Psychiatrist vs. Psych NP?

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If you do the same things that the psychiatrists do but for less money, why doesn't the hospital just hire a bunch of NPs to replace the MDs?

Good question. The answer is complex and varies by state/location/specialty.

In psych, there's a shortage of physicians, but there's also a bad shortage of mid-levels. Did you know that psych is one of the highest paying fields for PA's? It's because there aren't any, so the few that exist can command high prices. That's one reason.

Second, many people still want an MD treating them. Depends on the problem, but for the more serious things, it's true. Less of problem in inpatient psych, given the insight of the patient population, but can be an issue for outpatient psych and definitely for things like cardiology, etc.

Finally, hospitals ARE doing this. Look at anesthesia. Look at some ER's. Look at some hospital-owned FP offices. It's happening, slowly. As the budget crunch comes down from the government over the next 5-10 years, I'd expect to see even MORE mid-levels working as "attendings."

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The nurse practitioner population will nearly double by 2025, according to an analysis published in the July Medical Care, the official journal of the medical care section of the American Public Health Assn.

“Nurse practitioners really are becoming a growing presence, particularly in primary care,” said David I. Auerbach, PhD, the author and a health economist at RAND Corp.
 
I'm not asking this to be antagonistic, but I'm wondering...what diseases do you learn about? Can you give us some examples, and the depth.

For example, does the depth extend to include Lyme encephalitis or other infectious diseases? Do you learn about the physiology of pregnancy and its effect on thyroid hormones, drug levels, and rx choice? Temporal lobe epilepsy? HIV and toxoplasmosis? Hemochromatosis as it relates to psychiatric disease?

These are just a few things off the top of my head that I diagnosed or had to deal with this past year as a 3rd year medical student

Would you have put 2 and 2 together and realized that your patient with depression, joint aches, fatigue, and heart arrhythmias (no obvious "bronze skin") had hemochromatosis?

I missed this one. I'll make this short. I use the mnemonic "MEND A MIND."

Metabolic
Electrical
Neoplastic
Drug
Arterial
Mechanical
Infectious
Nutritional
Degenerative
 
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I assume epilepsy, etc
 
Seizures might be neoplastic, vascular, etc.... epilepsy isn't by definition

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Seizures might be neoplastic, vascular, etc.... epilepsy isn't by definition

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epilepsy is the tendency to recurrent seizures...whether this is due to a brain tumor, an AVM, wegener's, autoimmune encephalitis etc
 
epilepsy is the tendency to recurrent seizures...whether this is due to a brain tumor, an AVM, wegener's, autoimmune encephalitis etc

haha....I gotta admit, a bunch of psych residents talking about epilepsy is always good for a laugh!
 
I guess the definition might have broadened, but most of my books still define it as a primary seizure disorder without an identifiable cause.

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haha....I gotta admit, a bunch of psych residents talking about epilepsy is always good for a laugh!

Yes. Because lowly psychiatrists should never do more than prescribe benzos to drug seekers.

I guess we're not certified by the board of psychiatry and neurology anymore. That's good, I hate neurology.

It's a good thing that you don't know anything about anything either, since you're also a "psychiatrist". Otherwise, you might be right about something, and I think that might cause the world to explode.
 
Yes. Because lowly psychiatrists should never do more than prescribe benzos to drug seekers.

I guess we're not certified by the board of psychiatry and neurology anymore. That's good, I hate neurology.

It's a good thing that you don't know anything about anything either, since you're also a "psychiatrist". Otherwise, you might be right about something, and I think that might cause the world to explode.
why do you hate it? Sure, they claim that they are better and they routinely insult us, but thats not a lot to hate about. Now IM vs Surgery, that is a stupid fight.
 
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I guess the definition might have broadened, but most of my books still define it as a primary seizure disorder without an identifiable cause.

I would be interested to know which books define as such because epilepsy has not to my knowledge been defined as such and is not by any of the major epilespy societies. Whilst the majority of epileptiform conditions are idiopathic, genetic causes are well established in a minority (e.g. autosomal dominant nocturnal frontal lobe epilepsy and Dravet syndrome), and the International League Against Epilepsy also notes structural/metabolic as a third etiological entity, e.g. neurofibromatosis, tuberous sclerosis, sturge-weber syndrome etc.

I have a special interest in epilepsies and plan on treating epilepsy when I finish residency, as in much of the world (where I will likely end up) epilepsy is classified as a psychiatric disorder.
 
You're almost beating a dead horse here about duties. Where I'm at there is almost no difference except the shrinks make more and my boss has to attended those dreaded management meetings and get beaten up by admin. I just see patients...and patients...and patients.

Duties do not connote expertise.
 
Haa! At least one person reads my posts.

:eek:

I loathe getting involved in this thread, but I'm confused, aren't complex partial seizures merely one type of seizure? I'm kind of with splik, "electrical" I suppose is what I'd call neurological, you can't ding someone for not understanding a semantic difference built to fit a mnemonic and then play holier than thou without looking a bit foolish.

In any case, at my med schools psych dept, the NP does a ton of good groundwork and the psychiatrists are a mix of remote managers and micromanagers. Either way it is very clear who is in the position of greater power, duh, but that doesn't in any way mean that NPs aren't important and competant providers. Also doctors will never be completely replaced by mid levels or whatever you call them especially in hospitals due to the medicolegal environment of the US. We need someone to blame...err...take responsibility for mistakes right?
 
i believe that scientologists are skeptical about medication in general, and medical treatment, they just reserve the most scorn for psychiatry.
 
Duties do not connote expertise.

Lovely usage....isn't the trouble in this case though that duties do connote, just incorrectly....

Ive just spent a wonderful 15 min exploring the difference between connote and denote....thanks:)
 
i believe that scientologists are skeptical about medication in general, and medical treatment, they just reserve the most scorn for psychiatry.

It goes more than that. They've put in millions specifically into fighting psychiatry, made a front-group called Citizens Commission for Human Rights, dedicated to fighting psychiatry, made an anti-psychiatry museum, and a video calling psychiatry an "industry of death."

This isn't just "scorn" for western medicine. They've accused us with causing the Nazi movement, making Osama Bin Laden into a terrorist using psychiatric techniques, say we're responsible for 9-11, among pretty much every other whacky thing you can think of. (Oh no, they're onto me. In real life I'm Cobra Commander, Destro, I need a shipment of laser assault rifles now!)

http://teapotatheism.blogspot.com/2009/02/scientology-psychiatry-made-osama-bin.html
http://en.wikipedia.org/wiki/Psychiatry:_An_Industry_of_Death

http://www.youtube.com/watch?v=Am69VRizgX8

Why take it to such extreme I don't know, but the theories are that Hubbard had a hard-on against psychology and psychiatry because in his attempt to make some money, he made a psychotherapy center that had no science backing up his practice and was shut down based on recommendations by both APAs. That psychotherapy center became Scientology and he turned it into a religion because as such, you can't define what is to be acceptable or not and he had tax shelter.

Some of their criticisms of the field actually are legit but are on the same grounds as having problems with any bad doctor. There are bad psychiatrists out there just as there's bad surgeons, ob-gyn doctors, policemen, etc. That's the type of stuff where I actually think there should be criticism going on because in that regard it would make us a better field. Unfortunately they're not trying to be an advocacy or consumer watch-dog group. What they do is instead of trying to bring-down the bad doctors in the field, they use them and try to portray the entire field as bad by only reporting the actions of the bad ones.

Then there's the other stuff that is true but is from decades to even hundreds of years ago that they're still trying to rake us over the coals such as lobotomies that fell out of favor decades ago. The rest of the stuff is just pure BS like trying to say we masterminded 9-11 (Hey Hitler, only we know you're really still alive, I'll see you at the party next weekend. Don't forget the bean-dip and tell Eva I said hi).

I've mentioned this several times in other threads. There are things in this field (as any field) that need improvement, and some things that frankly I think 10 years from now will be seen with scorn such as we now see lobotomies are bad treatment decades ago. A difference is I state these to improve the situation. The Scientologists have a paranoid belief that we're some type of space aliens (not joking) bent on taking over the world for the purposes of evil and are locked into some type of self-declared war upon us to take us down because they believe we're Decepticons or something like that. Hey if that was the case, where the heck is my holodeck? I'd love to put on the Playboy Mansion program (I'm being semi-sarcastic, we're all adults, and yes my wife occasionally reads these forums).
 
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It goes more than that. They've put in millions specifically into fighting psychiatry, made a front-group called Citizens Commission for Human Rights, dedicated to fighting psychiatry, made an anti-psychiatry museum, and a video calling psychiatry an "industry of death."

This isn't just "scorn" for western medicine. They've accused us with causing the Nazi movement, making Osama Bin Laden into a terrorist using psychiatric techniques, say we're responsible for 9-11, among pretty much every other whacky thing you can think of. (Oh no, they're onto me. In real life I'm Cobra Commander, Destro, I need a shipment of laser assault rifles now!)

http://teapotatheism.blogspot.com/2009/02/scientology-psychiatry-made-osama-bin.html
http://en.wikipedia.org/wiki/Psychiatry:_An_Industry_of_Death

http://www.youtube.com/watch?v=Am69VRizgX8

Why take it to such extreme I don't know, but the theories are that Hubbard had a hard-on against psychology and psychiatry because in his attempt to make some money, he made a psychotherapy center that had no science backing up his practice and was shut down based on recommendations by both APAs. That psychotherapy center became Scientology and he turned it into a religion because as such, you can't define what is to be acceptable or not and he had tax shelter.

Some of their criticisms of the field actually are legit but are on the same grounds as having problems with any bad doctor. There are bad psychiatrists out there just as there's bad surgeons, ob-gyn doctors, policemen, etc. That's the type of stuff where I actually think there should be criticism going on because in that regard it would make us a better field. Unfortunately they're not trying to be an advocacy or consumer watch-dog group. What they do is instead of trying to bring-down the bad doctors in the field, they use them and try to portray the entire field as bad by only reporting the actions of the bad ones.

Then there's the other stuff that is true but is from decades to even hundreds of years ago that they're still trying to rake us over the coals such as lobotomies that fell out of favor decades ago. The rest of the stuff is just pure BS like trying to say we masterminded 9-11 (Hey Hitler, only we know you're really still alive, I'll see you at the party next weekend. Don't forget the bean-dip and tell Eva I said hi).

I've mentioned this several times in other threads. There are things in this field (as any field) that need improvement, and some things that frankly I think 10 years from now will be seen with scorn such as we now see lobotomies are bad treatment decades ago. A difference is I state these to improve the situation. The Scientologists have a paranoid belief that we're some type of space aliens (not joking) bent on taking over the world for the purposes of evil and are locked into some type of self-declared war upon us to take us down because they believe we're Decepticons or something like that. Hey if that was the case, where the heck is my holodeck? I'd love to put on the Playboy Mansion program (I'm being semi-sarcastic, we're all adults, and yes my wife occasionally reads these forums).

There was a very intersting website I found years ago that stated that Hubbards hatred of psychiatry stemmed in part from being ignored by VA when he tried to get mental health treatment for himself. Had a lot of intersting alleged documents of his written to VA requesting help and personal accts from those close to him that he seemed to fit the bill of a paranoid schizophrenic.

They detailed some pretty interesting things a bout his bizarre behavior in the navy, several examples of paranoid delusions, etc. I hope its still up and running. I'll post it in a separate thread if I can re-find it.
 
There was a very intersting website I found years ago that stated that Hubbards hatred of psychiatry stemmed in part from being ignored by VA when he tried to get mental health treatment for himself. Had a lot of intersting alleged documents of his written to VA requesting help and personal accts from those close to him that he seemed to fit the bill of a paranoid schizophrenic.

They detailed some pretty interesting things a bout his bizarre behavior in the navy, several examples of paranoid delusions, etc. I hope its still up and running. I'll post it in a separate thread if I can re-find it.

I seem to remember seeing some scanned hand-written notes of his about scientology (at least as best I could tell) that wouldn't discredit this claim, although I could be misremembering things.
 
I seem to remember seeing some scanned hand-written notes of his about scientology (at least as best I could tell) that wouldn't discredit this claim, although I could be misremembering things.

Yes! These kind of documents were on this site. THere were also typed pages, documents to and from the VA, and others. It was prob about five years ago. When I am finally OFF for a whole weekend this weekend I will spend some wonderful leisure time looking for the site, I hope its still around.
 
Yes! These kind of documents were on this site. THere were also typed pages, documents to and from the VA, and others. It was prob about five years ago. When I am finally OFF for a whole weekend this weekend I will spend some wonderful leisure time looking for the site, I hope its still around.

A (very) quick google image search pulled up one or two notes in which he writes about Xenu and a few other things, but I don't think either of them is the note to which I was originally referring. Still makes for some interesting reading, though.

If the site you're talking about isn't still up, I'd be surprised if a half-dozen haven't taken its place at this point, given the publicity scientology's received after all of Tom Cruise's media frenzies.

Edit: And enjoy the weekend off.
 
'd be surprised if a half-dozen haven't taken its place at this point

Scientology has an established reputation of silencing people through intimidation. This was well-documented in Time Magazine among several other sources. Their typical modus operandi is launching a lawsuit against someone, and then when the person wins, they launch another, then another, forcing the person into bankruptcy.

They've also bought out some of their most vocal critics, and then have the same organization they took over write pro-Scientology material before silenting causing that group to just quietly go away.
 
Scientology has an established reputation of silencing people through intimidation. This was well-documented in Time Magazine among several other sources. Their typical modus operandi is launching a lawsuit against someone, and then when the person wins, they launch another, then another, forcing the person into bankruptcy.

They've also bought out some of their most vocal critics, and then have the same organization they took over write pro-Scientology material before silenting causing that group to just quietly go away.

Scientology uses CHCC, and their campaign has gained rapid support by people who feel cheated by psychiatry in general. Think about why CHCC keep spewing things like SSRI's don't work, Psych is pseudoscience, or STOP LABELING. It appeals to people's emotion and instinct. And Instinct and Emotion are much more powerful than logic and rationale (Young Ron Paul Supporters, Anti-War protesters and Anti Psychs have a lot in common)

Hell, this sentiment is so powerful that it has branched to other medical fields (although not as potent.) You know have a new generation of activist Medical students that believe this ****. Here are two rambles by a medical student and his experience with psych.

http://halfmd.wordpress.com/2008/02/25/the-fake-doctors/

http://halfmd.wordpress.com/2008/02/05/you-wont-believe-the-stuff-i-saw-today/
 
Scientology uses CHCC, and their campaign has gained rapid support by people who feel cheated by psychiatry in general. Think about why CHCC keep spewing things like SSRI's don't work, Psych is pseudoscience, or STOP LABELING. It appeals to people's emotion and instinct. And Instinct and Emotion are much more powerful than logic and rationale (Young Ron Paul Supporters, Anti-War protesters and Anti Psychs have a lot in common)

Hell, this sentiment is so powerful that it has branched to other medical fields (although not as potent.) You know have a new generation of activist Medical students that believe this ****. Here are two rambles by a medical student and his experience with psych.

http://halfmd.wordpress.com/2008/02/25/the-fake-doctors/

http://halfmd.wordpress.com/2008/02/05/you-wont-believe-the-stuff-i-saw-today/

Their chant at the APA protests was "drugs, shock, and death, all you have left!" accompanied by ten foot tall mobile screening of chcc movies, roving images of empty beds and dangling restraints, piles of money, etc.
 
Also, to anyone thinking of joining these folks, be prepared for your world to get a whole lot whiter. Divers they're not.
 
Scientology uses CHCC, and their campaign has gained rapid support by people who feel cheated by psychiatry in general. Think about why CHCC keep spewing things like SSRI's don't work, Psych is pseudoscience, or STOP LABELING. It appeals to people's emotion and instinct. And Instinct and Emotion are much more powerful than logic and rationale (Young Ron Paul Supporters, Anti-War protesters and Anti Psychs have a lot in common)

Hell, this sentiment is so powerful that it has branched to other medical fields (although not as potent.) You know have a new generation of activist Medical students that believe this ****. Here are two rambles by a medical student and his experience with psych.

http://halfmd.wordpress.com/2008/02/25/the-fake-doctors/

http://halfmd.wordpress.com/2008/02/05/you-wont-believe-the-stuff-i-saw-today/[/QUOTE

it's interesting to see the comments on those posts....including most coming from people in "mainstream" medicine. we are kidding ourselves if we believe significant numbers of students, residents, and attendings in other fields don't take this specialty seriously....or at least as serious as other things.

I *do* think psychiatry can do some good, and I *do* think we can improve it. I think it's an uphill battle in many respects though......
 
to expand on this, I think why so many med students, residents, and attendings don't take psychiatry all that seriously isn't as interesting as many want to believe: they think the non md people(psychologists and the good lcsw types) do therapy as well or better than us, and they think the pharmacotherapy aspect of things isnt too damn complicated.....I think a lot of them do acknowledge the difficulty in assessment/dx, but they feel the difficulty in even establishing dx guidelines makes this a joke anyways....
 
to expand on this, I think why so many med students, residents, and attendings don't take psychiatry all that seriously isn't as interesting as many want to believe: they think the non md people(psychologists and the good lcsw types) do therapy as well or better than us, and they think the pharmacotherapy aspect of things isnt too damn complicated.....I think a lot of them do acknowledge the difficulty in assessment/dx, but they feel the difficulty in even establishing dx guidelines makes this a joke anyways....

I can't believe I'm about to say this, but I think you're right. :laugh:

I think in terms of simple cases or single med management this is definitely the case. Once they start dealing with more complicated cases though, they quickly get in over their heads.

I'm on medicine now, and we've got someone on a complex regimen being complicated by a slightly prolonged QT, TONS of anxiety, and a very difficult diagnostic (at least as far as psych goes) case. Medicine guys have been begging the patient to accept a psych consult for weeks. Finally relented and they are so grateful. :bow::bow::bow:

I like this new, calmer vistaril. I've now read two of your posts today without wanting to murder you! New record! W00t!
 
Also, to anyone thinking of joining these folks, be prepared for your world to get a whole lot whiter. Divers they're not.

Goebell's statement is beginning to show suit. These MD's are beginning to show their anger. Soem even want to kill us with CHCC crap. Creating an alternate APA is already too stupid. BTW, Does anybody agree with me that we need a new biological way of diagnosing, rather than the DSM. They do have a point on the DSM.
 
BTW, Does anybody agree with me that we need a new biological way of diagnosing, rather than the DSM. They do have a point on the DSM.

We're not ready for a biological way of diagnosing, (and I don't know if we'll ever be ready to be that simply reductionistic).
 
We're not ready for a biological way of diagnosing, (and I don't know if we'll ever be ready to be that simply reductionistic).

Well, we have to develop a reductionist way of psychiatry soon. Many think Neuro already has the answer. Why do you think people want to see a neurologist instead of a psychiatrist, or people want their Family physician to prescribe and help rather than facing a minor stigma.
The DSM also do have some Pharma industry connections. It is too soon to tell but in 50 or so years, a reductionist or super-biological model will have to be apart of the bread and butter.
 
Well, we have to develop a reductionist way of psychiatry soon. Many think Neuro already has the answer. Why do you think people want to see a neurologist instead of a psychiatrist, or people want their Family physician to prescribe and help rather than facing a minor stigma.
The DSM also do have some Pharma industry connections. It is too soon to tell but in 50 or so years, a reductionist or super-biological model will have to be apart of the bread and butter.

Why will we? And is this a good necessity?

What Answer does neuro have?

How is said stigma related to purported necessity (and possibility) of reductionism?

Why state the pharma connections, and again, how does that imply we should have reductionism?

If it is too soon to tell, how do you tell it is seemingly going to be a part of what bread and butter?

And most importantly, even if all of that is explained, why do we think that everything can be boiled down to simple biological tests...even if that would be preferred by stigmatized patients, pharma, et al.

Will biological cures fix poor social environments, homelessness, abuse, too? Thatd be sweet.
 
Well, we have to develop a reductionist way of psychiatry soon. Many think Neuro already has the answer. Why do you think people want to see a neurologist instead of a psychiatrist, or people want their Family physician to prescribe and help rather than facing a minor stigma.
The DSM also do have some Pharma industry connections. It is too soon to tell but in 50 or so years, a reductionist or super-biological model will have to be apart of the bread and butter.

I say it again...how young, how naive!

*addendum*

so why do none of my patients when i ask them 'so how did someone like you end up being a mental patient?' say 'because of a chemical imbalance' (or some other reductionistic model unless they've been well indoctrinated?)

Today I was teaching my medical student about levels of explanation, and how we could understand schizophrenia from 4 different perspectives with 4 different patients. Only one of these patients did I use a neurobiological model (and even this wasn't entirely reductionistic because it used the idea of dopamine as mediator of motivational salience combined with dynamic, cultural, cognitive elements to explain positive symptoms of psychosis). The other 3 patients I formulated their psychosis using cognitive, social realist, and developmental deviance models respectively. These students now have a lot more understanding and empathy, and a sense of feeling their way into the patients' experiences than they would if I had a single explanatory level or framework for all of them. If your naiveity turns out to be reality, then I fear for the future of psychiatry and patients we care for.
 
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Why will we? And is this a good necessity?

What Answer does neuro have?

How is said stigma related to purported necessity (and possibility) of reductionism?

Why state the pharma connections, and again, how does that imply we should have reductionism?

If it is too soon to tell, how do you tell it is seemingly going to be a part of what bread and butter?

And most importantly, even if all of that is explained, why do we think that everything can be boiled down to simple biological tests...even if that would be preferred by stigmatized patients, pharma, et al.

Will biological cures fix poor social environments, homelessness, abuse, too? Thatd be sweet.
1. Technically, none. But they make up for it by having a great understanding and anatomy of both the brain and nervous system (i believe splik said that and i thank him.)

2. It proves that, while empathy and compassion drive psychiatry, people (like me) will still bitch about how there are no tests or so called "reliable" figures for diagnosis. These usually come from disgruntled outpatients or badly treated inpatients (very rare now.) Splik also brings up a good point that mental patients don't say that they have a chemical imbalance. Most of them allude to trauma or personal problem.

3. I am just speculating (i did a lot of that in grad school) on how present day people (through analysis and logic.) I have to stop my behavior so i don't piss off the whole forum.

4. I believe the DSM was an attempt to have some sort of reductionism. Albeit, the latest rendition will be quite disappointing as it is vulnerable to scientific politics (see: Mercola institute, the paleo movement and Homeopathy.)

5. I don't think everything could be explain with biology. I recognize that lots of medicine can be exposed to politics. When people don't get what they want (consistency, curable illness) they (me) bitch about it.

6. I'd be lying if i said cures can fix abuse, homelessness or poor social environments. I think it can increase the opportunity to get out of it. Who knows, maybe Robert Heinlein's future will come to fruition.
 
I say it again...how young, how naive!

*addendum*

so why do none of my patients when i ask them 'so how did someone like you end up being a mental patient?' say 'because of a chemical imbalance' (or some other reductionistic model unless they've been well indoctrinated?)

Today I was teaching my medical student about levels of explanation, and how we could understand schizophrenia from 4 different perspectives with 4 different patients. Only one of these patients did I use a neurobiological model (and even this wasn't entirely reductionistic because it used the idea of dopamine as mediator of motivational salience combined with dynamic, cultural, cognitive elements to explain positive symptoms of psychosis). The other 3 patients I formulated their psychosis using cognitive, social realist, and developmental deviance models respectively. These students now have a lot more understanding and empathy, and a sense of feeling their way into the patients' experiences than they would if I had a single explanatory level or framework for all of them. If your naiveity turns out to be reality, then I fear for the future of psychiatry and patients we care for.

Sorry about the naivety of my post. I know that psychiatry come from both compassion and empathy. Both of them are very, if not the most, important components in treating mental illness (Autism is a big example of how both of these can work.) Despite the progress in the last fifty years, people will always yearn for "proof". And some of them do have a point. Such as chemical imbalance or the oversimplification of the science. While a reductionism is not exclusively good, it can hurt much. Yes, we should not part from psychotherapy, compassion or understanding. I am just trying to say that exploring the biology will aid and compliment that.
 
Their chant at the APA protests was "drugs, shock, and death, all you have left!" accompanied by ten foot tall mobile screening of chcc movies, roving images of empty beds and dangling restraints, piles of money, etc.

leading to a halt at the movie screen and runback when they realize that the attendings, who see the psychiatrists, are paging them for a "meeting."
 
Sorry about the naivety of my post.

Don't apologize, it is just inexperience and believing all the guff about how the neurosciences will completely revolutionize psychiatry. Well that is not going to happen anytime soon. As for neurology having a better understanding of the neuroanatomy and pathology underlying their patients symptoms - well that's great but how much has it actually changed management? Or take Parkinson's disease- symptoms are somewhat under psychological control, become worse under stress, can be induced and ameliorated under hypnosis, a simply neuroanatomical model doesn't explain this. Even the very symptoms and presentation of Parkinson's disease varies from different cultures! Then there are the variations in individual differences that shape how the illness is experienced. It is ironic that at the very moment the rest of medicine is better trying to understand the social and psychological determinants of health and the experience of illness, psychiatry should seek to focus on the level of explanation that largely ignores these aspects and instead shift from minstering to the fractured mind, to the metaphorically broken brain.

The problem with the remedicalization of psychiatry is it has been at the expense of the humanity and compassion that underpinned traditional medical practice. This is true for all areas, but psychiatry was the final vestige of the compassion-based medicine, which took the patient's experience as the central focus of concern. It is no wonder there are so many patients seeking out 'alternative' models of treatment when they don't feel understood or listened to in the current model of care. Now, I am not foolish enough to believe that somehow being nice to my psychotic patients is going cure them, but we have adopted a reductive approach that does not foster connection, and instead disconnection from our patients and their experiences.

This week I (along with my medical students) will be taking some of the patients to the art museum. These patients have a hard time trusting people, feel alienated, and one of them has never been to an art museum before. Now, I'm sure there are a lot of people who feel that it is not a psychiatrists job, they should just make diagnoses and prescribe meds etc, but I believe this is part of my job to try and make a meaningful connection with my patients, to see how they fare in the real world before discharge, to open them up to new experiences. Plus I've not been to this art museum yet! And why should those Birkenstock-wearing, granola-munching recreational therapists get to have all the fun! I'm sure my students think I'm mad but they will play along if they want to honor their rotation ;)
 
This week I (along with my medical students) will be taking some of the patients to the art museum. These patients have a hard time trusting people, feel alienated, and one of them has never been to an art museum before. Now, I'm sure there are a lot of people who feel that it is not a psychiatrists job, they should just make diagnoses and prescribe meds etc, but I believe this is part of my job to try and make a meaningful connection with my patients, to see how they fare in the real world before discharge, to open them up to new experiences. Plus I've not been to this art museum yet! And why should those Birkenstock-wearing, granola-munching recreational therapists get to have all the fun! I'm sure my students think I'm mad but they will play along if they want to honor their rotation ;)

Are these inpatients? How did you manage to set this up considering all of the potential liability? There was an old movie on cable recently where the psychiatrist took his pts out on the town; the Dream Team.
 
We're not ready for a biological way of diagnosing

Even if a biological method were invented to diagnose, and there is research in this field, it still may not be worth it due to cost. If a guy tells you he is depressed, looks depressed, and wants an antidepressant, would it really be worth a test that was hundreds of dollars to be needed before you diagnose him and give out a medication?

Now yes, it could be worth it if the guy was using a not guilty by reason of insanity defense for a murder case, but IMHO not for the above example.
 
Are these inpatients? How did you manage to set this up considering all of the potential liability? There was an old movie on cable recently where the psychiatrist took his pts out on the town; the Dream Team.

these are inpatients with schizophrenia. most of our pts are too ill to take out (or DTO etc) but these are close to discharge. one is so psychomotor ******ed there is no way he is absconsion risk, the other has OA so can't do a runner! the art museum is walking distance from the hospital (even for these patients) - trust me nothing is going to happen! I have already taken them on walks/ice cream etc this is just a bit more. Some of the patients (none of mine, mind - i think it was mainly the PD ones) went to see a Shakespeare production last week!
 
these are inpatients with schizophrenia. most of our pts are too ill to take out (or DTO etc) but these are close to discharge. one is so psychomotor ******ed there is no way he is absconsion risk, the other has OA so can't do a runner! the art museum is walking distance from the hospital (even for these patients) - trust me nothing is going to happen! I have already taken them on walks/ice cream etc this is just a bit more. Some of the patients (none of mine, mind - i think it was mainly the PD ones) went to see a Shakespeare production last week!

Ah. Very Cool. I'm sure they will have a great time!
 
these are inpatients with schizophrenia. most of our pts are too ill to take out (or DTO etc) but these are close to discharge. one is so psychomotor ******ed there is no way he is absconsion risk, the other has OA so can't do a runner! the art museum is walking distance from the hospital (even for these patients) - trust me nothing is going to happen! I have already taken them on walks/ice cream etc this is just a bit more. Some of the patients (none of mine, mind - i think it was mainly the PD ones) went to see a Shakespeare production last week!

Is it true that you were once in the british system? Perhaps even worked in the NHS? Why did you move to America?
 
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