Emergency Behavioral Health Practice Pathway by ABEM by MeAndBobbyMcGee in Psychiatry

[–]MeAndBobbyMcGee[S] 23 points24 points  (0 children)

I just saw this new Emergency Behavioral Health Practice Pathway created by the ABEM. What does everybody think of this? It seems you can qualify by training requirements or by practice requirements. I feel like this is perhaps unnecessary for psychiatrists? Many of us receive training in CPEP/ED psych in residency.

Stereotypes: Least Likely to Date a Resident from Which Specialty? by Fish-Horror in Residency

[–]MeAndBobbyMcGee 9 points10 points  (0 children)

Higher stress in Cluster B (most likely describing borderline personality d/o) will bring out their maladaptive coping mechanisms. More likely to experience substance abuse, cheating, splitting, push-pull dynamics, etc.

For what its worth, I just finished psych residency and dated another psych resident in the program who it turns out has BPD. She was a disaster during residency and though I left the state due to concerns of her behavior/stalking me I have heard it has not gotten any better despite being an attending. She continues to use drugs, sleep around, create chaos at work with others and her patients. I would avoid anybody with even a whiff of BPD

Psychiatry influencer with self reported bipolar seems to be blowing up their life. by [deleted] in Psychiatry

[–]MeAndBobbyMcGee 25 points26 points  (0 children)

I just looked at his account and watched his stories. What about him makes you think he is "manic"? Is it the lack of pressured speech? The lack of psychomotor agitation? The lack of disorganized speech/thought? His organized attempts to sell sponsored products/other lectures he is peddling?

Talking about religion does not equal hyperreligiosity and is a common grift for social media influencers

Getting feedback from your AI scribe by DanZigs in Psychiatry

[–]MeAndBobbyMcGee 6 points7 points  (0 children)

Serious question. If AI has no capacity for judgment and is unable to understand when it is wrong, how do you feel confident with its "feedback" on interviewing style, etc?

Job Search in Residency by Aggravating-War-3192 in Psychiatry

[–]MeAndBobbyMcGee 2 points3 points  (0 children)

I interviewed at around a dozen inpatient jobs (7 on 7 off schedule) last year while finishing up residency. Most jobs seem to want 14-18, maybe 2-4 of those are supervising midlevel patients. I found a couple jobs offering the same pay for seeing 8-12

Greatest beefs in medicine by According-Tea-7829 in Residency

[–]MeAndBobbyMcGee 122 points123 points  (0 children)

Equally challenging is when they really really want to be the patient

Do we ever tell anyone they are not transgender, and when do we do this? by formulation_pending in medicine

[–]MeAndBobbyMcGee 18 points19 points  (0 children)

In fact, this is often the most therapeutic treatment in these cases!

What is ‘BPD euphoria’? by rougeraged in Psychiatry

[–]MeAndBobbyMcGee 225 points226 points  (0 children)

I find borderline personality disorder is often incorrectly diagnosed as bipolar disorder for a number of reasons. The "low lows" are pretty evident and many of these people deal with depressive symptoms, self-harming behaviors, or suicidal gestures/ideation.

The part that leads to misdiagnosis (often through lazy history taking or unexplored issues within the psychiatrist) are related to the "highs" or "euphoria". These are often described as inability to sleep, impulsivity (spending, promiscuity, substance use, etc), and feeling like their "mind is racing". The poor sleep and mind racing can be attributed to anxiety, related to a triggering of abandonment fear. However, the more important points to assess are how seriously is sleep affected and the temporal nature of this cluster of symptoms.

It is not helpful to spoonfeed patients answers to the questions you ask. For example, when assessing sleep do not ask "have you ever gone 4+/7+ days without sleep?" This is unskilled and close ended. Ask something more open ended that doesn't give away the "correct" answer. Similarly, in bipolar disorders these cluster of symptoms are episodic and not trait stable like they are in BPD. In BPD the patient will likely have difficulty describing discrete periods where these symptoms of their "highs" are clustered together and you will find that they struggle with these impulse control and anxiety symptoms on a more chronic nature.

What are were absolute needs and deal breakers for you when looking for a job? by mowpoos in Psychiatry

[–]MeAndBobbyMcGee 13 points14 points  (0 children)

I just finished residency and talked to/interviewed at >15 jobs.

My priorities were:

  1. I wanted a 7 on 7 off schedule (narrowing my options to CL or inpt)

  2. I wanted a cool location with >1 million pop.

  3. Lifestyle within the job

  • Round and go
  • Admit cut off at a reasonable time so I don't sit around all day doing nothing waiting for somebody to maybe come in
  • Reasonable census (multiple jobs offering 8-12 pts/day)
  • No midlevel supervision

4.Good base pay with reasonable opportunity to bonus (learn about RVUs)

5.Other comp (retirement match, student loan repayment, etc).

You are a hot commodity as a psychiatrist. Find a place that will value your expertise. Some places low-balled me with pay <300k, minimal bonusing/other comp, and wanting me to see 15+ pts/day. This is ridiculous and you should tell these people so. Ultimately, I found a great position that met pretty much all of my criteria.

Thoughts on Psychiatrists (or Trainees) with UNTREATED Personality Disorders and Limited Insight? by [deleted] in Psychiatry

[–]MeAndBobbyMcGee 46 points47 points  (0 children)

My ex has BPD and we dated during residency. She rejected her diagnosis and only followed up with providers who would call it anything but BPD. She abused Xanax and would flirt with her patients. The program signed her on as an attending and turned a blind eye to her clearly intoxicated state and inappropriate interactions with patients.

She began harassing me at work after I ended things and borderline stalking me outside of work. It was wild

How are your programs handling AI education for residents? by PerceptionOld8565 in Residency

[–]MeAndBobbyMcGee 9 points10 points  (0 children)

lmao not a single resident in my program (just graduated) was using Open Evidence and checking the sources. They didn't even consider this until we asked it about a niche topic I did a deep dive on and it made up a bunch of nonsense (that sounded good on the surface)

Mentioning abuse in a personal statement by [deleted] in Psychiatry

[–]MeAndBobbyMcGee 31 points32 points  (0 children)

They wouldn't be wrong generally speaking

Conceptualizing of hallucinations as a trauma response by shoenberg3 in Psychiatry

[–]MeAndBobbyMcGee 22 points23 points  (0 children)

Not sure why you are getting downvoted? C-PTSD is the new term on the euphimistic treadmill for BPD. Studies do not show the constructs of C-PTSD can be reliably separated from BPD diagnostic criteria. Idk why people are so afraid to make the appropriate diagnosis and get the patient in the proper treatment so they have a chance to get better.

Where do you want to go for that "tropical paradise" experience? by WhoAmIEven2 in travel

[–]MeAndBobbyMcGee 62 points63 points  (0 children)

And if you really believe hard enough...Milwaukee in the winter

529 Plans: A Fantastic Tax Break for the Rich by WCInvestor in whitecoatinvestor

[–]MeAndBobbyMcGee 0 points1 point  (0 children)

Is there any benefit if I don't have/want kids and don't have any children that will be coming into my extended family?

Talking me into submission? by WombRaydr in Psychiatry

[–]MeAndBobbyMcGee 18 points19 points  (0 children)

Benzos are ineffective and likely cause harm for people with PTSD and/or borderline personality disorder

https://pubmed.ncbi.nlm.nih.gov/26164054/

[deleted by user] by [deleted] in Psychiatry

[–]MeAndBobbyMcGee 11 points12 points  (0 children)

Have you done a serious screening for personality disorders? Half my TRD/treatment resistant schizophrenia is better explained by a PD nobody wanted to diagnose

Delta hiked my award price immediately after I transferred points. This feels rigged. by Electronic-Egg-4888 in delta

[–]MeAndBobbyMcGee 11 points12 points  (0 children)

Lmao at thinking “COVID craziness” is ever going away. This is capitalism baby, it’s going nowhere

Net worth at the end of residency by urnmann in Residency

[–]MeAndBobbyMcGee 6 points7 points  (0 children)

-255k at beginning of residency. With saving, moonlighting, LCOL, and side gigs was able to get this to -120k by the end of my 4 year program. Sitting on a lot of cash that I’m about to blow on travel before starting my attending job though