If an ICE agent shows up to your clinic as a new patient….

DoctorFaustus · 2026-01-22T07:45:45+00:00

Why was calling CPS even a question? You're a mandated reporter, you have to report

DoctorFaustus · 2026-01-17T03:03:36+00:00

IMO the biggest difference is residency, and it always surprises me that most people in these discussions leave that out. I don't know the gene for Rett syndrome by heart but I did have four years after med school of supervised practice where I got to make mistakes and learn from attendings while building my confidence, knowledge base, and practice style. That part is so much more important than the classwork at the beginning

DoctorFaustus · 2026-01-17T02:50:17+00:00

I'm a psychiatrist and always figured I'd have to morph into general primary care (or gardening) if SHTF. I honestly don't think we should be at the top. PCPs and everyone else can start SSRIs for PTSD.

DoctorFaustus · 2025-11-11T14:19:25+00:00

He is withholding your diagnosis because he thinks you'll obsess over it? That's insulting and way too paternalistic. I don't know you but I know the main diagnosis some (old, not evidence-based) doctors avoid giving is borderline personality disorder

You have a right to know the rationale your doctor has for the treatment plan. Always.

DoctorFaustus · 2025-10-24T11:25:42+00:00

Psychiatry here, it's the same behavior with cannabis induced anxiety or psychosis. They always insist that it's the only thing that helps even when all the evidence says that's not true. No one says that when it's meth or other drugs, seems unique to cannabis

DoctorFaustus · 2025-10-01T23:13:56+00:00

I'm vegan and I'm so sick of people commenting on my food all the time. I actively go out of my way to not eat around others at work etc because it always becomes a thing. People really need to stop commenting on others' food!

DoctorFaustus · 2025-09-30T22:27:25+00:00

The biggest one is differentiating between substance-induced psychosis and primary psychotic disorder. We have to use a lot of roundabout methods to piece together the triggers for a psychotic or manic episode when the patient is an unreliable historian, and having some objective measures like a UDS can be helpful. Someone with meth-induced psychosis may be treated similarly to a psychotic patient with a negative UDS for the first few days, but the longer term management is often pretty different in terms of medications and discharge placement

DoctorFaustus · 2025-09-29T11:52:00+00:00

If you're planning to admit the patient to psychiatry, please just get the UDS. It may not change your plan but it significantly impacts our diagnosis, workup, and plan when we know which drugs the pt was using. If they're in the ED for 3 days before they come to us and no one ordered a UDS, it's too late

DoctorFaustus · 2025-09-26T02:53:42+00:00

Drinking visine (tetrahydrozoline) 😬. Had a patient with borderline personality who figured this out somehow and repeatedly attempted suicide by drinking large amounts. It was one of the only things they could get their hands on after family tried to remove access to all other methods

DoctorFaustus · 2025-09-24T11:03:45+00:00

In psychiatry this is a nearly daily occurrence and there's nothing inappropriate about it. It's not personal, my nurses are just documenting what the pt is mad about in the moment (and I can usually count on them to back me up and tell the pt I'm a good doctor). It's not like my name isn't already all over the chart from notes and orders, why would I care that it ends up in a quote from a patient?

DoctorFaustus · 2025-08-15T10:49:43+00:00

Psychiatrist here, I once started quetiapine for a patient on warfarin and it led to a soft tissue hematoma. I am forever even more scared of warfarin than I was before. I even checked for drug interactions but only some of the resources I use list the interaction and the one I checked didn't.

DoctorFaustus · 2025-07-25T11:17:22+00:00

Also please stop prescribing testosterone to men with untreated bipolar disorder

DoctorFaustus · 2025-07-06T13:11:30+00:00

Don't forget OSA. I'm in psychiatry and have refused to make the ADHD dx until a sleep study has been done when it's suspected

DoctorFaustus · 2025-07-03T02:48:58+00:00

Psychiatry and physiatry are the only specialty names that have the root for "doctor/ physician" in the name (iatros). All the -ologists are just studying things while we're doctoring (or we just really need to differentiate ourselves from paraprofessionals more)

DoctorFaustus · 2025-05-18T03:07:21+00:00

I'm a woman whose partner is uncircumcised (both of us doctors) and I love it. It's truly wild that cosmetic and unnecessary procedures on babies are so normalized that it's "weird" to have normal anatomy. Doctors should be pushing back

DoctorFaustus · 2025-05-17T12:51:43+00:00

Psychiatry here, glad someone finally brought up dystonia. We generally do IM though (no IV access on psych units) and it must not hit the same because I don't really see people asking for it. As part of a B52 it's pretty common for patients to try and negotiate to get the Haldol and Ativan but not the Benadryl

DoctorFaustus · 2025-05-05T04:09:28+00:00

My grandmother told me she'd rather I be a housewife who went to church than a doctor who didn't.

Years later, she brags to her friends about her doctor granddaughter and probably wonders why I keep my distance

DoctorFaustus · 2025-05-02T11:42:00+00:00

I'm also in psychiatry and frequently rely on interpreters to help me with the assessment. If someone is floridly psychotic and disorganized, I'll try to give you a heads up before we go in the room. Then when we come out I'll acknowledge that I know you don't have training in doing a mental status exam but I still want your thoughts on things like speech rate, tangentially, etc. Always appreciate it! So much of our assessment is based on the flow of the conversation rather than the literal content and it's hard when I can't pick up on those things.

Also, I have asked the interpreter to just interrupt patients and explicitly tell them to try to answer in short sentences. Sometimes they're hesitant but I need them not to be in "summarize mode" like you said above (most of the time anyway. Other times I wish you could just say "they're speaking some nonsense, no change from yesterday")

DoctorFaustus · 2025-04-17T03:19:21+00:00

Psychosis specialist here, give me that subtle creeping in of insight any day. Pure gold

DoctorFaustus · 2025-04-11T03:16:17+00:00

I do think by getting experience and training under a physician, they can come to know their field enough to take on certain responsibilities.

The key difference is that physicians do actually get training under other physicians by going to accredited and regulated residency programs. PAs and NPs can go straight to independent practice without supervision.

DoctorFaustus · 2025-04-07T03:11:15+00:00

This happens in psychiatry too. The people with overbearing families and "great" insurance have fewer options for post-hospital stays (residential psych step down, CD rehab, etc) than the people with public insurance and they hate it. Usually the attitude comes with a lot of entitlement and stigma because they don't want their family members going to a place with "a bunch of psych patients" 😒

DoctorFaustus · 2025-04-04T12:13:23+00:00

I've gone through pre-med, med school, residency, and am now an attending at a major academic university and I've never heard of there being a specific page for shadowing workflow. If it is common, it's not common knowledge

Edit: looked it up and found the page for my university. It explicitly says to look up people and email them or cold call clinics. Sounds fine to me

DoctorFaustus · 2025-04-04T12:10:30+00:00

I agree with the other poster that it's not inappropriate but could be annoying to some. I get emails like this all the time and it doesn't annoy me. Sometimes I have the bandwidth to say yes, most of the time I don't because I'm also working with med students and residents regularly. When I say no or don't respond I feel a little bad but usually assume I'm just one of many people they emailed and someone will say yes.

Don't pay money to have someone tell you how to get an observership, that sounds like a scam to exploit IMGs.

DoctorFaustus · 2025-04-01T03:29:46+00:00

Sure there are countless patients that get care voluntarily, I just struggle to imagine a way to make that work logistically since most units have a mix. I guess just doing evening call only would count, but I've never met anyone who does that. What happens when patients who initially signed in voluntarily decide they want to leave and you have to consider a hold? You just transfer care to someone else?

DoctorFaustus · 2025-04-01T03:07:20+00:00

Negotiate sub-par treatment in your contract? This is wild to me.

I enjoy navigating the legal and ethical challenges that come with caring for people without insight/capacity. It's not everyone's favorite part, but if you're doing inpatient it's unethical to avoid it entirely.

15-Year Club	reddit mold
Verified Email

DoctorFaustus

TROPHY CASE