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Two questions about Emergency Medicine

crippledoc

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    1. What would happen to an EM physician who refused to work with psychiatrists?

    2. Is it possible for EM physicians to refuse medicare and medicaid payments if they see the patients for free?
     
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    docB

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      Some people have religious and/or ethical problem with psychaitrists. Scientologists come to mind.

      To answer the questions it would be almost impossible to practice EM and refuse to work with any one specialty. You would be unable to see any patients who need that specialty and so would have to dump those patients on your colleagues which would be totally unfair and make you not worth it. You also would not be able to work single coverage which makes you even less worth while as an EP. You really can't be a viable EP an treat all CMS patients for free. I don't know of any group, hospital or position in the whole field that would take someone who can't/won't see CMS patients. Pair that with the psych thing and there's no place out there for someone with those issues.
       

      crippledoc

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        Some people have religious and/or ethical problem with psychaitrists. Scientologists come to mind.

        To answer the questions it would be almost impossible to practice EM and refuse to work with any one specialty. You would be unable to see any patients who need that specialty and so would have to dump those patients on your colleagues which would be totally unfair and make you not worth it. You also would not be able to work single coverage which makes you even less worth while as an EP. You really can't be a viable EP an treat all CMS patients for free. I don't know of any group, hospital or position in the whole field that would take someone who can't/won't see CMS patients. Pair that with the psych thing and there's no place out there for someone with those issues.

        I was speaking of refusing CMS payments, not refusing the patients.
         

        notdeadyet

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          I was speaking of refusing CMS payments, not refusing the patients.
          I can't imagine anything from a hospital down to a doc-in-a-box that would be willing to hire someone that refuses to accept payments from what's usually a reasonable chunk of their patentbase.

          EM2BE's right about the free clinic idea. Unfortunately, as a nice slice of that pie is psych-related, that probably wouldn't fly.
           

          zinjanthropus

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            1. I'm not sure what "refuse to work with psychiatrists" means. You wouldn't see the psych patients? You wouldn't make appropriate referrals (that's potentially malpractice)?

            2. Your job as an employee is to make money for your hospital/contract group, etc. Your job as a physician is to see patients. You can take CMS payments and meet both goals. I'm just not sure I understand your question. Are you saying you want to take patients who have no funding/couldn't get medicare/medicaid? That's possible and often social work will be involved with those patients. Plus, it's mandatory to stabilize under EMTALA (unless you don't get CMS funds I guess - is that what you are implying..a way out of EMTALA?)

            My suspicion is that your knowledge base isn't quite there for these to be insightful questions.
             

            Red Beard

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              Wow, what a bizarre post.

              Dude starts an account in 2006, but doesn't post anything until yesterday when he goes and starts flipping out in the psych forum for no reason, then comes here and posts this.

              Wonder what happened in his life recently?

              Oh the fantastic stories behind the scenes at SDN. :laugh:
               

              ineedsleep

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                Wow, what a bizarre post.

                Dude starts an account in 2006, but doesn't post anything until yesterday when he goes and starts flipping out in the psych forum for no reason, then comes here and posts this.

                Wonder what happened in his life recently?

                Oh the fantastic stories behind the scenes at SDN. :laugh:

                The other forum was an interesting read. One does wonder what goes on outside of computerland to produce such posts from an individual.
                 

                nymbarra

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                  Yikes! Tom Cruise, is that you? :laugh:

                  I have high regard for psychiatry, especially after having spent a month at the county mental health treatment center. One of my most memorable ED patients was a HIV+ schizophrenic homeless man who was jumped. :(

                  But there was a recent meta-analysis that showed SSRIs were comparable to placebo for mild to moderately severe depression. Only in the most severe cases of depression were SSRIs better than placebo.

                  http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0050045&ct=1

                  Lots of issues with the study- the heterogeneous patient populations, follow-up times, specific medication differences, etc. The study speaks more to publication bias (ie, journals not publishing negative studies) and direct-to-consumer advertising / overprescription more than anything. Will be interesting to see how new imaging modalities like fMRI will change the field of psych...
                   
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                  EM2BE

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                    :laugh::laugh::laugh::laugh::laugh:

                    Thanks lots...wonder if the kid ever figured out what the actual book was for psych....probably not. I almost got someone involuntarily committed last week...so ironic this came about. Maybe it was her who started it :idea: Doubt it though. She did say I was going to ruin her life if I called her in (not a hospital pt, just sister's roommate). But then I found out last time she told them she was going to commit suicide, they told her she could go home as long as she reported back within 24 hrs :eek: Decided it would defeat the purpose in sending her in at that point.
                     
                    D

                    deleted65604

                      Working with psychiatrists isn't very hard. I know I 'm simplifying the matter hugely, but usually, if someone comes into the ER with depression and they say the S word, I call psychiatry for admission.

                      At my main campus, the psych resident comes down and admits them, or rarely, discharges them home after arranging follow-up. At a small private hospital, a social worker or psychiatric case worker comes down and decides the disposition while communicating by phone to a psychiatrist. Compared to other specialties (lets face it, about 1/3 of doctors are complete buttholes), psychiatrists are very nice and helpful people (On a personal level, and from the standpoint of patient care, as well as from a "Help me get this person out of my ER" standpoint). I do think that SSRIs are over prescribed, especially in children. I think there is a big problem with a short staffing of psychiatrists, which leads to less time spent doing cognitive therapy.

                      I remember on my psych rotations in med school, listening to people describe their lives and what they do on a daily basis. I'd think in my head, "You are fat, ugly, unemployed and treat other people rudely, and as a result, no one wants to be your friend. Of course you are depressed." Some attending psychiatrists would listen to them briefly and adjust their medication and send them on their way, not commenting on anything that the patient needed to change about their lives. On occasion, they would refer them to group therapy sessions that were conducted by psychologists. I'm sure they would all love to spend as much time as Freud did back in the day, analysing people and delving into every aspect of their life until the person finds out how to help themselves, but that would mean they would see about 2 patients per day. Like in all specialties, there are great psychiatrists who accomplish much good, and there are others who kind of go through the motions.

                      Not only are they extremely useful people to help you with suicidal patients, they are really good at reducing symptoms of psychosis. People can really get wacked out when they go off there medications and they have severe psychophrenia. They run a lot of great programs that keep people from being dangerous like depot shots for out-patient schizophrenics.

                      I would like some additional info about your exposure to psychiatry, and why you think they are such bad people. I really think we could generate some good discussion if you talked about why you think psychiatrists shouldn't exist and backed it up with some evidence, whether it be from personal experience, rumor-mill, or evidence-based literature.
                       

                      docB

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                        Working with psychiatrists isn't very hard. I know I 'm simplifying the matter hugely, but usually, if someone comes into the ER with depression and they say the S word, I call psychiatry for admission.

                        At my main campus, the psych resident comes down and admits them, or rarely, discharges them home after arranging follow-up. At a small private hospital, a social worker or psychiatric case worker comes down and decides the disposition while communicating by phone to a psychiatrist. Compared to other specialties (lets face it, about 1/3 of doctors are complete buttholes), psychiatrists are very nice and helpful people (On a personal level, and from the standpoint of patient care, as well as from a "Help me get this person out of my ER" standpoint). I do think that SSRIs are over prescribed, especially in children. I think there is a big problem with a short staffing of psychiatrists, which leads to less time spent doing cognitive therapy.

                        I remember on my psych rotations in med school, listening to people describe their lives and what they do on a daily basis. I'd think in my head, "You are fat, ugly, unemployed and treat other people rudely, and as a result, no one wants to be your friend. Of course you are depressed." Some attending psychiatrists would listen to them briefly and adjust their medication and send them on their way, not commenting on anything that the patient needed to change about their lives. On occasion, they would refer them to group therapy sessions that were conducted by psychologists. I'm sure they would all love to spend as much time as Freud did back in the day, analysing people and delving into every aspect of their life until the person finds out how to help themselves, but that would mean they would see about 2 patients per day. Like in all specialties, there are great psychiatrists who accomplish much good, and there are others who kind of go through the motions.

                        Not only are they extremely useful people to help you with suicidal patients, they are really good at reducing symptoms of psychosis. People can really get wacked out when they go off there medications and they have severe psychophrenia. They run a lot of great programs that keep people from being dangerous like depot shots for out-patient schizophrenics.

                        I would like some additional info about your exposure to psychiatry, and why you think they are such bad people. I really think we could generate some good discussion if you talked about why you think psychiatrists shouldn't exist and backed it up with some evidence, whether it be from personal experience, rumor-mill, or evidence-based literature.
                        I don't think that there's any good discussion that can come from this guy's question. He was clearly a troll. At the risk of avoiding the profanity filter when your rebuttal to a statment is to call someone a "f--ktard" you've demonstrated conclusively that you are a troll and you have nothing useful to add. I answered him early on before he declared himself but I wouldn't do it again. Anyone who's interested in issues related to psychaitry can amble on over to the psych forum.
                         

                        FLTDOC1

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                          I worked for many years in a busy community ED and can actually say - I never directly interfaced with a psychiatrist. Not because I refused to do so. We just didnt have any available.

                          There are several special case such as ophthalmology, neurology, plastic surgery, psychiatry and others that are daily consultants in an academic emergency room but are rarely seen in community EM practice
                           

                          pseudoknot

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                            Rendar5

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                              Maybe he'll explain himself if we start cussing at him. Should we make fun of his mom?

                              Wouldn't help. he hates his mom for allowing him to be forced into psychiatric help anyway. The question is whether he's 18, you can't really be 2pc'd as a minor. You need a parent or guardian to allow it (at least in my state).
                               

                              NSAIDAllergy

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                                I was pretty amazed at how the people in the psychiatry forum continued to take the high road in dealing with that guy for almost the entire thread. Of course it only seemed to make the troll dude more angry...

                                Those psych guys are pretty good at keeping their cool while the patient in denial hangs themselves with their own BS (no pun intended):D
                                 

                                Jeff698

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                                  My first thought was "great, the Scientologists found the EM forum". I took a look at the thread over in psych and a PGY1 (Luft) nailed it early in the discussion:

                                  "The thing about large, angry, blanket statements are that they often say much more about the person saying it than about whatever it is they are talking about."

                                  Luft, my man, you are wise.

                                  Take care,
                                  Jeff
                                   
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