Where have you been?

[Anasazi23]

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Members don't see this ad.

Better question: Who cares?

Seriously though. I wanted to drop in after what some may have noticed was a conspicuous absence from the forums for a bit.

Long story short: I took a job near Miami that wound up being horrible for me. Did some locums throughout the state for a bit, and am now settled into a forensic hospital - a position that is much better for me.

My business had kept me away from the boards, as I was working crazy hours, or staying in hotels during the locums stints.

I was able to check in every so often, but certainly not as much as I had liked. Most recently, the World Series games took up some time too

😀😀😀Yankees WIN!!!😀😀😀

 

[Doc Samson]

😀😀😀Yankees WIN!!!😀😀😀

🙁😡🙁😡

 

[Anasazi23]

Oh yeah...you and that whole....Boston thing.

Yeah, sorry 😎

Boston should make some interesting moves in the hot-stove season.

 

[billypilgrim37]

I told a psychotic patient he would have to stay an extra week because he was a Yankees fan. He gained the week back by laughing.

 

[OldPsychDoc]

Was someone gone?

 

[Anasazi23]

Said like a true psychoanalytic attending.

Bravo!

I released a criminally insane felony convict early because he picked the Yanks in 6. I'm sure it will all work out fine.

 

[OldPsychDoc]

Said like a true psychoanalytic attending.

Bravo!

I released a criminally insane felony convict early because he picked the Yanks in 6. I'm sure it will all work out fine.

Well of course! The Yankees needed every available psychopath on their roster to win in 6.

 

[Regnvejr]

Hmm, some kind of sport thing, right? Like base jumping? Who were they and what do they do again? World peace, right?

😉

 

[Regnvejr]

.

 

[Regnvejr]

.

 

[Regnvejr]

.

 

[Regnvejr]

.

 

[Regnvejr]

.

 

[Regnvejr]

%$#@%$@#%$# lags

 

[psychfun]

hi anasazi,

you mentioned that you did some locums' jobs....would you please shed some light on experiences of those? anything to keep in mind especially when others who have no prior work experience accept such positions? did it work out better financially?

thanks!

 

[whopper]

Yankees WIN!!!

Hmm, this year it came down to the two teams I like the most--the Yankees and the Phils. I wanted the Phils to win only because the Yankees have won some many WSs.

I was wondering how your job worked out, and I speculated you weren't on the boards because of your move. How's your forensic job? Is it in a state institution? Are you doing any private work?

Hmm, maybe you ought to PM me with your responses.

 

[Anasazi23]

In response to psychfun - I wrote a longer post on the whole locums experience, some of the in's and out's. I'll try to dig it up.

In terms of my new job, I don't mind discussing it online, as it could help others learn from the types of facilities in which a psychiatrist can work.

I am now an attending forensic psychiatrist at a state-contracted and privately run forensic "hospital" in Florida. There are two such hospitals in the State of Florida, to my knowledge.

Most patients come to us from the court / jail system after being found Incompetent to Proceed (ITP) from an evaluator in the courts. Charges range from low grade (tampering with fire equipment, which amounts to patients trying to flood their cells by pulling down the fire sprinkler, a felony), to 1st degree murder, kidnapping, rape, etc.).

There are "wings" of the hospital, of which the psychiatrists split their time. Each psychiatrist has a team which consists of a psychologist, social worker, "team coordinator," nurses, and others. The psychiatrist oversees the team, and the psychologists conduct periodic evaluations to determine their baseline competency level, which consists of knowledge of legal proceedings, etc. The patients attend "classes" daily on competency restoration, which are largely run by the psychologists. The psychologists then generate reports to the court and the patient eventutally returns to face his charges, unless they are determined to be "non-restorable."

Other patients include those who are NGRI. Their length of stay varies by charge and their psychiatric progress.

The pay is quite competitive, the hours are good, and the autonomy is also good. I'm glad to say that I now have a solid forensic oriented job that will still allow time for periodic moonlighting and private practice, which I'm working on.

 

[notdeadyet]

Each psychiatrist has a team which consists of a psychologist, social worker, "team coordinator," nurses, and others. The psychiatrist oversees the team, and the psychologists conduct periodic evaluations to determine their baseline competency level, which consists of knowledge of legal proceedings, etc. The patients attend "classes" daily on competency restoration, which are largely run by the psychologists. The psychologists then generate reports to the court and the patient eventutally returns to face his charges, unless they are determined to be "non-restorable."

Thanks, Anasazi23, this is helpful. But in this model, what exactly is the psychiatrist doing?

 

[OldPsychDoc]

Thanks, Anasazi23, this is helpful. But in this model, what exactly is the psychiatrist doing?

"periodic moonlighting and private practice" 😀

 

[whopper]

My setup was similar in Ohio. Pretty much the same exact thing though we had different names for them.

Someone incompetent to stand trial were called RTCs because we were supposed to "restore them to competency."

Thanks, Anasazi23, this is helpful. But in this model, what exactly is the psychiatrist doing?

The psychiatrist prescribes medications as most of those who are incompetent are so due to mania or psychosis. In my setting, and I'd bet its pretty much the same for our leader, the psychiatrist does what any inpatient psychiatrist does, but the goal is not so much for stabilization to be discharged, but stabilization to be found competent to stand trial. There's a difference. There are several who are not commitable, but still can't hold their own in court due to mental illness. It's a different standard.

If the psychiatrist is good-he or she will lead the treatment team and coordinate them well like a good starship captain. I have seen some psychiatrists just come in, give the meds, write the notes and leave. It really is more sophisticated than that if you want to do a good job. The doctor should listen to the staff's input and work with the staff to coordinate the team better.

Examples--violent patients should always have an antipsychotic PRN if possible. Attendings should be having daily contact with staff on the danger factor of any patient. Attendings should keep tabs on how much PRN benzos a patient is getting. If the person is getting them round the clock at every available opportunit, that's a reason to stop them. (Heck I don't even give them out unless the person is violent or withdrawing).

The psychiatrist and psychologist should also be on the same page when coordinating their efforts to treat people on the unit. My psychologist and I would formulate behavioral plans (95% the work of the psychologist), and I defferred issues to where her training superceded mine.

 

[Anasazi23]

Whopper gives a good base description of the psychiatrist's duties. He's exactly right in the sense that under Sell vs. US, the court can commit a patient for restoration of competency, though you may not admit that same patient to an inpatient unit in a different setting.

Incompetency can be the result of profound depression (rare) and more commonly, due to acute mania or psychosis.

There is a [not so] surprising amount of violence here, which often requires a heavy handed medication approach. The reality is that all patients are facing felony charges, and many are repeat felons. So while the state may prefer to see these patients as "innocent" and "not convicted," the reality is that many or most of the patients are mentally ill violent offenders.

 

[whopper]

a typical long term or forensic inpatient unit will have the following--several of which are not on a short term unit.

Psychologist: psychometric testing including a SIRS, TOMMs, MMPI, M-FAST, neuropsychological testing etc. The psychologist can write a behavioral treatment plan where a patient can be rewarded for doing specific behavior. E.g. a borderline cutter will get rewards each time she does not cut herself for more than a few days.
The psychologist can also do in depth psychotherapy for the patients in need of this. The facility where I work at now provides DBT, and its the first time I've actually been able to get patients DBT. Where I did residency we learned about it but did not have anyone that offered DBT where we could refer a patient.


Occupational Therapist. This person can provide physical excercise classes, assess the person's ability to function independently (e.g. hygiene, able to identify dangerous objects, work common items such as plug in a device etc).

Nurses: The nurse manager is someone you need to talk to who keeps all the staff (minus the psychologist) in line. Trek Equivalent: Scotty

Internal Medicine doctor: You need to call up the IM doctor whenever there's a medical problem that's out of your expertise. e.g. someone with cervical cancer, or someone who's HR goes to 25. Yes--both of those happened on my unit when I was an attending.

SAMI counselor (has different names in other states: SAMI is substance abuse/mental illness. In NJ they were called MICA: mental illness/chemical abuse. The person specializes in drug counseling and quantifying the person's substance abuse issues.

Patient's Right's advocate: This person makes sure the patient's rights are being observed and they are given the tools to communicate with lawyers and other people that can prevent them from being abused.

The rest are self explanatory
Dietician
Security/police officers
social worker

The psychiatrist needs to coordinate all of the above to make sure the machine is rolling.

From my experience, a good inpatient attending is one who knows how to manage a team of people. The ones that just write the notes, prescribe meds and leave without listening to staff are usually not good attendings. I for example remember an attending who gave patients as much benzos as they wanted even though the staff told him the patient was abusing the benzos. I remember specific weekend doctors coming into a unit because they were covering on the weekend, and patients asked him if they could be discharged tomorrow. He told all of them yes because he didn't want to deal with a debate even though he had no idea if the person would be discharged or not. He didn't care-he just wanted to get in and out in the least amount of time possible.

Then the following day when the patient was not discharged, the patient would get mad and mention that the doctor promised discharge. It caused a lot of problems for the staff--yet the attending just kept the same problem going on, and on and on.....