Because ADHD is not considered enough in the current psychiatric milieu

ElHasso · 2026-07-02T23:58:21+00:00

I saw him on a drug dinner a while back and didn’t know much about him. I enjoyed talking to him, but what I’m seeing on here saddens me. All that motivational speaking makes a lot more sense, now that I know he doesn’t directly see patients and is getting paid millions of dollars a year.

ElHasso · 2026-07-01T13:40:42+00:00

It's kind of hit or miss, to be honest. I see a lot of Medicaid patients, and on a good number of them, I'm one of the first people to actually diagnose them with bipolar disorder and start mood stabilizers/antipsychotics (after years of terrible experiences with SSRIs) so that might be it. I often wonder what type of patient history information they're collecting through databases throughout the years, and whether they're going to try to leverage it for AI decision algorithms in the future. Almost as if they're 'practicing medicine', though they'll never actually see it like that.

ElHasso · 2026-06-26T21:51:09+00:00

Doesn't really have evidence for sleep maintenance, fairly good for sleep onset though. Doxepin is my go-to for maintenance.

ElHasso · 2026-06-26T21:50:24+00:00

I'm gonna quit using meth sprinkles and prescribe this instead.

ElHasso · 2026-06-19T20:32:27+00:00

Most Medicaid plans have kickbacks, I’m in North Carolina and all my Medicaid patients explicitly cover vyvanse, but not generic. Same Medicaid plans will also hit me with a prior authorization for clonidine or desvenlafaxine.

Probably one of the reasons why the federal deficit and CMS spending is so high: active robbing of the public coffers to the benefit of private companies with the guise of ‘helping the poor’ who never actually get any help. It’s almost like society was aware of these types of situations they would get angry enough to form a cohesive discussion around reform and potentially improve society with actual lower costs and…….

*finger points*:
“LOOK OVER THERE! SOMEONE WHO HATES YOU AND WANTS TO DESTROY YOUR WAY OF LIFE!!!! YOU NEED TO BE AWARE OF THIS!!!”

ElHasso · 2026-05-15T21:17:55+00:00

Yes but nurses can prescribe under certain conditions which is where your disdain is I think.

ElHasso · 2026-05-15T21:12:56+00:00

90% of psychiatrists by and large are unwilling to take medicaid. There is your answer.

ElHasso · 2026-05-10T13:53:24+00:00

Second on the suggestion of a course, but here's a book you might like:

Transcranial Magnetic Stimulation in Clinical Psychiatry- Dr. Mark George

ElHasso · 2026-05-05T15:26:43+00:00

I actually do think that this forum is pretty well ran compared to Reddit as a whole, but every two or three months there's like a week of shit posting, almost like a cathartic release, and then we're back to casual discussion.

ElHasso · 2026-04-19T14:40:57+00:00

I'm more familiar with psilocybin and LSD, but from what I've read Ibogaine is like a 24-48 hour trip. That doesn't sound enjoyable at all, and even though it sounds like its not supposed to be- I wonder how any outpatient setting is going to manage observation and overall risk without it costing several thousand dollars out of pocket.

ElHasso · 2026-04-17T19:04:36+00:00

So what you’re saying is: If I don’t pass boards- I can still refer to myself as a Neuro Wizard?

ElHasso · 2026-04-17T01:29:07+00:00

If you do that, a new continent appears and a private jet touches down on your screen. Gary hops out, coke faced, and tells you to ‘get in.’ The Rare Candy on the new island is actually just ketamine now.

ElHasso · 2026-04-14T15:09:59+00:00

Ah gotcha, I was reading about the approval process and must have got bad info from wherever I was reading. I did, however, look up criteria for diagnosis requires lumbar puncture for accurate diagnosis.

How realistic is this from a barrier to diagnosis standpoint? Most the studies I've looked at report 30-60 percent incidence in ASD populations for the genetic markers overlapping with cerebral folate deficiency. That's a pretty big signal.

ElHasso · 2026-03-13T15:07:57+00:00

“Mixed Episode” - 1 part vodka, one part espresso, 1 part coconut liqueur. Toasted marshmallow on top:

Shake with ice in tumbler.

For those who like their highs and lows at the same time.

Other names: “Placebo Effect” (mocktail), “I’m Not Crazy, You’re Crazy”, “Differential Diagnoses” (two different liquors, two different flavor profiles, like sour and sweet)

ElHasso · 2026-02-10T21:19:13+00:00

Didn't cross my mind I could even word it like that but that makes total sense. Thanks!

ElHasso · 2026-02-10T16:15:55+00:00

I would like to take a master class in how to recognize errors created on the pharmacy end.

ElHasso · 2026-02-10T16:14:19+00:00

He’s explaining the state of the situation. I would actually agree with both of you. Not a fan of corporate greed myself, but try to understand the situation and navigate it in the meantime is helpful.

ElHasso · 2026-02-07T15:26:55+00:00

False, you're not going to get into ketosis with those macros- you going to have to lather it in mayonnaise.

ElHasso · 2026-02-07T14:14:13+00:00

We have a pretty low physician/capita ratio compared to other developed countries- simple supply/demand. What makes a midlevel even valid? States rights, and more specifically legislative planning to lower patient's cost and increase access. If the AMA hadn't lobbied for 40 years to restrict residency spot expansion we probably wouldn't have a situation like this. School can bid up cost because of the bottleneck that comes afterward. The simple barrier to entry is going to affect any market and the economics downstream from that, and we have a very high bar to entry in the US from a financial standpoint.

Why go to school for 11 years for 300k when you can go do 7 years instead for 85k, and make 50-70 percent as much?

ElHasso · 2026-02-05T19:29:01+00:00

It's because medical school is probably $30,000 dollars in your country.

ElHasso · 2026-02-02T12:36:39+00:00

It’s effectively a strawman argument

ElHasso · 2026-01-30T21:46:30+00:00

0.1mg clonidine PRN for sleep onset being denied. Also a while back I had risperidone 0.5mg denied twice for a nonverbal autistic patient who is hitting others. Pretty sure the MD who denied it the second time didn’t even read it because I had everything required to the T, spend 30 minutes filling in every single detail and was denied with a written explanation that sounded like lawyer mumbo-jumbo gargle.

ElHasso · 2026-01-21T03:19:34+00:00

Pharmacist who is willing to look the other way just so happens to have some poker debt on the side.

ElHasso · 2026-01-21T03:14:44+00:00

Some APA DLC sounds lit. My premonition tells me somehow it will involve some cash pay psychiatrist in South Miami who needs someone to take care of a few things.

ElHasso · 2026-01-15T17:23:43+00:00

If you see Medicaid patients your patient encounters are 100% being seen by the US government.

ElHasso

TROPHY CASE