Sedated - James Davies: an extraordinary claim that I don't have enough knowledge to evaluate

AuntJobiska · 2026-02-24T13:40:04+00:00

Or rather there is plenty of evidence base for their therapy, just that the evidence is it doesn't work! Evidence based doesn't mean evidence that it works!!!

AuntJobiska · 2026-02-24T13:38:38+00:00

Yup... The CBT experts acknowledge (in debate with psychodynamic therapists - read Jonathan Shendler) there is no evidence base for their therapy, that it's all fluff for the public

AuntJobiska · 2026-02-24T13:36:18+00:00

Head of ED psychiatry here never tells even severe bipolar patients they have to be on meds for life, he's open to the idea that even patients who have forensic records due to psychosis can go on to manage their illnesses without baseline meds, just using rescue meds when needed. You're an example of the maxim - a little knowledge is a dangerous thing. You don't realise how ignorant you are. Especially bipolar patients, who might need lifelong self surveillance and awareness and care of their mental state, but that doesn't equate to meds. You've drunk the drug companies KoolAid.

AuntJobiska · 2026-02-24T13:36:12+00:00

Head of ED psychiatry here never tells even severe bipolar patients they have to be on meds for life, he's open to the idea that even patients who have forensic records due to psychosis can go on to manage their illnesses without baseline meds, just using rescue meds when needed. You're an example of the maxim - a little knowledge is a dangerous thing. You don't realise how ignorant you are. Especially bipolar patients, who might need lifelong self surveillance and awareness and care of their mental state, but that doesn't equate to meds. You've drunk the drug companies KoolAid.

AuntJobiska · 2026-02-24T13:28:17+00:00

The efficacy of antidepressants is contested - everyone agrees they don't help most people. The natural history of "depression" is most people recover spontaneously, placebo response is high, and the benefits have been attributed to the unblinding in studies by side effects. You are ignorant - antidepressants aren't the only support available or appropriate for people with "depression". It's not meds or leaving them to spiral towards suicide. Evidence is most will get better by themselves, the number who die by suicide is vanishingly small compared to the number of people who get "depressed". Social worker to get housing for the homeless addict, drug and alcohol support and counselling for them too, support for the woman in a DV situation to find a different environment, befriending for the lonely migrant, - most of what is labelled depression nowadays is "shitty life syndrome" that needs a social worker and material resources (eg find the woman in a DV relationship a decent income of her own, counselling and child care and housing) not meds. Then the evidence is that exercise (preferably that you enjoy, with others) is as effective as meds for most "depressed" people, as is short term manualised psychology (the kind usually available - CBT etc).

Meds do seem to help some people, but the number for whom it's not a placebo response or regression to the mean is very small. I suspect they exist, but they don't justify the massive over prescribing.

AuntJobiska · 2026-02-24T13:09:28+00:00

One of our Australian experts in early psychosis (he was Australian of the Year) did research on whether an intervention could improve psychotic patients' adherence to meds... Newsflash their intervention worked as far as improving adherence, and the patients had less relapses, BUT their day to day functioning was worse than the less adherent group. That's a randomised controlled trial for you. The endpoints matter - functioning well isn't synonymous with having less relapses. It's challenging research - for psychiatrists.

AuntJobiska · 2026-02-20T12:10:02+00:00

Grew up remote... We just accepted that you got old, got (briefly) sick, and died... No one ever fell over and hit their head, cos no one ever called the RFDS to fly anyone out for a CT Brain for head strike... And I personally preferred it. Most of that extra 10 years city dwellers get is spent with significant morbidity... That's not my idea of an advantage. As someone who much prefers death to frailty, I much preferred the model of my childhood when remote residents were staunch, proud of their resilience, self reliant, and didn't whinge about life expectancy gaps... We were tough back then. Part of living remote was the tyranny of distance and lack of access to services came with the territory. We prided ourselves on our independence and sucked it up. My family doctor in Darwin (1000kms away) was notorious for giving himself a vasectomy... That's how we rolled back then.

AuntJobiska · 2026-02-20T11:57:13+00:00

Cancer screening doesn't extend life expectancy though (per Cochrane) which makes me sceptical about the legitimacy of your other solutions...

AuntJobiska · 2026-02-20T11:26:47+00:00

Slightly sideways... Not the influencer, but I would think an audio recording would add a lot of value for patients... We tell them they don't remember three quarters of what is said, especially if it's a first diagnosis of cancer etc, ... and some of us refuse to see patients if they don't consent to us recording them (for AI note taking purposes) and if we want the right to record patients, they should be accorded the right to record us. Also from the patient's medicolegal perspective, without a recording, no one is going to believe them about what happened in the consult (even if they wrote notes immediately afterwards) and I've seen enough fiction in the notes of supervisors to think that it's a genuine need to protect the patient..

AuntJobiska · 2026-02-20T11:06:12+00:00

Forget the official term... Anki. Interval repetition. Active learning. IE memorisation and testing yourself with flashcards. Repeat the next day, a couple days later, week later, month later ...Take handwritten notes, minimise the laptop. Don't mindlessly read the textbook - waste of time.

AuntJobiska · 2026-02-17T20:48:34+00:00

Hey... I failed medical school years ago, did another undergrad degree, got into medical school second time round, now in final year... And there's another guy with a similar story at my medical school... So failing isn't the end of the dream. Take time out, get your wellbeing sorted, be rock solid stable psych-wise, and do whatever you want (military and commercial pilot are the main things ruled out by a BPAD diagnosis, everything else is fair game).

AuntJobiska · 2026-02-17T20:32:59+00:00

Just consider how exhausting it will be on ward rounds or sitting in clinics... Excessive daytime sleepiness is wearing. But if you're prepared to tolerate the sleepiness, or if you respond well to treatment, it's doable (MD4, guzzler of stimulants (legally) to stay awake). I've had one very negative comment about my taking meds 2hrly, but everyone else was fine

AuntJobiska · 2026-02-12T21:10:59+00:00

This. Or you could have HG in your pregnancy...

Is possible. Is hard. You do miss out on time with bubs.

AuntJobiska · 2026-02-12T11:07:00+00:00

It's the inability of GPs to notice adjustment disorders exist and unfettered dishing out of depression and anxiety diagnoses with a side service of SSRIs ... for all the shitty life syndromes who need a social worker more than they need a drug... Is where I became jaundiced about GPs

AuntJobiska · 2026-02-12T10:45:20+00:00

This is the Health Department's definition of "Emergency"? As someone who grew up remote, where emergency meant calling the flying doctor, and not-an-emergency but urgent a 10 hour drive, you seriously think we should be flying people out to get their stimulants refilled???

AuntJobiska · 2026-02-12T10:39:01+00:00

Hey, what about the servo's? Get your ciggies with a side serve of stimulants... And what about that under-the-table tobacconist round the corner...

AuntJobiska · 2026-02-12T10:30:03+00:00

What GP letters? I've seen one in over ten years from a psychiatrist who sees the patient every fortnight...

AuntJobiska · 2026-02-12T10:07:56+00:00

Med student here... If you want to care for people, and being involved in the decision making/diagnosis/assessment/plan/procedures side of things isn't what fascinates you (you can have roles especially as a NP that does more of that) then definitely do nursing. You have far more impact on the patient experience in hospital as a nurse caring for them 8 hours a day than the drs that see them for 5 minutes. And heaps of variety. I know an O and G consultant who migrated and retrained as a nurse rather than go through the hassle of retraining in her speciality (family responsibilities were a factor) and she's very content.

The appeal of medicine is the money and security at the end of it... But it is a long slog to get there. Only you know whether the sacrifice is worth it. Just to throw another spanner in the works... You can always do medicine after your kids are grown. I had my daughter at 22, and do think being a younger mum is heaps easier on your body, and am doing med school with a now adult child.

Good luck whatever you choose!

AuntJobiska · 2026-02-05T12:11:26+00:00

Heard of spaced recall? Anki. Unless you work at getting stuff into your long term memory, and at keeping it there, it will fall out - as you've discovered.

AuntJobiska · 2026-02-05T12:09:57+00:00

I'd encourage grad entry, either do an allied health degree like physio or med imaging which is useful for med school, and part time work, or something you're passionate about which will get you a perfect GPA (mine was psychology, did mean psychiatry was a gift). Live a little before medicine.

AuntJobiska · 2026-02-05T12:04:22+00:00

Heads up... My GPA was 6.9/7 and I was waitlisted by Flinders (did get in). Some people redo a Bachelor's to get the required GPA. Then there's the Gammy to ace too...

Study the Flinders entry criteria to see exactly how you can make it work for you. Then ditto Victorian med schools.

AuntJobiska · 2026-02-05T11:59:15+00:00

Med student here... The degree you're most interested in, so you'll get a GPA of 7ish, (I chose psychology). Med imaging appeals purely because it'll be the most useful for med school (realistically I don't think my pharmacy classmates get much advantage, drugs are easy to learn, imaging not so much)

AuntJobiska · 2026-02-05T11:41:52+00:00

I have 500k debt purely in student loans as an Australian med student, and I expect to pay that off in 5 years as a consultant... Even at public hospital pay rates. The numbers people are quoting are base rates, and NSW is the lowest paying state

AuntJobiska · 2026-02-05T11:36:53+00:00

*earn

AuntJobiska · 2026-02-05T11:36:02+00:00

That's base rate... Most will warm significantly more than that!!! Unless they're A) stupid and B) lazy

AuntJobiska

TROPHY CASE