctor!" (she has done this before)
Oh God, I almost choked! :lol:
 

Faebinder

Slow Wave Smurf
10+ Year Member
May 24, 2006
3,507
10
251
Pennsylvania
Status
Attending Physician
I ask the question because I was at an airport (not on an airplane) and saw an old man lifeless on the floor. A cluster of cops and paramedics were surrounding him, and at his head, drawing something into a syringe, trying to establish an airway, etc. was some young doc, clearly just a guy waiting for a flight who jumped in to help.

Now, my instant thought was this guy's probably EM, anesthesiology. But, I wondered, would ANY doc, of any specialty, just by the fact that they are a doctor, be the best person to jump in and run that ship? Or would some specialties, like psych, be best to leave it to the first responders.
When I was doing surgery prior to psychiatry, there were several 20+ practicing surgeons who you couldn't trust to run a code. If the chief resident was not there, they would be lost.

Give it up! People deep into practice have forgotten a lot of techniques. Heck even some IM docs out there forgot codes. If you don't do something on a regular basis, you will forget it likely, so it's up to you to decide to jump in and help or not at that point depending on how you feel you reliably you maintained your "side" skills.

With the way litigation is now a days, dont be shocked if many dont jump in. The claim that you are fool-proof protected for good samaritan act is not true. Do you really wanna lose your license?
 

sideways

Removed
Aug 8, 2009
1,669
11
0
Status
Medical Student
When I was doing surgery prior to psychiatry, there were several 20+ practicing surgeons who you couldn't trust to run a code. If the chief resident was not there, they would be lost.

Give it up! People deep into practice have forgotten a lot of techniques. Heck even some IM docs out there forgot codes. If you don't do something on a regular basis, you will forget it likely, so it's up to you to decide to jump in and help or not at that point depending on how you feel you reliably you maintained your "side" skills.

With the way litigation is now a days, dont be shocked if many dont jump in. The claim that you are fool-proof protected for good samaritan act is not true. Do you really wanna lose your license?
I was just trying to gauge "doctorly" knowledge levels, broadly speaking. I guess my suspicions were confirmed: medicine is just so vast and so GD specialized that you can't have it all.
 

235750

Guest
10+ Year Member
Dec 5, 2008
636
4
0
Status
Non-Student
But, I wondered, would ANY doc, of any specialty, just by the fact that they are a doctor, be the best person to jump in and run that ship?...I was just trying to gauge "doctorly" knowledge levels, broadly speaking.
I think the misunderstanding is that you're equating basic life support with "doctorly knowledge". What I and others are trying to say is that, they are completely separate.

You're talking about memorizing predetermined algorithms. The best person to 'run the ship' is whoever has the best upper body (chest compressions can get very exhausting). Have you ever used an AED? It literally speaks to you and directs the next course of action. You can't show off your med school education in this scenario

Whatever branch of medicine you choose, spend one day every 4 years maintaining your ACLS cert. Then you'll be able to act very 'doctorly' :)

I do think you bring up an excellent point regarding basic procedures that every doctor should know. And I think you could modify your question to ask a more probing query, something like, 'how many of you maintain your ACLS certification? How many require it for working/residency?' I have found that many specialty residencies, including psychiatry, do not require ACLS which is a shame. As Faebinder said, this is seen in many other types of medicine too.
 

sluox

15+ Year Member
Jan 4, 2002
1,708
766
381
Status
Attending Physician
I have found that many specialty residencies, including psychiatry, do not require ACLS which is a shame. As Faebinder said, this is seen in many other types of medicine too.
Depending on institutional policies, ACLS may or may not be required. However, I would say most of the psych residency programs require ACLS, especially since there is a 6-8 month inpatient training requirement during first year. Also ACLS can come in handy for inpatient detox units/substance abuse, psych EM, VA/suburban/forensic rotations when you are the only in-house staff physician, etc.

A couple of other things to keep in mind is that psych emergencies are very common, and in many scenarios (i.e. a group of people healthy enough to be on a plane) potentially be more common than physical illnesses, and being a psychiatrist may actually be very useful in a number of community emergency situations. I can guarantee you the probability of seeing a panic attack on a plane is much much higher than seeing a heart attack. In other instances, i.e. trauma, the main issue is to keep everyone calm and call for the appropriate help, which I think psychiatrists are more than qualified to do. I think the idea is to be comfortable in dealing with an emergent situation and be cool and collected and figure out the appropriate next step with limited resources, and this should be part of any psychiatry residency program.
 

whopper

Former jolly good fellow
15+ Year Member
Feb 8, 2004
6,850
1,609
381
Visit site
Status
Attending Physician
Some hospitals will have pharmacists who double-check prescription orders and dosing behind the physician. If they think there is a mistake, they will contact the prescribing physician for clarification. Some medications are also ordered as, "Pharm to dose".
Happens in my hospital. We have some very tough cases here. It's a long term care facility. We have people who are chronically violent with attacks daily, treatment resistant to even clozapine, hypothermia from Depakote, etc.

Whenever we have a very strange case, we consult with the pharmacists from time to time. The formulary at the hospital is state approved and reviewed by several doctors, including pharmacists to include dosage ranges well above the manufacturer's recommended dosage.
 

jettavr6

10+ Year Member
Feb 24, 2008
502
137
281
Status
Attending Physician
ACLS should be mandatory for all physicians. You WILL encounter a situation at some point, where it will come in handy.

As for pharmacists being the ones to prescribe, I completely disagree. Medication is different than the "art of medicine." We dose according to the individual and not exactly by the book. Quite honestly, I've never heard of a pharmacist who wanted the ability to prescribe. The vast majority of the pharmacists I know are walking encyclopedias of pharmacology and do excellent work. They have caught my mistakes from time to time and or provided me with alternative medication choices, mechanisms of actions, etc. Pharmacists are an essential part of the treatment team, and I wish they could sit in on interdisciplinary rounds!
 

ArkansasRanger

10+ Year Member
Feb 9, 2009
1,504
5
0
Arkansas
Status
Pre-Medical
Billy Pilgrim answered your OP straight away.

What could a doctor do in this situation that couldn't be accomplished with someone who took BLS?

Planes have AEDs, any idiot can operate them and do chest compressions/breaths in-between. As a former paramedic I can tell you that running codes is pretty mind numbing work.

All you have to do once out of med school is to keep up on the guidelines for chest compressions/breaths ratio. That keeps changing. Everything else is the same

You can do challenging CMEs and keep up on your general medical knowledge. I knew one psychiatrist who keep his ACLU and ATLS up to date, and he'd do wildlife medicine for his CMEs. Like any specialty it's up to you to stay current
former paramedic here too so this sounds like medic humor, but I've gotta ask

aclu eh?

WILDLIFE MEDICINE ????
 

st2205

Attending
10+ Year Member
Oct 29, 2006
1,832
1,089
281
Status
Attending Physician
I am guessing he mean wilderness medicine
Not exactly. After an intensive course and 200 preceptorship hours you receive certification in C&A psychiatry (canine & animal) from this man: