Psych

[Angry Birds]

I have zero sympathy for psych patients now. I don’t think we should treat it. Let patients kill themselves. I don’t care. Learn to cope with your problems. Be an adult.

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[hoot504]

Hmmm, sounds like there's a story behind this thread.

 

[RustedFox]

Yep.

I'm on board.

Let them kill themselves.

The planet is overpopulated by 1.5 billiion or so.

Really.



No argument.

 

[clibby]

We have some burnt out EM docs in this forum...

 

[Zebra Hunter]

While I don't agree with the sentiment of the OP, and I doubt the OP truly does either (probably just had a rough shift), I do think we should have more protection to tell a patient to GTFO when they are likely malingering. Preferably, I could discharge the homeless guy immediately who has presented for the 10th time in the last 6 months for wanting to kill himself or get permanent placement for the chronically off his meds schizoaffective disorder dude, so that our local psych facilities had more space for those that truly need crisis intervention. The mental health system in the US is in shambles because of patient abuse of the system, lack of a permanent solution for the chronically 'gravely disabled', and the risk of turning anyone away due to fear of being sued.

 

[GonnaBeADoc2222]

Our job is really hard.

I have friends in addiction medicine and psych. What's nice for them is that they get to see mostly motivated patients in an outpatient setting who are engaged in their own care.

We are the "safety net." While ideally this would mean that we are the last bastion of hope for some people and able to provide real services, in practicality it ends up being a never ending revolving door of the same patients, suicidal patients boarding in the hallway for 30 hrs, medicalization of things like alcohol intoxication, etc.

Every shift ends.

 

[Angry Birds]

Hmmm, sounds like there's a story behind this thread.

Yesterday over fifty percent of my ER was psych. I wanted to section myself.

 

[Tenk]

I don’t think we should do the dog and pony show for all these attention seeking teens and 20 year olds. Should just be a very fast medical clearance and outpatient referral. The only real inpatient psych should be for schizos and other people who could endanger others. Yeah, maybe 1/1000 of those people will go home and actually kill themselves but it would save so much time and money for society and not reward these people for coming in and saying they feel sad.

 

[VA Hopeful Dr]

Yesterday over fifty percent of my ER was psych. I wanted to section myself.

You're pregnant?

 

[WilcoWorld]

I don’t think we should do the dog and pony show for all these attention seeking teens and 20 year olds. Should just be a very fast medical clearance and outpatient referral. The only real inpatient psych should be for schizos and other people who could endanger others. Yeah, maybe 1/1000 of those people will go home and actually kill themselves but it would save so much time and money for society and not reward these people for coming in and saying they feel sad.

You've got a good point there.

 

[bravotwozero]

Yesterday over fifty percent of my ER was psych. I wanted to section myself.

Yup, been there, done that. Also personally witnessed a nurse being put into a headlock by a psychotic 16 year old who had been boarding for 5 days. Had that patient not been a pedi case, would have just called the cops and have her sent to jail. That was the turning point for me, in deciding I wanted to work there as less as possible. When my group got the contract for another ED, I jumped at the opportunity to switch.

 

[engineeredout]

Rotated at one hospital who did a tele-psych sort of thing, where a psychiatrist would interview the patient, and eventually come back and tell us something like "she doesn't have a well defined plan, I don't think she's an active danger to herself, can follow up with outpatient services". Seems like a better use of resources than sending them all to the nearest crisis center.

OTOH these nonsense suicidal patients are my easiest patients of the shift. They get the "psych order set" (worthless labs and UDS that the crisis center won't accept a patient without) and the unit clerks handle arranging transportation.

 

[turkeyjerky]

Rotated at one hospital who did a tele-psych sort of thing, where a psychiatrist would interview the patient, and eventually come back and tell us something like "she doesn't have a well defined plan, I don't think she's an active danger to herself, can follow up with outpatient services". Seems like a better use of resources than sending them all to the nearest crisis center.

OTOH these nonsense suicidal patients are my easiest patients of the shift. They get the "psych order set" (worthless labs and UDS that the crisis center won't accept a patient without) and the unit clerks handle arranging transportation.

We have a telepsych program, unfortunately I've rarely if ever seen them recommend discharge except for when it was painfully obvious, and it that case they invariably recommend I write a Rx for some antidepressant, without any establishment of followup care. So I don't find it completely useful