psych np's taking over

[vistaril]

It's not related to that sole comment. No need to play coy. And it kinda sounds like you're building up for some big soliloquy on what "service" means in anticipation of my retort. I guess my question for you is which column do you think packs the heavier punch in the description of your career choice:

A) easy job
B) helping a sick person in need

Like I said before, I don't care what the answer is. I "get" both. But I think we all crave a bit of honesty. You're honest about everything else. I see no reason not to trust your answer to this question.

Im not trying to be coy, but I just feel as if it is sort of a faulty question. Change 'easy' job to job I feel more comfortable doing, and I'll play along and go with a......but how 'easy' it is is really up to the person practicing. A couple saturdays ago I ran through like 50 outpatients(well not quite but almost it seemed)...is that 'easy'?

---

Members don't see this ad.

 

[kindasorta]

Im not trying to be coy, but I just feel as if it is sort of a faulty question. Change 'easy' job to job I feel more comfortable doing, and I'll play along and go with a......but how 'easy' it is is really up to the person practicing. A couple saturdays ago I ran through like 50 outpatients(well not quite but almost it seemed)...is that 'easy'?

I'm not interested in arguing semantics. I know you're smart, and I know you know what I mean. You basically answered it and I accept your answer. I guess the follow-up is do you think you're cheating your non-SMI patients out of money? Are you a charlatan of sorts?

 

[vistaril]

That's not true, and that's not what splik said (and even if he intended it, it's not a necessary consequence of what he said). I'd say it's useful for helping us to discuss what it is we see in patients, deciding on treatment, and research.

it definately can be useful for the purposes of research(can be said about much of the dsm).....

I don't find it as useful for those other things.

 

[vistaril]

I'm not interested in arguing semantics. I know you're smart, and I know you know what I mean. You basically answered it and I accept your answer. I guess the follow-up is do you think you're cheating your non-SMI patients out of money? Are you a charlatan of sorts?

no of course not, I think there are many non-smi patients who benefit from mental health care(including some of my patients).

 

[kindasorta]

no of course not, I think there are many non-smi patients who benefit from mental health care(including some of my patients).

Any depressed or anxious patients that benefit?

 

[vistaril]

Any depressed or anxious patients that benefit?

Sure....someone would have to be insane to believe a really good therapist can't help *some* patients with *some* issues above placebo. That's just common sense.

 

[kindasorta]

Sure....someone would have to be insane to believe a really good therapist can't help *some* patients with *some* issues above placebo. That's just common sense.

Well then what more can you ask for. You act like other specialties wave a wand of obsolescence over their patients maladies. Every goddamn specialty in medicine deals with crude and often times hopeless attempts at cure or comfort. At least in psych you're dealing with inarguably the most intimate and troublesome or debilitating of all problems in medicine. To be able to help those patients, even once in a while, is striking. People think some cancer doc is idol material. Well, I can tell you that they fail as much if not more than psychiatrists. But I can also tell you that a successful psychiatrist can overcome the failure of all specialties. I've seen people that are dying yet are happy. I've seen people that will live decades who are miserable. The mind is where these choices are made. I just find it awfully strange when someone, especially someone in the field, compares success rates of tendon repair to mental health. Psychiatric illness is exponentially more complex. It's also why we are still in our infancy. But my god, it is so much more engaging and meaningful and the stuff of life-long learning and effort.

 

[clement]

Well then what more can you ask for. You act like other specialties wave a wand of obsolescence over their patients maladies. Every goddamn specialty in medicine deals with crude and often times hopeless attempts at cure or comfort. At least in psych you're dealing with inarguably the most intimate and troublesome or debilitating of all problems in medicine. To be able to help those patients, even once in a while, is striking. People think some cancer doc is idol material. Well, I can tell you that they fail as much if not more than psychiatrists. But I can also tell you that a successful psychiatrist can overcome the failure of all specialties. I've seen people that are dying yet are happy. I've seen people that will live decades who are miserable. The mind is where these choices are made. I just find it awfully strange when someone, especially someone in the field, compares success rates of tendon repair to mental health. Psychiatric illness is exponentially more complex. It's also why we are still in our infancy. But my god, it is so much more engaging and meaningful and the stuff of life-long learning and effort.

But the problem is, some things shouldn't be "medicalized,"
i.e. personality disorders, even for the sake of symptom suppression.

 

[kindasorta]

But the problem is, some things shouldn't be "medicalized,"
i.e. personality disorders, even for the sake of symptom suppression.

Have you been drinking clement?

 

[someguy321]

It's clear approval from the highest ranking official in the US. Whether you believe in the message itself is irrelevant.

it would mean more if he ever kept a promise... its propaganda man.. go ask the vets coming back how much mental health attention theyre getting being all addicted and PTSD'd out

 

[AcronymAllergy]

it would mean more if he ever kept a promise... its propaganda man.. go ask the vets coming back how much mental health attention theyre getting being all addicted and PTSD'd out

For its part, the VA has certainly made efforts to increase and improve MH care to returning service members. That being said, there's always more that could be done.

Although at the same time, it's also a matter of 1) making the available services known to veterans (which, again, the VA is at least attempting to improve upon), and 2) actually having individuals capitalize on said services.

 

[someguy321]

For its part, the VA has certainly made efforts to increase and improve MH care to returning service members. That being said, there's always more that could be done.

Although at the same time, it's also a matter of 1) making the available services known to veterans (which, again, the VA is at least attempting to improve upon), and 2) actually having individuals capitalize on said services.

i was under the impression that someone that only serves a normal 4 yrs cant utilize VA services

 

[Atom bum]

Y'all mother ****ers are depressing. I understand the need to be realistic, but you have to find some good in what you do.
Vista, if you were my psychiatrist, I would kill myself.

 

[Armadillos]

..do you know of a single community psychiatry provider who wouldn't love an antipsychotic that blunts the cognitive deficits in schizophrenia for example?

schizophrenia as defined by the dsm is of limited usefulness, and since psychiatrists wrote that it doesn't make psychiatrists look good.

Are you serious?

Like literally 10 posts ago you used the one word term schizophrenia to describe a patient so that other physicians could understand some of the characteristics of the patient you were talking about, in addition you used the term to essentially frame a research question "can X drug blunt the cognitive deficits in schizophrenia" if thats not useful then I don't know what you consider useful.

 

[splik]

whilst much of what vistaril says is questionable or complete guff, it is surprising people seem to react strongly to some things which should be relatively uncontroversial. psychiatrists aren't all making $500k a year and most psychiatrists, even working full time will be on the lower end of the earning potential compared to other physicians. The reality is that psychiatry does tend to attract lower quality applicants compared to other specialties. psychiatry is not as well regarded as other specialties and many physicians do have negative views of psychiatry and psychiatrists. there are many psychiatrists who are quite frankly so terrible you might prefer a decent NP. the evidence base for many of our drugs is quite weak. most psychiatric diagnoses are not valid constructs. the DSM-5 is an embarrassment to the profession. I don't think there is anything controversial about any of this, and believing these things to be true does not mean you should have chosen another profession. Psychiatry is actually one of the best fields for tolerating a diversity of perspectives and tends to be more critical than many other spheres of medicine where there are similar problems.

 

[notdeadyet]

i was under the impression that someone that only serves a normal 4 yrs cant utilize VA services

It's more complicated than this.
If you serve 20 years and retire, you essentially get healthcare for life. If you serve 2 or 4 or 6 or whatever years and are honorably discharged, you can pay for healthcare at a VA like an HMO and you also get free care for any injury or illness that is service connected, which can range from a busted knee while parachuting to PTSD from being raped while serving to gout that developed while active duty. The VA is pretty liberal with what's "service connected."

 

[notdeadyet]

psychiatrists aren't all making $500k a year and most psychiatrists, even working full time will be on the lower end of the earning potential compared to other physicians.

I'd agree if we stated that psychiatrists as a specialty will be on the lower end of earning potential compared to other specialties. For every neurosurgeon there are about hundreds of pediatricians, family practitioners and outpatient internists, and psychiatrists have as good or better earning potential.

The how psychiatrists are viewed thing always makes me sigh because it's the dressed up older sister of the "prestige" argument. Work hard and do good work and your efforts will be respected by folks with a head on their shoulders. There may be some dinosaurs out there who disregard your field as a whole, but really, who gives a $hit? You should spend as much time worrying about them as you should worrying about the docs who will think less of you because you're a woman. Fuggem.

 

[Atom bum]

I'd agree if we stated that psychiatrists as a specialty will be on the lower end of earning potential compared to other specialties. For every neurosurgeon there are about hundreds of pediatricians, family practitioners and outpatient internists, and psychiatrists have as good or better earning potential.

The how psychiatrists are viewed thing always makes me sigh because it's the dressed up older sister of the "prestige" argument. Work hard and do good work and your efforts will be respected by folks with a head on their shoulders. There may be some dinosaurs out there who disregard your field as a whole, but really, who gives a $hit? You should spend as much time worrying about them as you should worrying about the docs who will think less of you because you're a woman. Fuggem.

Damn right.

 

[vistaril]

whilst much of what vistaril says is questionable or complete guff, it is surprising people seem to react strongly to some things which should be relatively uncontroversial. psychiatrists aren't all making $500k a year and most psychiatrists, even working full time will be on the lower end of the earning potential compared to other physicians. The reality is that psychiatry does tend to attract lower quality applicants compared to other specialties. psychiatry is not as well regarded as other specialties and many physicians do have negative views of psychiatry and psychiatrists. there are many psychiatrists who are quite frankly so terrible you might prefer a decent NP. the evidence base for many of our drugs is quite weak. most psychiatric diagnoses are not valid constructs. the DSM-5 is an embarrassment to the profession. I don't think there is anything controversial about any of this, .

well that is pretty much all the stuff I usually state.

 

[CounselortoMD]

I had no idea that my rather benign comment, about who can/should have the rights and authority to practice psychotherapy, was going to trigger such a passionate debate! But I'm glad it did, because these arguments and insights being discussed are very interesting.

I still maintain that a medical degree is not essential--nor perhaps even ideal--to prepare mental health clinicians for the practice of psychotherapy (i.e., counseling). That said, I certainly acknowledge that there are plenty of medically-educated psychiatrists who are well-trained, competent, and highly successful at delivering psychotherapeutic services.

However, I also firmly believe that there are numerous non-medical mental health professionals, from several other clinical disciplines, who practice psychotherapy equally as well as their physician colleagues (such as licensed clinical psychologists, LPCs, LMFTs, and LCSWs). These individuals all possess extensive didactic/clinical training in the theories and techniques of talk-therapy, and have excelled for many years in their roles as psychotherapists. Their work is almost completely psychosocial in nature, and the biomedical component of their daily duties is virtually nonexistent.

I don't see any parallel between non-physician mental health clinicians practicing psychotherapy, and the advancement (or encroachment, if you will) of mid-level healthcare providers (i.e., NPs, PAs) into the biomedical realm of psychopharmacology.

 

[vistaril]

I had no idea that my rather benign comment, about who can/should have the rights and authority to practice psychotherapy, was going to trigger such a passionate debate! But I'm glad it did, because these arguments and insights being discussed are very interesting.

I still maintain that a medical degree is not essential--nor perhaps even ideal--to prepare mental health clinicians for the practice of psychotherapy (i.e., counseling). That said, I certainly acknowledge that there are plenty of medically-educated psychiatrists who are well-trained, competent, and highly successful at delivering psychotherapeutic services.

However, I also firmly believe that there are numerous non-medical mental health professionals, from several other clinical disciplines, who practice psychotherapy equally as well as their physician colleagues (such as licensed clinical psychologists, LPCs, LMFTs, and LCSWs). These individuals all possess extensive didactic/clinical training in the theories and techniques of talk-therapy, and have excelled for many years in their roles as psychotherapists. Their work is almost completely psychosocial in nature, and the biomedical component of their daily duties is virtually nonexistent.

I don't see any parallel between non-physician mental health clinicians practicing psychotherapy, and the advancement (or encroachment, if you will) of mid-level healthcare providers (i.e., NPs, PAs) into the biomedical realm of psychopharmacology.

I don't either, but going forward as psychiatrists it impacts our future.....as you state(very nicely) above, it certainly doesn't take medical training(or a medical approach) to deliver psychotherapy. Likewise, it does take some level of medical training to practice psychopharm, but in most all cases not MD level of training. Combine the two, and where does that leave us in the future?

 

[JourneyAgent]

whilst much of what vistaril says is questionable or complete guff, it is surprising people seem to react strongly to some things which should be relatively uncontroversial. psychiatrists aren't all making $500k a year and most psychiatrists, even working full time will be on the lower end of the earning potential compared to other physicians. The reality is that psychiatry does tend to attract lower quality applicants compared to other specialties. psychiatry is not as well regarded as other specialties and many physicians do have negative views of psychiatry and psychiatrists. there are many psychiatrists who are quite frankly so terrible you might prefer a decent NP. the evidence base for many of our drugs is quite weak. most psychiatric diagnoses are not valid constructs. the DSM-5 is an embarrassment to the profession. I don't think there is anything controversial about any of this, and believing these things to be true does not mean you should have chosen another profession. Psychiatry is actually one of the best fields for tolerating a diversity of perspectives and tends to be more critical than many other spheres of medicine where there are similar problems.

I would have expected that you would have been perceptive enough to realize its a question of intent and tone among other things.

For instance, do we give you any flack for the way you pose these questions about our weaknesses?

In any case, I've been dragged into irrational waters with this worm. So I'm done with humoring his need for conflict and attention.

But as I like your sense of humor I couldn't let your rebuttal go as if was hitting the target you think it does.

 

[DOC PENGUIN]

So your argument is, out of every single specialty derived from medical school training, psychiatrists use the least? Very well... It still doesn't matter. None of this matters.
QUOTE]

sure...that is part of my argument. As to your 'it doesn't matter' comment, ummm, none of this 'matters'. That's the nature of a discussion board. People discuss things about the current state of their field, what could be done differently/better/worse/etc, what the future holds....that is sort of the concept of these boards. Disagreement is acceptable.

That said, if this same series of posts were started in a medicine or surgery forum, the overwhelming consensus would be 'well duh.....'

Really, I call your bluff. Start one NOW. Because the only positive thing i have heard of (walking through your list of posts) was doing a Psych ER rotation.

Edit: SOrry Atom Bum, I was trying to post back to Vistiral not you, my bad.

 

[Member 3]

Interprofessional models of practice are the wave of the future, and will be important in psychiatry to be able to provide access to care in a cost-effective fashion. I am grateful for my NP and PA colleagues.

 

[Atom bum]

You know what else is the wave of the future? Psychiatrists that utilize their med school training instead of shunning it. The old school of separating psych and medicine needs to be abandoned. You absolutely should understand the endocrine system so you can prescribe medicine with the best of intentions instead of just throwing pills at a problem.

 

[vistaril]

You know what else is the wave of the future? Psychiatrists that utilize their med school training instead of shunning it. The old school of separating psych and medicine needs to be abandoned. You absolutely should understand the endocrine system so you can prescribe medicine with the best of intentions instead of just throwing pills at a problem.

oh please share with us how an extensive understanding of the endocrine system allows us to do this?

 

[Atom bum]

oh please share with us how an extensive understanding of the endocrine system allows us to do this?

As soon as you share how ophthalmologists use more of their med school training than psychiatrists.

 

[DOC PENGUIN]

As soon as you share how ophthalmologists use more of their med school training than psychiatrists.

He'll just throw out the surgeon card and then lambast you. if you want to argue Psychiatry's flaws, do it with Splik, as he is much more insightful.

 

[JourneyAgent]

As soon as you share how ophthalmologists use more of their med school training than psychiatrists.

I don't know if there's just a shortage of medically oriented psychiatrists here that tend to defending the field from it's spoiled children who couldn't figure out anything to useful to do with themselves besides acting out their psyhcosexual urges to get poled by the alpha specialties or what?

But it makes me sick to think of such perpetual beta company. Even as someone who likes nerds and eccentrics. If there really is no backbone, pride, and creativity in medicine with what we're doing. I have a crack of doubt about this field now. I'm happy with palliation when we have little else to offer. And looking for opportunities to use my medical training to help deliver medical care to the mentally ill. But if defending this pricks insolence is the best we can muster here....And...if that's representative....I just don't know. It's nauseating.

 

[billypilgrim37]

Don't worry. Most of us are trying to practice "rolling with resistance". In the emergency room, when somebody's on a rant about something ridiculous, it's generally best to just let them finish it off. Like the doberman in National Lampoon's Christmas Vacation, sometimes it's best to just let him finish when he gets ahold of your leg.

I can't help to throw in something sarcastic here and there. Vistaril is misrepresenting (i.e., flat out lying about) himself in some ways, and in other ways not.

Sometimes he actually says things that are accurate (broken clock is correct twice a day), and sometimes he even shows a slight edge of self awareness. But most of the time he's just playing to the lowest common denominator, and identifying with lazy, simplistic criticisms of psychiatry, hiding behind the fact that other medical fields (who, by definition, know much less about psychiatry than we do) don't have respect for our patients, and therefore don't have much respect for us. The extent to which this is true is highly variable, but apparently it's a pretty rich dynamic where he is. He's talked about his GI fellow fiancee, and it seems like in order to fit in, he's had to learn to criticize his field so he can hang with the cool kids. It's probably easier to agree that psychiatry is a joke when his IM friends think that than it is to articulate the actual value of what we do and risk not having anybody to go to the strip clubs with him. I've heard it gets kind of lonely in a strip club.

All I know is the practice of psychiatry he sees doesn't have a lot to do with what I see, and he struggles to be imaginative enough to imagine that other people have other experiences. He seems to be in a pretty resource-poor work environment where the psychiatrist's job is to pat somebody on the head with one hand and hand him a script with the other. That's not what all of us do.

So take heart. He's clearly in the minority in most of his opinions, though some of them have enough half-truths to not be entirely dismissable with a simple argument.

 

[JourneyAgent]

Don't worry. Most of us are trying to practice "rolling with resistance". In the emergency room, when somebody's on a rant about something ridiculous, it's generally best to just let them finish it off. Like the doberman in National Lampoon's Christmas Vacation, sometimes it's best to just let him finish when he gets ahold of your leg.

I can't help to throw in something sarcastic here and there. Vistaril is misrepresenting (i.e., flat out lying about) himself in some ways, and in other ways not.

Sometimes he actually says things that are accurate (broken clock is correct twice a day), and sometimes he even shows a slight edge of self awareness. But most of the time he's just playing to the lowest common denominator, and identifying with lazy, simplistic criticisms of psychiatry, hiding behind the fact that other medical fields (who, by definition, know much less about psychiatry than we do) don't have respect for our patients, and therefore don't have much respect for us. The extent to which this is true is highly variable, but apparently it's a pretty rich dynamic where he is. He's talked about his GI fellow fiancee, and it seems like in order to fit in, he's had to learn to criticize his field so he can hang with the cool kids. It's probably easier to agree that psychiatry is a joke when his IM friends think that than it is to articulate the actual value of what we do and risk not having anybody to go to the strip clubs with him. I've heard it gets kind of lonely in a strip club.

All I know is the practice of psychiatry he sees doesn't have a lot to do with what I see, and he struggles to be imaginative enough to imagine that other people have other experiences. He seems to be in a pretty resource-poor work environment where the psychiatrist's job is to pat somebody on the head with one hand and hand him a script with the other. That's not what all of us do.

So take heart. He's clearly in the minority in most of his opinions, though some of them have enough half-truths to not be entirely dismissable with a simple argument.

Thanks Billy. From all the students here struggling to pick something we feel drawn to that others tend to denigrate. We really appreciate you and the others taking time to help us though the process.

 

[F0nzie]

This thread is a disaster.

It's important for medical students to have a basic understanding of healthcare reform and how the practice of medicine is shifting towards more cost containment strategies to mitigate the unsustainable healthcare costs. With this, comes a push for more mid-level providers that can be trained at a lower cost with less years of education to meet shortage demands more quickly. Also, there is a shift toward reimbursement cuts for procedures for nearly all medical specialties. General psychiatry is essentially immune to these changes unless you deliver ECT all day which already reimburses poorly and is not likely to be affected. There is also a shift toward increasing salaries for the primary care specialties-- this trend is very apparent.

As for Psychiatry, it is well established in the medical community and not likely going anywhere for the rest of our lifetimes. I can however identify with the frustration with the lack of new and exciting pharmacology that will place us on the cutting edge of science within the medical community. We need to recognize the limitations for rapid advancement into new and novel treatments in this highly complex and relatively underfunded specialty.

The current practice environment is very good. Lot of job opportunities. Fairly good negotiating power for flexible scheduling. Very livable salary. Great hours. Limited call or no call. I am very satisfied.

 

[vistaril]

As soon as you share how ophthalmologists use more of their med school training than psychiatrists.

opthalmologists are surgeons....that alone forces them use more of their med school training.

 

[vistaril]

I don't know if there's just a shortage of medically oriented psychiatrists here that tend to defending the field from it's spoiled children who couldn't figure out anything to useful to do with themselves besides acting out their psyhcosexual urges to get poled by the alpha specialties or what?

But it makes me sick to think of such perpetual beta company. Even as someone who likes nerds and eccentrics. If there really is no backbone, pride, and creativity in medicine with what we're doing. I have a crack of doubt about this field now. .

All I can say is that if you actually believe the stuff I(a psychiatrist) write is degrading to psychiatry, you probably want to cover your ears/eyes for what people who actually do denigrate the field say/write about our field. I'm pretty darn content to be in this field....I just take it for what it is and am not going to hold back criticism at times.

frankly a lot of this I see expressed in this thread, especially from med students, seems defensive and goes towards exposing their self doubts and insecurities more than anything else.

Additionally, I don't think anyone picks a specialty in part because of what people say on an anonymous message board. Gosh I hope they don't.

 

[vistaril]

He'll just throw out the surgeon card and then lambast you.

lol....'throwing out the surgeon card' to argue what someone does is related to med school is like 'throwing out the nobel card' to argue someone was an important scientist or 'throwing out the 16 majors card' to argue jack nicholas was a great golfer.

 

[vistaril]

I don't know if there's just a shortage of medically oriented psychiatrists here that tend to defending the field from it's spoiled children who couldn't figure out anything to useful to do with themselves besides acting out their psyhcosexual urges to get poled by the alpha specialties or what?

But it makes me sick to think of such perpetual beta company..

whoa....just because you are a beta in medicine(or really below the betas) doesn't mean you have to be a beta in other phases of your life.

My fiance makes a lot more money than me(or at least is about to in 5 months) and is in a more respected occupation, but that doesn't mean I assume beta role in other areas. I decide what's for dinner, where we go on vacation, where we live, etc....and that's the way she likes it.

Additionally, you're comment about 'medically oriented psychiatrists' doesn't make sense given your other arguments. The only way for a psychiatrist to step out of sub-beta role in occupational hierarchy is to go with a less biological/medical approach. Because stephen stahl himself is not going to 'outmedical' anyone in medical specialties...changing the playing field(ie being an analyst) is really one way to work your way into a non-beta role. It will be on a different sort of playing field, but at least it can be a non-beta role...

 

[billypilgrim37]

My fiance makes a lot more money than me(or at least is about to in 5 months) and is in a more respected occupation, but that doesn't mean I assume beta role in other areas. I decide what's for dinner, where we go on vacation, where we live, etc....and that's the way she likes it.

But she picks the strip club, right?

Sent from my DROID RAZR using SDN Mobile

 

[Atom bum]

opthalmologists are surgeons....that alone forces them use more of their med school training.

How? Stop beating around the bush and answer me. So far I have not done a single god damn surgery in med school. Do surgeons take Hs and Ps? I doubt it. Do surgeons make a differential list? Maybe but so does everyone else.
Am I going to the worst med school in the country because we have not been doing surgery daily?

Mother ****ing Poe's law up in this thread.

 

[vistaril]

How? Stop beating around the bush and answer me. So far I have not done a single god damn surgery in med school. Do surgeons take Hs and Ps? I doubt it. Do surgeons make a differential list? Maybe but so does everyone else.
Am I going to the worst med school in the country because we have not been doing surgery daily?

Mother ****ing Poe's law up in this thread.

arguing how surgery is related to medical school is absurd......actually stooping to the level to answer such a question opens up the possibility of answering how *anything* is related to medical school.....how is the pulmonary exam related to med school? how is acid-base evaluation related to med school? how is the cardiac exam related to med school? And on and on.....I mean it's like asking 'how is medicine related to medical school'?

 

[BS81]

General surgeons definitely use their medical school training. They actually manage their patients on the floors, etc. Ophthalmologists, I don't know... I still don't see it. They do their 15-30 minute procedures 20-30 at a time per day. They do eye exams. Where is the need for med school in that?

At least we had an integrative Neuroscience course first year and a month of Psychiatry/Behavioral Sciences during second year, plus six weeks of Psych third year. The extent of ophthy during med school is learning about glaucoma and the drugs that effect it... and that's about it.

 

[vistaril]

But she picks the strip club, right?

Sent from my DROID RAZR using SDN Mobile

heck no....she isn't even always invited.

 

[Atom bum]

arguing how surgery is related to medical school is absurd......actually stooping to the level to answer such a question opens up the possibility of answering how *anything* is related to medical school.....how is the pulmonary exam related to med school? how is acid-base evaluation related to med school? how is the cardiac exam related to med school? And on and on.....I mean it's like asking 'how is medicine related to medical school'?

I'm not talking about surgery, I am talking about Ophthalmology. I realize general surgeons utilize a lot of what we learn, but ophthalmologists? Come on man.

As far as how endocrinology is important? What about mental instability caused by excess hormones? How about the many many endocrine related side effects caused by many of the drugs utilized by psychs? I guess that doesn't count because it could be learned in a specialty program right? Kind of like an ophthalmologist could learn about the eye from a specialty program? Oh wait, I guess not, because they are surgeons.....................

 

[billypilgrim37]

heck no....she isn't even always invited.

Come on, dude. Let her pick some!

You might be humored by this. My friend eloped while she and a few of us were out in San Francisco. After the wedding and an impromptu dinner/reception, she looked at me and said, "Hey! You've never been to a strip club! Do you wanna go?" I said, "Sure!" She asked, "A male one or a female one?" I replied, "Umm..."

(Hey, there's a reason we disagreed so much on that "spectrum of sexuality" thread!)

Her new husband nixed it (she looked pretty disappointed), and we went to Bourbon and Branch instead (Where I accidentally paid 40 bucks for a double of black maple hill? The whole bottle doesn't cost that much! I could never live in a place where I can't afford the bourbon.).

 

[vistaril]

As far as how endocrinology is important? What about mental instability caused by excess hormones? How about the many many endocrine related side effects caused by many of the drugs utilized by psychs? I guess that doesn't count because it could be learned in a specialty program right? QUOTE]

No it doesn't count because your points were some combination of vague, superficial and meaningless. Yes, there are many endocrine related side effects caused by different psych drugs. One should know these and that will affect prescribing practices. But knowing that Olanzapine causes increased risk for hyperglycemia, dyslipidemia, etc does not imply that an 'extensive'(your word) understanding of the endocrine system is needed.

 

[Atom bum]

As far as how endocrinology is important? What about mental instability caused by excess hormones? How about the many many endocrine related side effects caused by many of the drugs utilized by psychs? I guess that doesn't count because it could be learned in a specialty program right? QUOTE]

No it doesn't count because your points were some combination of vague, superficial and meaningless. Yes, there are many endocrine related side effects caused by different psych drugs. One should know these and that will affect prescribing practices. But knowing that Olanzapine causes increased risk for hyperglycemia, dyslipidemia, etc does not imply that an 'extensive'(your word) understanding of the endocrine system is needed.

Jesus christ. There is a difference between debate and being straight up contrary.

Oh look, you know the side effects. Why does it cause them? Did you just read the insert? Do you have any idea how the drugs you prescribe work? If you answer yes, there is your med school education.

Still haven't answered how opthalmologists use more training than psychiatrists.
You know what is funny about this? I asked my friend, an ophthalmology resident about this and he said "I gave up medicine to be an ophthalmologist". I guess his opinion doesn't count for some reason.

 

[BS81]

well that is pretty much all the stuff I usually state.

You just have a habit of hyperbolizing everything you say and making everything sound as undiplomatic as possible. I think we can have some really interesting discussions regarding the things you bring up, but it seems like you are more interested in antagonizing than stimulating conversation.

 

[vistaril]

Come on, dude. Let her pick some!

You might be humored by this. My friend eloped while she and a few of us were out in San Francisco. After the wedding and an impromptu dinner/reception, she looked at me and said, "Hey! You've never been to a strip club! Do you wanna go?" I said, "Sure!" She asked, "A male one or a female one?" I replied, "Umm..."

(Hey, there's a reason we disagreed so much on that "spectrum of sexuality" thread!)

Her new husband nixed it (she looked pretty disappointed), and we went to Bourbon and Branch instead (Where I accidentally paid 40 bucks for a double of black maple hill? The whole bottle doesn't cost that much! I could never live in a place where I can't afford the bourbon.).

Dont know if they have changed it(i doubt they have), but as recently as a year and a half ago san fran had a local law that prevented full nudity at establishments that sold alcohol. So you either get full nudity and no beer/liquor, or not full nudity and beer/liquor. The result is that the full nudity places are really sketchy and low class for the most part, so I've never gone to them the times I have been in san francisco. The non full nudity alcohol clubs are hit or miss, with Gold club and hustler club being the best.

Honestly, if gold club didn't have the nudity restrictions, it would probably be one of the top 6-7 clubs in the country.

 

[vistaril]

You just have a habit of hyperbolizing everything you say and making everything sound as undiplomatic as possible. I think we can have some really interesting discussions regarding the things you bring up, but it seems like you are more interested in antagonizing than stimulating conversation.

well this is an anon message board...being a little contrarian and undiplomatic is cool. It's a nice contrast to the annoyance of having to do the opposite in real life(cordial and formal)

 

[xlithiumx]

well this is an anon message board...being a little contrarian and undiplomatic is cool. It's a nice contrast to the annoyance of having to do the opposite in real life(cordial and formal)

The fact that you find the need to be cordial an annoyance is both telling and unsurprising.

 

[JourneyAgent]

The Fonz is right. This thread is a mess.

Atom, I hear you. I think both of us would like 5 minutes in the ring with this dude, but, it's not worth it. It's like you said he's a femme fatale of contrarian drama. There's no pugilistic thrill of competing ideas, competing for the useful direction of psychiatry. You just end up feeling slimy for getting into it with It. As soon as It has you riled up It's happy. And back to waiting for the next surgeon in leather to come along.

It's just...so...not worth any of it.

The only bad thing is. It f@cks up the scene. What could be a place of good conversation, including the fruitful elements of Splik's revisionist psychiatry, becomes kardashian theater. But.... you know, that's how it goes.