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Role of psychiatrist in outpatient setting?

Discussion in 'Psychiatry' started by Medstudent2018, Jul 28, 2015.

  1. Medstudent2018

    Medstudent2018 lab rat
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    Is there any worry of psychiatrist roles being taken over by other medical professionals and eventually dying out in the outpatient setting?
    For example, from what I hear, many psychiatrists don't practice psychotherapy anymore since there are plenty of clinical psychologists/social workers/counselors who can perform the same role. This seems to leave psychiatrists with the primary role of medication management. But couldn't that be done by general internists or primary care doctors? Especially for those with common disorders (such as depression, bipolar, etc) that has been stable with medication for years...
    Pathology has seen a drop in available jobs partly because much of their work has become automated or delegated to other specialist lab technicians. Do you think that will ever be a concern in psychiatry?
     
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  3. manly_man246

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    s there any worry of psychiatrist roles being taken over by other medical professionals and eventually dying out in the outpatient setting? Almost every field is and has been threatened by mid-level encroachment and turf battles. Things are going to be alright. Every specialty has been freaking out off/on for the past decade or two. Nobody will fully take over because most physicians don't want to do what a Psychiatrist does. Mid levels are just that, mid-levels. They don't have the medical training Psychiatrists do as physicians. And unlike turf wars between gas/pm&r/ir/ortho for interventional spine patients it's not like anybody is getting overlapping training with what a psychiatrist does.
    For example, from what I hear, many psychiatrists don't practice psychotherapy anymore since there are plenty of clinical psychologists/social workers/counselors who can perform the same role. I think this is more personal preference than anything. Plenty of people out there want a physician to be their psychotherapist, just like plenty of people want their eye doc to be an ophtho, not an optometrist. Do a good job, market yourself well, and you'll keep the lights on, be able to bill more than those other folks, and still have a good life.
    This seems to leave psychiatrists with the primary role of medication management. But couldn't that be done by general internists or primary care doctors? You're a medical student, have you started your clinic rotations yet? Do you see PCPs and internists 1) interested in, 2) capable of, and 3) having the time to manage a patient's mental health issues? My experience has pretty much been No to all of the above. Also, if it were simply "medication management" residency wouldn't be 3-4 years long.
    Especially for those with common disorders (such as depression, bipolar, etc) that has been stable with medication for years... Sure. But these folks aren't actively seeking regular care, they're not the ones filling a new Psychiatrist's office and visiting frequently, bringing in the $$$. They're stable. Plenty of folks who need stabilization, and that can be a long process.
    Pathology has seen a drop in available jobs partly because much of their work has become automated or delegated to other specialist lab technicians. Do you think that will ever be a concern in psychiatry? Nope. Salaries may drop but Psychiatry won't ever become automated or delegated. There is such a huge need for Psychiatrists, even in large cities.

    Somewhat OT but may help the OP better grasp the current climate:
    Anesthesiologists have become managers of a flock of midlevels. At worst that could happen in Psych with NPs... but Psychiatry, unlike almost every other field, is more resistant to the current "hospitals buying up private groups/individuals" trend that is forcing people into employment with requirements like overseeing CRNAs, PAs, etc. (and driving salaries down). To practice as a Psychiatrist you need little more than a room and two chairs - and that's not just for psychotherapy, for providing psychopharm also. The majority of independently practicing psychiatrist would hvae to join hospital groups for a massive change to happen. Now if most Psychiatrists join hospital groups then yeah...you'll have a hard time getting patients because PCPs will refer their folks to in-network/in-house Psychiatrists. I'm being redundant but this is important: AFAIK there aren't a bunch of large Psych group practices out there, most people are practicing solo or in small groups, so the threat of a wave of rapid buyouts and consolidation is lessened.

    For comparison, large GI practices with senior partners close to retirement are selling to hospital groups and walking away with serious $$ as a retirement payday. Their new hires/junior partners will no longer have access to partnership tracks with opportunities to buy in to ASC and other alternative revenue streams as the hospital will now take all of this money and force them to work for a lot less than their senior colleagues made during their primes. US Oncology is buying up Onc practices, and the same thing is happening there. For better or worse, these revenue streams and practice models were almost never available to Psychiatry*** so they'll be okay salary and employment-wise. Anesthesia was almost entirely hospital dependent to begin with so they had no choice but to accept the CRNA movement.

    ***The enterprising few who had good business sense made a lot off Sleep, and there are still some opportunities available but not like what surgical subspec/GI/derm have. I'm damn well going to try to run a business and not just a practice when I finish my residency...but I haven't even started yet and who knows how things will look in 4-5yrs.
     
    #2 manly_man246, Jul 28, 2015
    Last edited: Jul 28, 2015
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  4. heyjack70

    heyjack70 Junior Member
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    I think they can, but most don't do a very good job when the patients get more complicated. It's true that mild depression and anxiety disorders that get better after 20 mg of prozac are in the PCPs wheelhouse, but beyond this most start feeling very uncomfortable, or at least should. It would be nice to get a referral before the patient is on 6 mg of xanax a day. If you think about this it starts to make sense; how much psych exposure and training do most primary care doctors get? 1 rotation in medical school. That's it. Everything else is self study or supervision from other primary care providers, which I believe is inadequate for the amount of psych diagnoses these doctors see. They should have at least a 6 month continuity clinic as residents in a psychiatric office. One of the biggest problems I see coming out of primary care is misdiagnosis, especially bipolar misdiagnosis because the patient has "mood swings" (and this is a problem amongst psychiatrists as well). And the patient with PTSD and borderline PD gets put on Zyprexa and gains 50 lbs or is given samples of Latuda that they can't afford but it's what the drug rep dropped off so why not try it, right? And when I get the note it looks like this.

    S: No physical c/o, continues to have mood swings and anxiety.
    O: 90% of this section will be an unremarkable physical exam and for
    PSYCH: Affect normal, it might say no SI
    A: Bipolar
    P: Latuda 40 mg QHS, Xanax 1 mg QID prn anxiety. RTC in 3 months.

    Woefully inadequate, and no risk assessment at all. And likely no notes documenting informed consent for Latuda, no mention of tardive dyskinesia, possible metabolic side effects, or that it has to be taken with food. No referral to a therapist because they missed the borderline PD.

    The biggest protective factor is most doctors do not want to manage mental illness at all, let alone refractory depression, any bipolar/schizophrenia, +/- personality disorder and addiction problems. They are more than happy to completely turn over all psych management to a psychiatrist if there is one with room for more patients.
     
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  5. manly_man246

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    Or put another way, there are enough bad Psychiatrists out there that there's certainly space for a few more good ones. :)
     
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  6. clausewitz2

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    Automation or deprofessionalization of pathology is a much easier sell because patients generally have no idea what a pathologist does and probably sort of assume that all that sort of thing is done by various machines that go "bing" already. At that point they mostly want accuracy and maybe a good price, irrelevant to them how that's obtained - they will probably never lay eyes on the person/computer responsible.

    People tend to be a little pickier about their mental health providers, when they can afford to be at any rate.
     
  7. Ceke2002

    Ceke2002 Purveyor of Strange
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    As a patient, god I hope not! It wasn't a Psychiatrist who rapidly titrated my first round with Seroquel up to a dosage of 1ooo-1200 mgs, because he didn't know when to stop upping the dose. It wasn't a Psychiatrist that forgot to double check the serotonergic properties of Tramadol when combined with Effexor, and ended up landing me in the ED as a priority 1 Emergency due to Serotonin Syndrome. It wasn't a Psychiatrist who eventually pushed me up to some ridiculously high amount of Xanax, that then took the combined efforts of another Doctor and an actual Psychiatrist to taper me off of over the course of a year. As for patients who have been stable for years, I'm diagnosed with Psychotic Major Depression (MDD with Psychotic Fx I think is the official term), I can be perfectly stable for years, don't even need to take medication, wouldn't know I'd ever been sick - until I have another episode and crash and require someone who know what they're doing in order to properly treat me because there can be a bit more to it than just 'here's your antidepressant in combination with an antipsychotic, see you when you need your next script'.

    And in my case I concede I may be luckier than some, no actually make that I *am* luckier than some, because the Psychiatrist I have now does do Psychotherapy. Last session we had a fantastic discussion on Relational Unit and Object Relations Theory as it pertains to C-PTSD stemming from childhood trauma - I even got a fantastic white board lecture complete with diagrams and arrows and all sorts of technical therapeutic terms, it was awesome. There are still good Psychiatrists out there, ones who do more than just throw medication at problems, don't discount them just because there are some bad eggs in the bunch as well. :)
     
  8. Frazier

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    Not really. As eloquently explained earlier, no other specialties are jumping over themselves to manage psych patients. When you get into med school and eventually the hospital, you will find that many services love to do the opposite and punt psych patients to the psych service. Outpatient is similar, FM/IM/OBGYN/PEDS, none of them throw out billboards and commercials on mental health to attract borderlines and eating disorders. They can Rx as they feel comfortable for what they wish, they are physicians after all. Similar to a psychiatrist can Rx as they feel comfortable for what they wish, they are physicians after all. But people tend to stay in their area of expertise if for no other reason than medico-legal risks.

    Psychologists and NP's can rx, but they aren't psychiatrists. They are psychologists and nurses that can prescribe.

    If I or my family need treatment for psychiatric condition, they'll go to a psychiatrist. If there are no psychiatrists and only psychologists and nurses that rx, I guess they have no choice but to utilize them...and that would be the role that those professions originally gained Rx rights for (ie filling the gap).
     
    #7 Frazier, Jul 28, 2015
    Last edited: Jul 28, 2015
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  9. TikiTorches

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    Free market will decide.
    I don't see physicians becoming obsolete.
     
  10. TikiTorches

    Physician Classifieds Approved 7+ Year Member

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    Wrong. They are trying to get these rights to make more money. Then call themselves doctor.
     
  11. Frazier

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    Yes, if I was unclear earlier, they gained the rights by petitioning to fill the gap (ie what they "gained Rx rights for"). What you describe is more like "what their personal motivation was for petitioning", not "what they were granted those rights for by authoritative bodies".

    Ulterior motives that you note are another story, one I tried to avoid in this thread.
     
  12. birchswing

    birchswing Patient/Interested in Psychiatry
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    The interesting thing is that, in the market, differentiation between practitioners comes directly from market regulation, which is to say that the government regulates who can call themselves what, what services they can and can't provide, and what claims they can and can't make.
     
  13. nitemagi

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  14. hamstergang

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    Prescribing psychotropic medications can certainly be done by PCPs, and this is in fact happening: "Fifty-nine percent of U.S. mental health drug prescriptions are written by family doctors, not psychiatrists" http://www.reuters.com/article/2009/09/30/us-drugs-mental-idUSTRE58T0NE20090930
    That was from 2009. But here's another quote: "primary care practitioners provide a larger percentage of psychotropic drug visits than psychiatrists in every psychotropic class except for those patients prescribed lithium" http://www.ncbi.nlm.nih.gov/pubmed/2904248
    And that's from 1988.

    And yet, there's still a huge demand for psychiatrists. PCPs have been and continue to prescribe for a lot of patients (some even with psychiatric disorders!*), but there's still a huge role for psychiatrists as the experts on this. So many of the patients aren't stable on the same medication for years and so require an expert to help establish the correct diagnosis and treatment.

    *In my searching around for the quotes above, I saw studies showing that even though PCPs are prescribing a lot of psychiatric medications, they are not giving a psychiatric diagnosis to many (most?) of those for which they prescribe psychotropics.
     
  15. manly_man246

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    Sure they can prescribe but that doesn't mean they do it well. The regimens people come in on are mind boggling even when they're being seen by a psychiatrist! Patient can't sleep do seroquel trazodone at night, patient now drowsy in am so they need a stimulant, patient now hypertensive and tachy let's put on a beta blocker and test for tsh. It happens all of the time. Plus, dissociative disorder, conversion d/o, schizophrenia... Nobody gonna touch that but a psychiatrist.
     
  16. shan564

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    PCPs won't take over psychiatric med management any more than they will for, say, rheumatology. Managing psychiatric medications is a specialty that requires years of training to learn how to do it properly.
     
  17. Armadillos

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    And despite various doomsday claims, as far as I can tell new grads are having no trouble findings jobs and are actually getting paid somewhat more than they were several years ago.
     
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  18. TikiTorches

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    And like the free market, its up to the consumer to decide.
     
  19. W19

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    @GroverPsychMD The problem is that the consumer is not 'that' educated when it comes to healthcare...
     
  20. birchswing

    birchswing Patient/Interested in Psychiatry
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    My point was that it's not a truly free market, especially when the choices you're saying consumers can make are only available because of market regulation. If there were no governing authorities, there would be a truly free market of various practitioners and gurus with no public licensing to differentiate between them. In briefer terms, the government regulates the market through licensing.
     
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  21. clausewitz2

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    Yeah, let's be real for a minute, in the absence of occupational licensing that prevents just anyone from hanging out a shingle and handing out psychotropics and laws that send people to prison if they try to "compete" without just such a license (which they must spend at least eight years obtaining at great cost IF they play the game hard enough to be given the opportunity), the job market for psych wouldn't be nearly as robust as it is. Not saying that this lack of a really free market in this respect is all bad, but it is definitely not a Randian paradise.
     
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  22. Dharma

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    Threads like these are a dime a baker's dozen on SDN and come in all types of specialty flavors.

    Worry not. Be good. Then they will come.
     
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  23. TikiTorches

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    Then why have licensing or education at all?
    Just give out all meds for free to everyone!
     
  24. nitemagi

    nitemagi Senior Member
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    There are no free markets, and medicine has never existed in such a system. Governments intervene, and the free market (just like natural selection) is based on the predicate of letting the less adaptive suffer and die. Organized society considers such a process inhumane. Limiting supply of "prescribers" doesn't increase the demand of the market, nor really change the supply. People can always find pill pushers on their local street corner, with all the risks there of deregulation.
     
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  25. splik

    splik Professional Cat at Large
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    well in a free market, there would be no licensing and education wouldn't be necessary as the market would decide who would be allowed to practice. And there would be no prescription privileges, you would be able to buy whatever drugs you wanted, and if you died....well that would be unfortunate. As I've written elsewhere, explaining why markets do not work and have no place in healthcare:

    The American Economist Milton Friedman, in his doctoral thesis, argued that licensing for physicians reduced the quality and quantity of medical practice. He went as far as saying licensure should be abolished as a requirement for medical practice. He regarded the American Medical Association as a powerful trade union that had protected its own interests at the public expense, leading to higher costs for lower quality care, and stifling progress and innovation. By stripping away the regulations required for medical training, anyone who wanted would be able to practice the profession they sought, increasing the availability of practitioners, increasing quality and reducing costs. A medical free for all, with anyone able to set up shop and provide medical treatment would be what medicine would look like in a truly free market system. That we do have regulations regarding who can practice medicine and related fields means there is no free market in healthcare.


    Friedman believed that the market provided the best way of ensuring access to care and driving up quality of care. With the market saturated with practitioners offering different treatments, there would be increased competition which would increase innovation, choice, and ultimately quality. Poorly performing practitioners would not be able to compete and would be removed from the marketplace absolving the need for regulations such as licensure to establish competence....

    Friedman may have been right on one point. He highlighted that the limits on medical school places and the rigorous requirements meant many people who could be excellent physicians were denied the opportunity. Further, he noted that the barriers led to back doors – we now have a glut of nurse practitioners, physicians assistants, and those practicing complementary and alternative medicine. Whilst nurse practitioners and other physician extenders have been valuable in widening access to healthcare, they frequently extend further than their training allows. Their training may be adequate for a specific role, but it does not a doctor make.


    and

    Consumer-driven healthcare reforms are based on laissez-faire economics that assume individuals are rational decision makers. The problem is that procuring healthcare is not like buying a new car or a new phone. Not only are decisions about healthcare more complex, the information more voluminous, the consequences more grave, but these decisions are also more emotive. Patients are patients and not consumers because they suffer so, their decision-making clouded by the emotions generated by the pain that won’t go away, that lump in the breast first noticed in the shower, that blood in the stool, that unshakeable cough. The signs that suggest a serious illness frighten us. Whilst some react by wanting to have as much control as possible, to search out the diagnosis, to choose their doctor, to choose their treatment, most want the reassurance that physician they see at their local hospital will have the expertise to make the best decisions for them, and to ensure they get the best care.
     
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  26. Jester25

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    I always get a good laugh when people say med management. I wonder what all the other docs in medicine are doing?
     
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  27. clausewitz2

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    I would suggest looking into the distinction between positive and normative statements in philosophy/econ. I was making one of the former.
     
  28. clausewitz2

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    Honestly I think from a traditional economic analysis point of view, the lack of price information available to most participants in the health care market and the overwhelming asymmetry of what is accessible is more likely to be what is fatal to it functioning properly in the United States. Points about emotionality aside (the homo economicus assumption is really not necessary for most models of agent behavior), people can't respond to price signals if they never receive those signals until well after care has been consumed.

    I take your broader point that there might still not be behavior perfectly in line with "what is cheapest" even in the case in which good price information was available, but that suggests to me that "objective health outcome" is not necessarily what people are always seeking when they consume health care. After all, a Lexus is just an expensive and plusher Toyota and doesn't actually deliver you to your destination any better, and yet they remain popular.
     
  29. Shikima

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    Are you peeking in my case load again? I got this same example which showed up on my doorstep, except it was Risperdal Consta 50mg along with Seroquel 200mg and Valium 5mg QID. She is shopping for a new psychiatrist who'll continue the same treatment protocol as hers had 'retired'.
     
  30. TikiTorches

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    More and more physicians are using "garage sale pricing" to have more price transparency. In direct pay practices, where you keep insurance out of the equation...
     
  31. TikiTorches

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    Nah. That's ok!
     
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  32. clausewitz2

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    I only suggested it because it is helpful in responding appropriately to empirical assertions that describe situations that have outcomes you don't like.
     
  33. TikiTorches

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    Thanks, but still nah!
     
  34. MacDonaldTriad

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    You two crack me up.
     
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  35. AcronymAllergy

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    Speaking as a psychologist who works in an integrated outpatient clinic--no, I don't see psychiatrists going anywhere anytime soon. Demand for their expertise is still quite strong, even with PCPs here managing many of the more stable and less-severe cases and multiple psych NPs also present. I'm actually pretty sure our psych NPs would be the first to object if administration tried to get rid of any of our psychiatrists.
     
  36. hamstergang

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    I never understood this criticism. There is a clear split in psychiatry between treating via psychotherapy and using medications. If you're not doing any structured therapy (outside the little that's done on all visits), what do you want to call it? Can't just call it "practicing psychiatry" because that implies therapy isn't psychiatry. Calling it med management is simple and explains what it is nicely. What's the harm in that name?
     
  37. heyjack70

    heyjack70 Junior Member
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    I guess to some extent it's frustrating because it seems to describe only a slice of what is done in the clinic. In contrast with other fields of medicine I believe our followup appointments are much more involved because we're basically doing a brief re-diagnostic, or severity assessment, on each visit. We check in about the person's mood, severity of depression, severity of specific depression symptoms, discuss social and biological factors (using drugs/alcohol, poor diet, no exercise) that could be worsening the depression, then prescribe, adjust, or change medications if needed. We also assess for needed psychotherapy referral, or chemical dependency treatment referrals. Then provide brief psychotherapy, possibly just focusing on supportive techniques, but often basic CBT or psychodynamic techniques. In contrast the PCP sees your blood pressure is up because the MA checked it before he came in, asks you about your kids, increases your HCTZ and that's it.

    I guess you could, and certainly many do, reduce psychiatry to med management. You could see people for 5 minutes like a busy PCP, have them fill out a PHQ-9 or GAD7 in the lobby, review these before you see them and just prescribe a new pill or dose and be done with it, but IMO that's not what psychiatry is, and it's a very risky way to practice

    Edit: not to knock PCPs because I know they see extremely complicated patients, and of course they're the ones really prescribing the psych meds in this country.
     
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  38. hamstergang

    hamstergang may or may not contain hamsters
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    Ok, so what else would you like to call these non-psychotherapy visits?
     
  39. splik

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    interesting. doesn't sound like how i work at all. just goes to show there is a large variability in how people practice.
     
  40. heyjack70

    heyjack70 Junior Member
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    A shrink wink think sink ink. It's not very good.
     
  41. birchswing

    birchswing Patient/Interested in Psychiatry
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    Or sometimes the visits start with the psychiatrist who has treated the patient for several years and has her chart in front of her asking, "So, what meds are you on again?" (she says it's faster for me to tell her than to look). And as soon as you answer, the psychiatrist starts writing out refills. And sometimes a PCP will schedule an hour with you to go over complex concerns. My PCP, for example, knows that I'm back in college, knows when I left, and worked with me to get the right amount of beta blocker to make going back tolerable (and returns calls which helps in titration). When I try to update my psychiatrist on my life beyond which pills I take, I get a "save it for your therapist" and "remember what this is" (med management) speech. Obviously some psychiatrists and PCPs are the opposite of these two examples. The last time I saw my psychiatrist I got a bit more time because I was the last of the day and she was in a good mood, but I never get as much time with anyone or as broad of advice regarding nutrition/exercise as with my PCP. It's why he's in the office till 7 PM every time I've seen him, two hours after every other person in the building has left.

    But to call what some psychiatrists do med management is a bit of a stretch, I would say. How many just ask perfunctory questions while not even looking up (any thoughts of killing yourself, any new side effects) and write refills? I don't think that even qualifies as med management. I've never thought of killing myself in a way where I wanted to or planned to, but sometimes I wonder what they would do if you said yes since it's so often asked in that perfunctory way where you can tell they just want you to quickly get through the formality of it. For an actually depressed person, I'm pretty sure being asked in a way where it's palpable that the person is just going through a checklist with their head down is probably the last situation in which you would feel like opening up. Based on what I read that psychiatrists do, I would say that many do more than med management. But based on real-life scenarios I've seen, I would say some do less than med management. I would maybe call it an in-person refill appointment? I don't mean to be glib, but I think there is wide variability and that "in-person refill appointment" is part of that variety.
     
  42. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    I think one question to ask yourself is "What does the patient call them?". I think they would just answer "seeing my doctor".

    I still have a small number of outpatients, and yesterday's clinic was notable in that though all 7 patients got refills on established meds, for only 1/7 would I say that psychiatric medication management was really anywhere near the main thing that went on: I primarily 1) reinforced a PCP's management of gastritis, 2) discussed management of diabetic neuropathy (and an unrelated court issue, AND how she felt about her mother...), 3) helped a guy get services for an autistic child, 4) got updates on everyone in an extremely chaotic family--and how she was coping through exercise, 5) discussed the breakup of a family business partnership and its effects on chronic back pain, and 6) advised about stress management for an upcoming cross-country move. Now these were admittedly all established patients who I know (all too) well, but I think it does give a slice of how varied our daily outpatient practice can be, and how "biopsychosocial" it gets in real life as well.
     
  43. Shikima

    Physician 10+ Year Member

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    Agreed OPD. Similar experience here.
     
  44. Jester25

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    Yeah. This is how I practice as well. I'm always inquiring about changes in the family dynamics, diet/nutrition, other medical conditions, etc etc. Saying what I do is "medication management" makes it sound like it's all I do when in fact it's only a small part of the entire visit. I don't even prescribe medications on certain visits/ re-visits! I personally think it's a degrading term. I don't screen neuroveg symptoms, ask about SI/HI and then increase their meds and send them on their way. That would take 5 min. What I do is practice psychiatry which includes all of the above and therapy if needed on a particular visit.
     
  45. Psychoanalysis

    Psychoanalysis Composer & Psychiatric Hopeful

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    I must say, as somebody who is Pre-Med and looking at Psychiatry very strongly, this is a beautiful sentiment to patient-oriented education and care. Granted, not many patients would be educated enough to receive this level of communication, but the idea remains positive. Thank you, for sharing this!
     
  46. birchswing

    birchswing Patient/Interested in Psychiatry
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    Some of what is being described as done in addition to medication but not at the level of psychodynamic therapy is very helpful. I used to see a wonderfully kind woman who was sort of like a social worker, I suppose. I think her title was perhaps community assistant. She would come out to the house twice a week when I was very agoraphobic and go on walks with me and we would talk. She was a very good listener and very good at helping me set goals. Very positive. I said at the time that it was a perfect complement to my therapy sessions, which to be honest, sometimes feel like they only worsen issues by beating them to death (though on occasion, there is something that happens in therapy that is changing). Unfortunately, this was through a community services board and I didn't meet their exact definition of who was supposed to be served so I couldn't keep seeing her.

    I think there is a good place for that. Maybe it falls in the realm of positive psychology?

    I personally haven't seen this taking place in outpatient psychiatry appointments, but I see from this thread that it does. It certainly would help if I lived in an area with private-pay psychiatrists, where I imagine more of that takes place.
     
  47. Ceke2002

    Ceke2002 Purveyor of Strange
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    You're very welcome, I'm glad you found it helpful. :) I did an AMA a while back now where I went into a bit more detail about how my Psychiatrist works, but pretty much he explains and educates me on almost everything. If we're doing therapeutic work for a particular dynamic or pathology, for example, he'll go through and give a brief description of the various schools of therapeutic thought and then hone in on the one he thinks is the best interpretation for the issue at hand, and then it's up to me say 'yes' 'no' or 'maybe' if I think he's on track, off track, or if one of the other modalities of thought might even resonate more for me in a particular situation. He'll also often explain some of the neurobiological theories/underpinnings of understanding the mind, including when it comes to any medication I might be prescribed - I'm told how the medication works, the receptors it targets in the brain, why those receptors are important and how they work, how the proposed medication works on a brain level in comparison with other medications, any expected side effects, and so on. I'm not a Doctor so he does have to dumb it down for me to a degree, but yeah I get a lot of patient education from him which I like because it makes it feel more like a collaborative working alliance rather than just someone telling me 'take this, do this, see you next month'.
     
  48. shan564

    shan564 Below the fray
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    Why is it that it's called "medication management" for psychiatrists and just called "management" or "evaluation and management" in other specialties? Nobody says that an endocrinologist is just doing "medication management."

    The specialized evaluation and management is what separates one specialist from another. An endocrinologist is better at assessing diabetes and hyperthyroidism, and I'm better at assessing schizophrenia and major depression. The endocrinologist might send the patient to a nutritionist, and I might send him/her to a psychotherapist... but a good endocrinologist will still provide some nutritional guidance, and I'll still do some brief psychotherapy interventions.
     
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  49. birchswing

    birchswing Patient/Interested in Psychiatry
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    I would guess that the difference is the frequency of visits.
     
  50. Doctor Bagel

    Doctor Bagel so cheap and juicy
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    25 patients in a day! How long are the appointments and how many follow ups? I'm really struck by this number. I don't think I could provide thoughtful care to this many patients in a day.
     
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  51. Ceke2002

    Ceke2002 Purveyor of Strange
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    You should see a small 'edit' just underneath your post - click on that and it will take you to another pop up screen where you can edit your post.
     
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