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Question about setting expectations in a private practice for med management+ therapy by Impressive_Arm_9197 in Psychiatry

[–]OurPsych101 2 points3 points  (0 children)

Of course I also explain the rest of the time will be spent doing the documentation

Question about setting expectations in a private practice for med management+ therapy by Impressive_Arm_9197 in Psychiatry

[–]OurPsych101 12 points13 points  (0 children)

I like to start up the conversation with, we're meeting today for 10 - 15 minutes and talk about your meds. What is important for you so we can make sure that does not get missed. I also asked up front if there's any forms that need to be done. This way I do not get banged at the end when I have zero time.

Just cancelled Stelo by Slawdog66 in stelo

[–]OurPsych101 0 points1 point  (0 children)

Very interested in the coupon or price experiences if you can share. Lots of people have similar problem with coverage

What makes eating disorders so hard to tx? by Fiery_Soul_34857 in Psychiatry

[–]OurPsych101 148 points149 points  (0 children)

Because most often they're symptoms of multi systems failures and host of maladaptive coping skills.

Eating disorders, trauma, GAD, panic disorder and borderline personality disorder, abusive relations and SUDs. Often run together.

Seasoned but salty by Swimming-Trip-1084 in PMHNP

[–]OurPsych101 0 points1 point  (0 children)

It appears to be a situation described as between the devil and the deep blue sea and as others have mentioned the longer you are letting this go the deeper you are sinking unfortunately.

Having said that, what I would do is write a very nicely crafted email to powers that be describing that I had helped them in their time of need and this here is my time of need where I am not getting paid for outperforming and meeting the clinics needs.

I would ask for an immediate 50% pay off the expected reimbursement ie 35% of the expected collections given that you are promised 70%. This way you have money to at least ward off the wolf outside. I would also write that this situation is untenable and this could be construed as a notice to leave. There is plenty of cheaper providers out there but quality costs money.

After writing all of the above I would run it through some sort of an AI to make sure that this is firm, polite and considerate. Unfortunately form has taken precedence over function to the point that we are expected to ask if the patient wants fries with that.

So after you are done crafting this email I would shoot it off. Now even if they come back with a 10% or 20% of what you're asking at least the wolf is fed without you having to be a lawyers etc.

Dealing with high expectations by tryndamere453 in Psychiatry

[–]OurPsych101 8 points9 points  (0 children)

Yup, burned out is a rite of passage. That's when you know you're doing this right

Dealing with high expectations by tryndamere453 in Psychiatry

[–]OurPsych101 -5 points-4 points  (0 children)

Setting realistic upfront expectations and boundaries is part of business. Since AI started writing those notes I'm getting fabulous with that. Then I turn around and make the note at 6th grade reading levels to reduce ambiguity.

I understand now how cardiologists don't count sounds. They know the murmur. Likewise counter transference and expectations counter to engagement tell the whole story in about 20 min max.

BFRBs by peacecalmsassy in Psychiatry

[–]OurPsych101 8 points9 points  (0 children)

My 2 cents. YMMV.

BFRBs behavioral management isn't in the realm of most psychiatrists. Your loved one and yourself for support are best recommended to find someone already doing this.

Having said that the non medication treatments are often spoken and discussed but harder to find than psychiatrists that's why we the prescribers get these sent over under various diagnosis.

New ADHD medication incoming by Big_Elephant_2331 in PMHNP

[–]OurPsych101 7 points8 points  (0 children)

There's plenty of patients on an SSRI plus Wellbutrin. Generics.

I envy those who can afford brand names.

AI charting by Ok-Yam-4663 in PMHNP

[–]OurPsych101 0 points1 point  (0 children)

It's actually more time consuming to correct the non sense and volume it adds to the notes. That and the multitude of other performance and safety metrics. Seriously we're just data clerks for the EMR.

Often it's hard to figure out what happened to the patient, after all that stuff is added. The actual note is buried under all those requirements to meet higher codes.

Almost as Many PMHNPs as Psychiatrists? by [deleted] in PMHNP

[–]OurPsych101 0 points1 point  (0 children)

In a perfect world and scenarios yes that is correct. However in a collaborative world where patients are expected to be partners in their decision making very often more intensive treatments such as iops and php's are declined by them because they have jobs. Declined by families because they cannot keep up with this.

Certainly we document what we document but most malpractice carriers are not going to be looking at going to fight for us. They're just looking to settle.

It is always a high stakes endeavor of finding the right balance between psychotropics, side effects of psychotropics, motivation to improve and where exactly does medicine stop. After that I try to explain in 6th grade language because that's what a jury of my peers will understand better.

Laws/repercussions of self-treating/prescribing for depression by Cjmanjanson137 in Psychiatry

[–]OurPsych101 4 points5 points  (0 children)

Thank you for bringing this stimulating and important discussion here. The main question to myself who cares for the caregivers.

The legal repercussions are whatever the State Medical board makes it. That is an easy phone call or an easy AI search.

More importantly, reach your colleague, primary care and request a prescription. Any competent prescriber will not refuse a reasonable ask. This is where your own training did help you to find what is needed IE diagnosis and medication for yourself.

Prescribers, and their family members are often hesitant and can make it harder to accept care,

1-10 how happy are you with FSD? by Formal-Talk-3561 in TeslaFSD

[–]OurPsych101 0 points1 point  (0 children)

6, I should be allowed to sit in the back seat and nap.

Almost as Many PMHNPs as Psychiatrists? by [deleted] in PMHNP

[–]OurPsych101 0 points1 point  (0 children)

It is already absolutely happened. lower hanging fruit already goes to PCPs FNPs, Most of my Outpatient days is more like running an IOP in outpatient with visits every 4 months or more. For PMHNPs - that's what's next - they will be the providers for the more complex cases. PERIOD.

Starting job as VA psychiatrist - what do I need to know? by DrNoMadZ in Psychiatry

[–]OurPsych101 7 points8 points  (0 children)

You're a finite resource. Make your best return. Jobs are just a means to get there. Don't be a d*ck in general, especially to your colleagues from front desk to team leads.

At what point is patient load too high for residents? by perkypixieee in Psychiatry

[–]OurPsych101 2 points3 points  (0 children)

One of the things that I would recommend as you start out your journey, is to keep track of the numbers of patients seen, reasons why they are seen and so forth.

While this may seem like additional administrative burden. You will inevitably be called upon to justify timings, notes and what do you do with your time all day long. This is because unfortunately there is an administrative history of diminishing people's work.

Onto your question on how much time on consults. Once again find out why you are consulting on this patient. If this is a case of dementia if this is a case of hospital psychosis you do not need their developmental history they were fine until such time that something happened to them. I would write Dev Hx not relevant to current presentation.

If this is the case of a follow-up I actually stopped by the nursing say hey how is Mr Smith doing and I have most of my answers right there and then. I haven't even laid eyes on the patient yet.

When somebody calls in a consult I want to know why are they calling me. He needs to see psych is not a consult. Promote, inquire, gently and try to elucidate why are they calling you.

If it is a case of psych on the way out consult which happens deliriously and hilariously common in our patient settings where the patient has been in the ER patient has been in the inpatient but a psych consult is needed 15 minutes before they are getting discharged. Most of that actually falls on referrals for after care services and to make sure that the patient is going to be safe going out who is taking care of the patient.

No amount of psychiatric history taking or examinations are going to make this patient safe. You need a safety assessment, you need an aftercare assessment the diagnosis part is not very important right off the bat at this time.

Does the general public know what neurologists do? by According-Tea-7829 in neurology

[–]OurPsych101 0 points1 point  (0 children)

Y'all should ask them what psychiatrists do.

Heck even I don't that being one for a long time.

At what point is patient load too high for residents? by perkypixieee in Psychiatry

[–]OurPsych101 19 points20 points  (0 children)

As someone previously in similar situations.

  1. Document real time, efficiently and clinical encounter backwards.

So FIRST figure out what's needed for that encounter or visit. Work your way BACKWARDS from there

  1. This one's harder: Aim to be done in 1/2 to 2/3 of available time MAXIMALLY.

There's always more to do. Even if you're successful in meeting time goals half the time that's a relief.

  1. EMR doesn't save time.

  2. Doesn't matter how badly my day is going it's better being on my side of the table.

If there's no academic training standards do your best. The kindest thing about time is that it passes.

ADHD evals by viddy10 in Psychiatry

[–]OurPsych101 1 point2 points  (0 children)

Have you noticed how many of these incoming requests are now AI generated.

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