VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

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Fan_of_Meehl said:
Agreed, it's a tool. All tools (even copy & paste) have their place. Using AI seems to be the wave of the future. I gotta get off my bum and get with the program.
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It is WAY overhyped. I honestly don't think you'd miss anything if you sat this one out. It is way too inaccurate to be useful in any practical way other than doing a decent job (mostly) of summarizing information or generating really generic text for templates or soulless emails.

OpenAI is lighting money on fire at this point. I am very curious how, even ignoring all the ethical issues that are likely going to catch up to them, they survive being woefully unprofitable. It is eye watering how much money they're spending.

Ed Zitron's podcast Better Offline is a lot of fun if anyone wants to spend an hour or two a week hating big tech. AI is a special passion of his.
 
Shiori said:
It is WAY overhyped. I honestly don't think you'd miss anything if you sat this one out. It is way too inaccurate to be useful in any practical way other than doing a decent job (mostly) of summarizing information or generating really generic text for templates or soulless emails.

OpenAI is lighting money on fire at this point. I am very curious how, even ignoring all the ethical issues that are likely going to catch up to them, they survive being woefully unprofitable. It is eye watering how much money they're spending.

Ed Zitron's podcast Better Offline is a lot of fun if anyone wants to spend an hour or two a week hating big tech. AI is a special passion of his.
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Meanwhile, I hand write my trauma history and clinical interview notes on blank printer paper I steal from the clinic copier, lol. Low tech is best. That's the fun part. Make it a face to face interview (instead of VVC), and I'm in heaven.

The friggin chart review prior to the interview trying to find the 2% of actual information among the 98% boilerplate BS text/disclaimers, template vomit, and copy/paste forests of text..

...not so fun.
 
Fan_of_Meehl said:
Meanwhile, I hand write my trauma history and clinical interview notes on blank printer paper I steal from the clinic copier, lol. Low tech is best. That's the fun part. Make it a face to face interview (instead of VVC), and I'm in heaven.
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This is one of my favorite things about PP, I can be old school. I ran out of insert pages for my portfolio notebook, so it's back to printer paper from my clinic laser printer.
 
Fan_of_Meehl said:
Meanwhile, I hand write my trauma history and clinical interview notes on blank printer paper I steal from the clinic copier, lol. Low tech is best. That's the fun part. Make it a face to face interview (instead of VVC), and I'm in heaven.

The friggin chart review prior to the interview trying to find the 2% of actual information among the 98% boilerplate BS text/disclaimers, template vomit, and copy/paste forests of text..

...not so fun.
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I am 50/50. I used to do a lot hand written notes. However, two screens and VVC has made CPRS much easier to manage. For PP, I am looking at templates and voice dictation. Trying to figure out the most efficient way to to complete notes so that I can spend more time seeing patients.
 
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Shiori said:
So, it looks like the videos for several TMS trainings were removed without bothering to take down the actual course. I have to attempt to do the training to find out whether it's still active or not.

Efficient.
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Be careful and make sure you don’t accidentally learn about the dangerous topic of diversity!
 
Real question….how are things like genetic and racial differences covered now in healthcare education? CEUs?

DMII risk factors for instance. There can be significant health consequences to not teaching this and/or practicing informed care.
 
Shiori said:
So, it looks like the videos for several TMS trainings were removed without bothering to take down the actual course. I have to attempt to do the training to find out whether it's still active or not.

Efficient.
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That’s been an on-going issue, ime! Not just the current admin.
 
Shiori said:
So, it looks like the videos for several TMS trainings were removed without bothering to take down the actual course. I have to attempt to do the training to find out whether it's still active or not.

Efficient.
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Psychologist1234 said:
Be careful and make sure you don’t accidentally learn about the dangerous topic of diversity!
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I just did one on Women's health and I am waiting to be fired for completing it. Also, secretly hoping to be fired for completing it.
 
Therapist4Chnge said:
Real question….how are things like genetic and racial differences covered now in healthcare education? CEUs?

DMII risk factors for instance. There can be significant health consequences to not teaching this and/or practicing informed care.
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It's a weird middle ground. I can still train people on these topics as long as it's clinical. In this case, I think they removed a ton of stuff that has words on the naughty list without considering they might actually be linked to things.

futureapppsy2 said:
That’s been an on-going issue, ime! Not just the current admin.
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I was looking specifically at LGBTQ+ trainings to prep for my own training I'm doing. These were available until recently. TMS has always been janky for sure.
 
Shiori said:
It's a weird middle ground. I can still train people on these topics as long as it's clinical. In this case, I think they removed a ton of stuff that has words on the naughty list without considering they might actually be linked to things.


I was looking specifically at LGBTQ+ trainings to prep for my own training I'm doing. These were available until recently. TMS has always been janky for sure.
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Our state still requires at least 2 CEU hours on diversity/multicultural issues every renewal period. Glad I already did mine in TMS.
 
futureapppsy2 said:
Apparently, they want to get rid of locality pay entirely.
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wow...that is really unfortunate if true bc many places are straight up not doable. No offense to AL, but there is no way that someone can survive in a place like Los Angeles, CA getting paid the same as someone in Mobile, AL. That is an unserious and flawed idea, by design I suspect.
 
Therapist4Chnge said:
wow...that is really unfortunate if true bc many places are straight up not doable. No offense to AL, but there is no way that someone can survive in a place like Los Angeles, CA getting paid the same as someone in Mobile, AL. That is an unserious and flawed idea, by design I suspect.
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Yeah, everyone in Hawaii, California, NYC, DC, etc will be screwed if this comes to pass, but I think that may be the goal, so…
 
futureapppsy2 said:
I’ve seen it floated around fednews Reddit by people apparently in the know, but it well could simply be baseless rumors.
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It would take an act of congress and 60 senate votes at this point. Hoping it doesn't happen because that would be the finishing blow for VA. No one is going to deal with this stuff and get paid even less than the less than market rate we already get paid. But as many here have said, that may be the point.
 
psy.d. 2021 said:
It would take an act of congress and 60 senate votes at this point. Hoping it doesn't happen because that would be the finishing blow for VA. No one is going to deal with this stuff and get paid even less than the less than market rate we already get paid. But as many here have said, that may be the point.
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Oh, I'm sure there is an obscure emergency war power that could be exploited to get it done without Congress. Regardless, we've seen that Congress is unwilling to actually enforce the checks and balances in the system.
 
Sanman said:
Well, Trump did try to remove locality pay his last term. So, there is that. Combine that with the contract cancellation and I would not be surprised.
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So we received written instruction from MH admin at our VA that there is a 'new' national policy that the MSA's 'have to follow': appointments that are missed by patients cannot be "no showed" until the end of the day.

If we call a patient and speak with them, we create a note (separate from the scheduled appointment note/encounter) and document our session?/assessment under that note.

If we call and do not reach the pt, we use the MH No Show note template under our telephone clinic (again, separate note/encounter).

Is this being enforced currently at your VA?

I'd always heard about (from the MSA's) the "we can't no show anyone for their appointment until the end of the day" "rule/policy" but this was always unofficially pushed back on by MH leadership for obvious reasons.

I mean, if I no longer have to beg the MSAs to no show these appts and no longer have to wait on them to do my documentation in order to avoid the dreaded 'action required' list of shame---then...great, it's a win for me...but...

What do you do when your shift ends at 4pm and two or three pts scheduled for earlier appointments in that day show up at 3:45pm wanting to be 'seen?' It's either 2 min appts or it's time to break out the overtime. How can any 'leadership' in MH fail to appreciate what a disaster this will be when implemented with SUDS/MH patients?

I guess it's gonna be like in that Fellowsgip of the Ring movie where the wizard character says, "A Wizard is never late, Frodo Baggins...nor is he early...he arrives PRECISELY when he means to." [LOL]
- Gandalf the Grey (also)
- Veteran the Tardy
 
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Fan_of_Meehl said:
So we received written instruction from MH admin at our VA that there is a 'new' national policy that the MSA's 'have to follow': appointments that are missed by patients cannot be "no showed" until the end of the day.

If we call a patient and speak with them, we create a note (separate from the scheduled appointment note/encounter) and document our session?/assessment under that note.

If we call and do not reach the pt, we use the MH No Show note template under our telephone clinic (again, separate note/encounter).

Is this being enforced currently at your VA?

I'd always heard about (from the MSA's) the "we can't no show anyone for their appointment until the end of the day" "rule/policy" but this was always unofficially pushed back on by MH leadership for obvious reasons.

I mean, if I no longer have to beg the MSAs to no show these appts and no longer have to wait on them to do my documentation in order to avoid the dreaded 'action required' list of shame---then...great, it's a win for me...but...

What do you do when your shift ends at 4pm and two or three pts scheduled for earlier appointments in that day show up at 3:45pm wanting to be 'seen?' It's either 2 min appts or it's time to break out the overtime. How can any 'leadership' in MH fail to appreciate what a disaster this will be when implemented with SUDS/MH patients?

I guess it's gonna be like in that Fellowsgip of the Ring movie where the wizard character says, "A Wizard is never late, Frodo Baggins...nor is he early...he arrives PRECISELY when he means to." [LOL]
- Gandalf the Grey (also)
- Veteran the Tardy
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This was enforced policy back at my last VA. If patients showed up at any point, we had to see them, even if just to briefly check-in with them and get them rescheduled. Multiple times, I had neuropsych patients show up hours late for evals; I had to try to see them that day if I had time, or maybe get in an interview and reschedule the testing if it wouldn't be too far out, or just reschedule them entirely if needed.
 
Fan_of_Meehl said:
What do you do when your shift ends at 4pm and two or three pts scheduled for earlier appointments in that day show up at 3:45pm wanting to be 'seen?' It's either 2 min appts or it's time to break out the overtime. How can any 'leadership' in MH fail to appreciate what a disaster this will be when implemented with SUDS/MH patients?
Click to expand...

You tell them you can't see them.
 
Fan_of_Meehl said:
So we received written instruction from MH admin at our VA that there is a 'new' national policy that the MSA's 'have to follow': appointments that are missed by patients cannot be "no showed" until the end of the day.

If we call a patient and speak with them, we create a note (separate from the scheduled appointment note/encounter) and document our session?/assessment under that note.

If we call and do not reach the pt, we use the MH No Show note template under our telephone clinic (again, separate note/encounter).

Is this being enforced currently at your VA?

I'd always heard about (from the MSA's) the "we can't no show anyone for their appointment until the end of the day" "rule/policy" but this was always unofficially pushed back on by MH leadership for obvious reasons.

I mean, if I no longer have to beg the MSAs to no show these appts and no longer have to wait on them to do my documentation in order to avoid the dreaded 'action required' list of shame---then...great, it's a win for me...but...

What do you do when your shift ends at 4pm and two or three pts scheduled for earlier appointments in that day show up at 3:45pm wanting to be 'seen?' It's either 2 min appts or it's time to break out the overtime. How can any 'leadership' in MH fail to appreciate what a disaster this will be when implemented with SUDS/MH patients?
Click to expand...
There is a rule that appointments couldn't be marked as no-shows if they were rescheduled the same day, I'm told because some patients didn't like being marked as no-show. It shouldn't matter (there are no consequences for no shows anyway) but it can create problems on the administrative side - cancellations disappear from Vista so it can look like there were openings, and the programs used to measure productivity can count no shows towards utilization but may ignore cancellations (e.g. if you were booked solid for a day but every veteran cancelled [or "cancelled"] then it might show you as 0% utilization that day when it should show 100%).
My understanding was that veteran's showing up too late to appointments or even without appointments was a separate matter, and the guideline there was basically accommodate the veteran however much you clinically reasonably can. The question of overtime would be a separate one, although at least on the physician side is an easier answer - by law we can't get paid for overtime, so we basically don't do it.

Creating a separate encounter for the no-show note seems ridiculous, as does making a note under the telephone encounter unless actual treatment is provided when you reach the veteran.
 
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Fan_of_Meehl said:
Unfortunately, local NS policy/procedure mandates that the call SHALL be made during the time of the scheduled appt.
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Ugh. In that case, i would wait until there's only like 5 min left in the appt time. If the pt wants to r/s for the same day and you don't have a reasonable way to see them, then I would tell them they need to r/s for another day. Ditto if they show up to the clinic in person.

The VA doesn't make enforcing boundaries easy, but it is possible.
 
My leadership sent out word that any "full time telemental health employees" are not to be assigned an RTO placement. Of course no word on if this is just temporary or what.
 
Sydney Huffman said:
My leadership sent out word that any "full time telemental health employees" are not to be assigned an RTO placement. Of course no word on if this is just temporary or what.
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According to leaked VA PowerPoint slides on Reddit, looks like FT telemental health staff are approved for 180-240 day extensions.
 
People in our already cripplingly understaffed service are starting to leave, some of them with very little notice. 🙁 word is that the whole program nationally has no money to hire for the foreseeable future, either.
 
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futureapppsy2 said:
People in our already cripplingly understaffed service are starting to leave, some of them with very little notice. 🙁 word is that the whole program nationally has no money to hire for the foreseeable future, either.
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"Good news and bad news. The good news is we are no longer cripplingly understaffed. The bad news is that we are now ludicrously understaffed."
 
aim-agm said:
"Good news and bad news. The good news is we are no longer cripplingly understaffed. The bad news is that we are now ludicrously understaffed."
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Go Dark Helmet GIF
 
Maybe I’m overly cynical, but I find it hard to believe that no direct patient care staff will be RIF’ed. it seems like if they’re cutting 15% of the workforce, there’s little way that direct care staff avoid that entirely. Safer relative to pure admin folks? Sure. But completely safe? I don’t know.

Thoughts?
 
futureapppsy2 said:
Maybe I’m overly cynical, but I find it hard to believe that no direct patient care staff will be RIF’ed. it seems like if they’re cutting 15% of the workforce, there’s little way that direct care staff avoid that entirely. Safer relative to pure admin folks? Sure. But completely safe? I don’t know.

Thoughts?
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Might depend on how they define "direct patient care staff." As in, if you aren't 100%, full-and-total clinical care, you're vulnerable.

Plus, they can just leave only clinical staff with no administrative or other support, knowing that doing so will make lots of people quit. Then the folks who remain are so overwhelmed handling things like their own scheduling and billing that waitlists become unmanageable, follow-up appointments occur once every 1.5 years, and outcome metrics (which they begin fastidiously gathering) understandably suffer, so they can then say, "see, we told you government healthcare doesn't work and government workers are lazy and bad at their jobs!"
 
futureapppsy2 said:
Maybe I’m overly cynical, but I find it hard to believe that no direct patient care staff will be RIF’ed. it seems like if they’re cutting 15% of the workforce, there’s little way that direct care staff avoid that entirely. Safer relative to pure admin folks? Sure. But completely safe? I don’t know.

Thoughts?
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Agree with what AA said. I think direct clinical or benefits people are likely safe.
 
futureapppsy2 said:
Maybe I’m overly cynical, but I find it hard to believe that no direct patient care staff will be RIF’ed. it seems like if they’re cutting 15% of the workforce, there’s little way that direct care staff avoid that entirely. Safer relative to pure admin folks? Sure. But completely safe? I don’t know.

Thoughts?
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It's hilarious to watch clinicians who went for all the non-direct-patient care roles a few years ago (licensed professionals) now all of a sudden being given 1-2 patient appointments per week (yes, this is a sudden development now, lol) so that--I suppose--they can be characterized as 'direct patient care staff.' I mean, I don't blame them (or their buddies in admin who are orchestrating this) for trying to maneuver to save their positions but...c'mon.
 
AcronymAllergy said:
Might depend on how they define "direct patient care staff." As in, if you aren't 100%, full-and-total clinical care, you're vulnerable.

Plus, they can just leave only clinical staff with no administrative or other support, knowing that doing so will make lots of people quit. Then the folks who remain are so overwhelmed handling things like their own scheduling and billing that waitlists become unmanageable, follow-up appointments occur once every 1.5 years, and outcome metrics (which they begin fastidiously gathering) understandably suffer, so they can then say, "see, we told you government healthcare doesn't work and government workers are lazy and bad at their jobs!"
Click to expand...
One of the things that isn't talked about enough is...

With all the push for 'measurement based care' (MBC) or (using the more recently fashionable phrase) 'patient reported outcome measures' (PROMs) being implemented widely and scrutinized (e.g., are the PCL-5's and PHQ-9's coming down over time in response to 'therapy/treatment' or not) is that the data for most VA patients are HORRIBLE. That's why we haven't seen them 'published' or even acknowledged widely despite all the data that are just sitting there in CPRS. There was an article publishing on some of the RRTP (residential) patients last summer, I think, and it painted a very bleak picture of outcomes according to these measures but nobody has published the data for general mental health. I mean, there's a good 20% or so of patients who respond the way they do in most of the outcome trials (with pre-selection criteria), but if they were to do a 'study' publishing the 'results' of just all the patients who are 'being seen for therapy' over the years in the VA MH system...the average results would be beyond pathetic and almost like there was 'no treatment' (effect) at all for all those expensive and time-consuming interventions. IN FACT, I think it is quite possible that what would be observed would be an AVERAGE INCREASE in self-reported psychopathology (on those checklists like the PHQ-9 or PCL-5) over time as a result of involvement in VA MH and we know why that is but nobody can talk about even considering the influence of symptom over-reporting/malingering and the disability context. There was a quote from a book a couple of years ago ('Wounding Warriors?') that was basically, 'Most of the veterans pretend to have disorders that we pretend to treat' and it's not far off these days.

VA admin and 'leadership' are just going to ride that ship to the very bottom of the ocean.

In the DSM-IV (which wasn't even that long ago) there was even a separate required criterion that had to be satisfied of 'ruling out malingering' before being able to even make a diagnosis of PTSD whereas, nowadays, merely asking someone interview questions ('describe a typical dream,' 'how many times in the past month has this happened,' or 'what sorts of reminders upset you') gets you accused of 'interrogating' them or results in a patient complaint/grievance or being labeled 'anti-veteran' or being told by other providers, 'Well, I'm an ADVOCATE for MY veterans...'--with the unspoken part left hanging in the air of 'but you are anti-veteran and are a big bad meanie and need to be shamed for it.' We're not even operating as adults anymore, let alone professional clinicians. Pretending not to notice when a veteran patient contradicts themselves, is a poor historian, blows validity scales out of the rooftop, scores a 79/80 on the PCL-5 while earning 100,000+/yr in a highly stressful occupation (with perfect performance reviews) while trying to shame you for not 'writing letters' in support of his quest to get designated as '100% disabled due to PTSD'...I just can't anymore. Pretending not to notice these things isn't 'advocating for veterans,' it's actually harming veterans.

The VA system is far more boned than most people even working there admit or realize. A lot of the structural and institutional pathology is relatively 'latent' at this point because of all the dancing around of the central problem of patient over-reporting of symptoms in relation to disability compensation. The house is ready to fall and it ain't gonna be pretty.
 
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Fan_of_Meehl said:
One of the things that isn't talked about enough is...

With all the push for 'measurement based care' (MBC) or (using the more recently fashionable phrase) 'patient reported outcome measures' (PROMs) being implemented widely and scrutinized (e.g., are the PCL-5's and PHQ-9's coming down over time in response to 'therapy/treatment' or not) is that the data for most VA patients are HORRIBLE. That's why we haven't seen them 'published' or even acknowledged widely despite all the data that are just sitting there in CPRS. There was an article publishing on some of the RRTP (residential) patients last summer, I think, at it painted a very bleak picture of outcomes according to these measures but nobody has published the data for general mental health. I mean, there's a good 20% or so of patients who respond the way they do in most of the outcome trials (with pre-selection criteria), but if they were to do a 'study' publishing the 'results' of just all the patients who are 'being seen for therapy' over the years in the VA MH system...the average results would be beyond pathetic and almost like there was 'no treatment' (effect) at all for all those expensive and time-consuming interventions. IN FACT, I think it is quite possible that what would be observed would be an AVERAGE INCREASE in self-reported psychopathology (on those checklists like the PHQ-9 or PCL-5) over time as a result of involvement in VA MH and we know why that is but nobody can talk about even considering the influence of symptom over-reporting/malingering and the disability context. There was a quote from a book a couple of years ago ('Wounding Warriors?') that was basically, 'Most of the veterans pretend to have disorders that we pretend to treat' and it's not far off these days.

VA admin and 'leadership' are just going to ride that ship to the very bottom of the ocean.

In the DSM-IV (which wasn't even that long ago) there was even a separate required criterion that had to be satisfied of 'ruling out malingering' before being able to even make a diagnosis of PTSD whereas, nowadays, merely asking someone interview questions ('describe a typical dream,' 'how many times in the past month has this happened,' or 'what sorts of reminders upset you') gets you accused of 'interrogating' them or results in a patient complaint/grievance or being labeled 'anti-veteran' or being told by other providers, 'Well, I'm an ADVOCATE for MY veterans...'--with the unspoken part left hanging in the air of 'but you are anti-veteran and are a big bad meanie and need to be shamed for it.' We're not even operating as adults anymore, let alone professional clinicians. Pretending not to notice when a veteran patient contradicts themselves, is a poor historian, blows validity scales out of the rooftop, scores a 79/80 on the PCL-5 while earning 100,000+/yr in a highly stressful occupation (with perfect performance reviews) while trying to shame you for not 'writing letters' in support of his quest to get designated as '100% disabled due to PTSD'...I just can't anymore. Pretending not to notice these things isn't 'advocating for veterans,' it's actually harming veterans.

The VA system is far more boned than most people even working there admit or realize. A lot of the structural and institutional pathology is relatively 'latent' at this point because of all the dancing around of the central problem of patient over-reporting of symptoms in relation to disability compensation. The house is ready to fall and it ain't gonna be pretty.
Click to expand...
I wonder if your VA might also be especially obnoxious and micromanaging.
 
Fan_of_Meehl said:
One of the things that isn't talked about enough is...

With all the push for 'measurement based care' (MBC) or (using the more recently fashionable phrase) 'patient reported outcome measures' (PROMs) being implemented widely and scrutinized (e.g., are the PCL-5's and PHQ-9's coming down over time in response to 'therapy/treatment' or not) is that the data for most VA patients are HORRIBLE. That's why we haven't seen them 'published' or even acknowledged widely despite all the data that are just sitting there in CPRS. There was an article publishing on some of the RRTP (residential) patients last summer, I think, and it painted a very bleak picture of outcomes according to these measures but nobody has published the data for general mental health. I mean, there's a good 20% or so of patients who respond the way they do in most of the outcome trials (with pre-selection criteria), but if they were to do a 'study' publishing the 'results' of just all the patients who are 'being seen for therapy' over the years in the VA MH system...the average results would be beyond pathetic and almost like there was 'no treatment' (effect) at all for all those expensive and time-consuming interventions. IN FACT, I think it is quite possible that what would be observed would be an AVERAGE INCREASE in self-reported psychopathology (on those checklists like the PHQ-9 or PCL-5) over time as a result of involvement in VA MH and we know why that is but nobody can talk about even considering the influence of symptom over-reporting/malingering and the disability context. There was a quote from a book a couple of years ago ('Wounding Warriors?') that was basically, 'Most of the veterans pretend to have disorders that we pretend to treat' and it's not far off these days.

VA admin and 'leadership' are just going to ride that ship to the very bottom of the ocean.

In the DSM-IV (which wasn't even that long ago) there was even a separate required criterion that had to be satisfied of 'ruling out malingering' before being able to even make a diagnosis of PTSD whereas, nowadays, merely asking someone interview questions ('describe a typical dream,' 'how many times in the past month has this happened,' or 'what sorts of reminders upset you') gets you accused of 'interrogating' them or results in a patient complaint/grievance or being labeled 'anti-veteran' or being told by other providers, 'Well, I'm an ADVOCATE for MY veterans...'--with the unspoken part left hanging in the air of 'but you are anti-veteran and are a big bad meanie and need to be shamed for it.' We're not even operating as adults anymore, let alone professional clinicians. Pretending not to notice when a veteran patient contradicts themselves, is a poor historian, blows validity scales out of the rooftop, scores a 79/80 on the PCL-5 while earning 100,000+/yr in a highly stressful occupation (with perfect performance reviews) while trying to shame you for not 'writing letters' in support of his quest to get designated as '100% disabled due to PTSD'...I just can't anymore. Pretending not to notice these things isn't 'advocating for veterans,' it's actually harming veterans.

The VA system is far more boned than most people even working there admit or realize. A lot of the structural and institutional pathology is relatively 'latent' at this point because of all the dancing around of the central problem of patient over-reporting of symptoms in relation to disability compensation. The house is ready to fall and it ain't gonna be pretty.
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-The perverse incentives of the SC system (and less than rigorous SC determinations) create many problems. It would help if the VHA could set (or would support) better limits, but practically it is very difficult to say no. In admin's lukewarm defense, their influence is curtailed by the rules and demands of Congress and politics.

-I would agree with calling them Patient Reported Measures (PRM or PReM), because that is the most accurate description of what the are. They are not measurements that reliably form the basis of care, and they do not necessarily provide data regarding outcomes.

-"I am an advocate for my veteran's as well. I am also forbidden from falsifying medical records and obliged to practice within the standard of care."

-I'm not sure why, but I rarely encounter veterans malingering conditions for SC (malingering for stimulants or benzos is a different matter). Could be an element of luck and different locale. Probably these veterans seek out psychiatrists less, and they also would take up much less of our time (30 minutes every 1-3 months vs. 1 hour every 1-2 weeks). There is less incentive to overreport symptoms to a psychiatrist (at least once stimulants and benzos are taken off the table) than to a psychologist. Lying to the latter just gets you free 1-hour vent sessions every couple weeks, lying to the former means that we would just trial other meds.

- Side rant - I find the idea of "untreatable" PTSD that these "advocates" may espouse as utterly ridiculous. Off the top of my head, of the many, many patients I have treated with PTSD who were actually engaged in treatment, I can only think of two that did not have remission of symptoms with treatment or are not on trajectory to achieve that (both had only partial improvement). One was during training (when I was much less adept at treating PTSD) and was very complex psychiatrically and medically (e.g. it was quite difficult to do exposure exercises because they had comorbid narcolepsy with cataplexy), and the other has multiple other conditions that are both deeply intertwined with their PTSD (to the point that improvement in PTSD is difficult to envision with controlling the conditions) and are quite difficult to treat (e.g. OCD) so we are still working through medication options. Granted, my career has not been that long and it could be argued I am uncommonly good at treating PTSD, but I still find it hard to escape the conclusion that while PTSD can be difficult to treat it is nevertheless eminently treatable.
 
cara susanna said:
I'm 75% patient care soooo fingers crossed, I guess?
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Sure, for which outcome? Even if you are not fired, will you be reporting to an office where you will be written up for arriving at 8:02am after being unable to find alternative parking because the lot is full and the facility has refused to issue you a pass?
 
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