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Psych consults in the ED?
HAHAHAHAHAHA
Sorry.
HAHAHAHAHAHA
Whew. Got any more jokes?
Psychiatry VS EM
Started by moto_za
Psych consults in the ED?
HAHAHAHAHAHA
Sorry.
HAHAHAHAHAHA
Whew. Got any more jokes?
What are you talking about? Every hospital with a psych residency program I’ve seen consults in the ED. Not my fault you work in a ED in the middle of nowhere.
Sure. And I would say that the increase in property values overwhelms any of the other perceived improvements for people who happen to be from those areas. Living in Dubuque or Minneapolis or St. Louis sounds miserable to me.
It's not that there are more college grads, although that's certainly true. It's that the types of jobs they had don't exist in the present day.
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deleted109597
209 Psych programs. That's 4 per state, and I bet it's not equally distributed. Not every place without a psych residency is in "the middle of nowhere".
I've also never seen a psychiatrist that wasn't a resident do ER consults.
It's almost like the places where everyone wants to live are the most expensive.
Part of it is a changing job market that's true. Another part is college major. None of my physics or chemistry friends had trouble finding work. The history ones did.
There is also a huge demand for blue collar jobs but we've spent 2 generations telling kids to go to college instead.
I'm glad I went into EM. I wouldn't change it for the world. And I'm not "salty" about anything. I'm very happy doing what I do. I haven't worked an ED shift in years. And I don't do psych either. I have a great, great, job. I'm blessed.
The vast majority of hospitals with EDs don't have psych residency programs or inpatient psych units. In those, hospitals the prevalence of psych consults is rare if not non-existent.
Agreed on the blue collar jobs. Plenty of extremely well paid jobs considering the minimal schooling needed. Yet the working class is still angry and overdosing. It's weird.
Probably confusing because you’re viewing addiction as some kind of character fault (they’re still overdosing) instead of a disease based on a combination of predisposition and availability of whatever drug you’re easily addicted to. It’s like saying “damn life’s so good why are all these people fat?” when looking at obesity and diabetes rates or “our air’s so clean now, why do all these kids still have asthma?”
Also, id have to say most of us in this forum aren’t particularly in the “blue collar job market” and don’t have a great understanding personally (although you probably see the results in the ED) of what welding and bricklaying does to your body after 20 years. We see a lot of these guys who got prescribed months/years of oxy for their chronic back pain from their “blue collar job” instead of real treatment and now they’re coming in for suboxone or overdosing on heroin because it’s so hard to get off it.
Do you like sleep? Weekends? Holidays? Talking to patients? Dealing with a whole lot of psychopathology? Not doing procedures? Letting your ACLS credentials gather dust and a fairly large percentage of the knowledge you mastered in medical school go to waste? Do you want patients that often hate and occasionally threaten to kill you? Psych.
Do you have ADHD? Like procedures? Like having a dozen patients under your care simultaneously? Don't mind weird shift changes? Enjoy fighting for admissions against people that think they know better than you? Having occasional high stress moments in which your patients might honest to god die? Do you want enough money to enjoy your 18 days a month off (many of which are spent recovering from shift flips)? Do you enjoy drug seekers and drunks? Consider a career in EM.
Do you have ADHD? Like procedures? Like having a dozen patients under your care simultaneously? Don't mind weird shift changes? Enjoy fighting for admissions against people that think they know better than you? Having occasional high stress moments in which your patients might honest to god die? Do you want enough money to enjoy your 18 days a month off (many of which are spent recovering from shift flips)? Do you enjoy drug seekers and drunks? Consider a career in EM.
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Right. But something is causing the working class to get really into drugs and to have high rates of depression even when jobs are plentiful. So something is causing this population to have these mental illnesses even when their lives should, in theory, be OK. Bricklayers have had musculoskeletal pain for generations; the addiction issues are recent, and not all of it is prescription-based. And there are plenty of blue collar/paraprofessional jobs paying six figures that aren't so physically strenuous. Nursing, RT, xray, line worker, electrician aren't as hard on the body. Anecdotally, I see a lot of working class folks (not in the ER, people I know personally) taking advantage of generous disability policies to retire at 35. There's a lot of secondary gain, and a huge victim mentality that more educated people seem not to have.
Kind of a broad brush you’re painting with there.
Yes, people have had pain for generations in all strenuous jobs and for many different reasons. However, this coincided perfectly with widespread opioid use when OxyContin hit the market and was marketed as a “nonaddictive painkiller”, prescriptions weren’t being monitored and pain became the “sixth vital sign” . There was a bit of a perfect storm of the push to control pain aggressively and a new widespread “nonaddictive” opioid that could control pain almost instantly.
To your other point, are there a lot of people on disability that shouldn’t be? Absolutely. However this victim mentality I think has a bit more to do with the environment you grew up in and the type of person you are rather than dividing it into “educated” and “uneducated”.
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deleted109597
A lot of people don't realize how long we've had a narcotic problem. It didn't start with OxyContin.
https://www.history.com/topics/crime/history-of-heroin-morphine-and-opiates
The problem with OxyContin wasn't the access, it was the acceptance by society of this drug, and the forced classification of a disease. It's not like life is more painful now. But whereas people are still allowed to judge drunks for using alcohol to forget their ills, now it's ok to have a doctor do the same with opiates. Many of these people aren't interested in quitting.
https://www.history.com/topics/crime/history-of-heroin-morphine-and-opiates
The problem with OxyContin wasn't the access, it was the acceptance by society of this drug, and the forced classification of a disease. It's not like life is more painful now. But whereas people are still allowed to judge drunks for using alcohol to forget their ills, now it's ok to have a doctor do the same with opiates. Many of these people aren't interested in quitting.
And the acceptance was driven by aggressive marketing by Purdue Pharma. It was also absolutely the access. People who would have never had tried to seek out heroin for their back pain/neck pain/whatever could easily walk into their doctor's office and walk out with a month's supply of OxyContin. If that doctor wouldn't do it, they could pretty easily find a doctor in their city who could. The acceptance is driven by widespread access.
"The promotion and marketing of OxyContin occurred during a recent trend in the liberalization of the use of opioids in the treatment of pain, particularly for chronic non–cancer-related pain. Purdue pursued an “aggressive” campaign to promote the use of opioids in general and OxyContin in particular.1,12–17 In 2001 alone, the company spent $200 million18 in an array of approaches to market and promote OxyContin."
"One of the cornerstones of Purdue's marketing plan was the use of sophisticated marketing data to influence physicians’ prescribing. Drug companies compile prescriber profiles on individual physicians—detailing the prescribing patterns of physicians nationwide—in an effort to influence doctors’ prescribing habits. Through these profiles, a drug company can identify the highest and lowest prescribers of particular drugs in a single zip code, county, state, or the entire country.21 One of the critical foundations of Purdue's marketing plan for OxyContin was to target the physicians who were the highest prescribers for opioids across the country.1,12–17,22"
"In much of its promotional campaign—in literature and audiotapes for physicians, brochures and videotapes for patients, and its “Partners Against Pain” Web site—Purdue claimed that the risk of addiction from OxyContin was extremely small.43–49"
The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy
I agree with your first point. Opioid addiction has been around for as long as you could harvest poppy plants. There was a huge problem in the 1970s with returning soldiers from Vietnam when they were exposed to heroin while deployed.
I'm not sure what y0u're referring to when talking about the "forced classification of a disease".
Greenville, SC, all the time. Now, they have a psych residency, but did not when I was there.
My point in posting that video is not to endorse irrational risk or wing-suit proximity flying, which is insanely dangerous. It is to take inspiration in what the guy is saying. That any of us can live a better more inspired life by not letting fear hold us back. For him, it's fear of heights. For someone else it might be a fear of failure. For another, it may be fear of change, fear of rejection, and so on. I think we let this affect us more than we realize sometimes, even we in EM, who I think generally are much more willing to choose action in the face of fear than the average person.
The human race has had a problem with opiates since they discovered natural opium thousands of years ago. The pendulum swings back and forth, throughout history. Once the problem is tamped down and the societal devastation from opiates becomes less apparent, society forgets how dangerous they are and finds another excuse to let the bull out of the barn. Then, opium (or other derivative or synthetic du jour) wreaks more devastation, the dangers become more appreciated to society at the time, use falls out of favor and restrictions area put in place. This lasts long enough for a future generation to forget how dangerous opiates are, and convince themselves they can outsmart the dangers, once again. Look throughout human history and you'll see this cycle repeat over and over.
In fairness they did have an attached psych hospital...
Well, it was just "the pavilion". I went over there once. Ironically/coincidentally, I had a low blood sugar when I was over there.
For what it's worth, I wasn't trying to make a point at all. Perhaps if we were in the same room I would have made this comment with an inflection that suggested that, regardless of what I said, it was just an off-hand comment that jumping like that looks utterly terrifying...thats all. I agree with what you are saying
Although his tackling of his fear is gonna result in death
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What do you do?
The blue collar jobs now don't pay enough. $15/hr in 2018 is not the same as $15/hr 1968.
That's not to blame anybody....it's just what happens when we have a global economy and many of these jobs are now in Mexico, China, and India.
I'm seeing way more than that per hour.
I have a patient who owns an electrician company. He will pay 15 an hour for the first 6 months while you learn the trade even if you have never spliced a wire before. If you're a qualified electrician, he pays 30 an hour with a bonus based on productivity
I did an Interventional Pain fellowship a few years ago and that’s what I do now.
Oh, no worries. It’s all good.
Thank God for Go Pro, so that guy can fly 150 mph in a squirrel suit, while we watch on our couches through a laptop in full HD, fully inspired without leaving our risk-free cocoon of comfort, until we’re good and ready. Lol, right?
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And yet, as you've said in the past, he can't find anyone who can pass the whiz quiz.
Same with the steam cleaners ($20/hour starting), and glass guy (also $20/hour).
Weirdly enough the HVAC people are the only ones not having trouble.
Our community hospital employs a psychiatrist, although access to him is limited. The psych consult has barriers unlike other consults.
I had a similar dilemma, was very interested in EM, was on the EM path for a bit. This is one of those questions, as I had learned, that cannot be answered until you actually DO both. Take 4th year electives in each if need be and that will clear things up pretty fast. Going through is very different than hearing and reading about. For me, staying up overnight was terrible for my system, and I wouldn't trust someone's life in my hands being a zombie. Lot's of respect to those who can do it.
You won't love both equally.
Here's my two cents as a psychiatry resident, so I may be a bit bias. Both medical specialties are in demand, with obviously EM being way more prestigious at this point considering how competitive it is. Both will have pros and cons, you will never enjoy anything 100%. Eventually even if you do enjoy your work, it still becomes work which is fine. I think there are a few questions to ask yourself such as, if you want to do psychiatry, are you okay with being perceived as perhaps inferior or "less" of a physician? Both specialties are very rewarding but both also have malingering patients too. They take a heavier toll on your emotions than one would think. Which do you like to study more? Which flows better when you're hitting the books?
Both make good money but EM is more.
Procedures are limited to TMS and ECT in psychiatry. You ain't intubating no one unless thats your jam.
Do you like to do longer or shorters H&Ps?
I'm not sure there is a consultation aspect in EM, there is psychiatry though so if you like being referenced by gen med for special needs than perhaps psychiatry.
There are a plethora of these questions. If anything this post made things more confusing lol
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Although some would disagree, I view many of the patients sent from clinic as consults.
Fainted in clinic —> ed
Hypoxia in clinic —> ed
Chest pain that made someone uncomfortable —> ed
Fell yesterday and maybe lost consciousness? —>ed
Briefly diaphoretic in clinic —> ed
And the less reasonable ones
Htn to the 200s? Oh my! —> ed
Hyperglycemia to 350s in ortho clinic! (Hba1c 16)—> ed
Clear appendicitis (child happily jumping up and down, eating a granola bar on initial exam, no abdominal tenderness, afebrile, fell off the slide at recess and has mild right rib tenderness where they landed) —> ed
Have had all of these, most multiple times per month, with some variation or twist. The bottom three were in the last week. They used to annoy me, but viewing them as consults helped me a lot. Sometimes people consult for quick access to resources (ct, labs, etc)
But maybe it’s just a coping mechanism
good point
I think your perspective on prestige will evolve once out of residency. Most doctors don't care about prestige after residency, the whole competitive thing vanishes when you leave training. Psychiatrists are generally well respected, more so than ever before as society makes mental health more prominent.
Also, there's an upturn in competitive stats in recent psych applicants as of late. I predict it will continue as the millennials lean towards optimizing life balance.
Lastly, psychiatrists can now make as much as surgeons.
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What is this prestige thing people keep throwing around?
Things change. ED and dermatology used to be bottom of the barrel in terms of "prestige." Now they are both quite competitive and pretty well compensated. Lots of people respect hospitalist, other don't and see me as a glorified secretary. I assure you, I don't care.
I'm never going to cut out a necrotic gallbladder, I've never going to do an endoscopy or do an angiogram. I'm quite comfortable with that. In psych you have to be comfortable with not practicing what most people think of as medicine. I would suggest if other people's opinion mattered so much, then whatever you do will be hard for you.
Things change. ED and dermatology used to be bottom of the barrel in terms of "prestige." Now they are both quite competitive and pretty well compensated. Lots of people respect hospitalist, other don't and see me as a glorified secretary. I assure you, I don't care.
I'm never going to cut out a necrotic gallbladder, I've never going to do an endoscopy or do an angiogram. I'm quite comfortable with that. In psych you have to be comfortable with not practicing what most people think of as medicine. I would suggest if other people's opinion mattered so much, then whatever you do will be hard for you.
Technology has gotten better while human nature has remained fairly static. Perhaps the end result is that we simply have found more and efficient means of expressing and indulging our dysfunctions with the result being what you observe. After all, no mongol raiding party posted its exploits to Facebook and had them spread around the world like Black Friday shoppers do.
I wish we could go back in time and give them iphones with facebook live + instagram. Their selfie game would be savage.
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deleted859535
Same damn thing. Marginally less bloodshed.
Agree with most of what you are saying except for the fact that you are looking at things from an egocentric view of living in a first world as a middle class person.
Plenty of people still living in the dark ages without electricity, food and plumbing all over the world. Heck, even right here in the back woods of America. They are not as fortunate to live a nice comfortable life. And maybe they're more affected by psychopathology simply because of their poor living conditions.
I do believe that in this day and age of modern drugs, machines and abundant food, some of those drugs and machines (computers, TV)including social media have for sure increased psychopathology.
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deleted109597
Although there will always be people that will try to twist positivity into negativity to serve their political goals and narratives, these charts show an undeniably positive trend, in line with what I've been saying on this thread.
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this thread was dead for about a week until revived by ninja.
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deleted109597
SDN policy is to not post new threads when the information is covered in another.
It's relevant to this post.
It was still on the front page.
