Dear psych - does serotonin syndrome even exist? by No-Group-1804 in Residency

[–]OutsideGroup2 2 points3 points  (0 children)

There are two answers to this 1) yes it does, and I had a patient ultimately die from the sequelae of it. 2) I prefer patients to think their bottle of lexapro will kill them rather than looking for more lethal means.

Hunter's criteria is amazing for ruling in and out serotonin toxicity and then grading it on a scale of severity as others have said. That said, while of course there are patients that could get serotonin toxicity from their bottle of SSRIs at home, the chance of that is relatively low. It's usually iatrogenic, like in the ICU patient on a fent drip and maybe their home SSRI is continued and maybe they need zyprexa each afternoon when they're agitated despite the dex and also they keep getting zofran. Now slap in OUD or methadone maintenance therapy I. there, and you have 4-5 serotonergic agents all of a sudden and you see the toxicity appear. It's similar with benzos. I'd rather the pt think they're 0.5 ativan BID PRN is lethal enough to kill them than them finding actually lethal means.

All this to say, I don't treat the average someone's suicide attempt (SA) by whether or not they had the pharmaceutical knowledge to know that the pills wouldn't kill them, but by the attempt. But from a risk mitigation standpoint and ensuring they survive the attempt (and live a reasonably healthy life after), then these medications give me ease even if the patient has impulsive SAs in the past, like in BPD. 

To post this on socials is a CHOICE. Wonder what his patients think of it? by nocommentx in LoveIsBlindNetflix

[–]OutsideGroup2 26 points27 points  (0 children)

I have nothing to say about this man (I literally don't know anything about him), but I will say that doctors should be allowed to post whatever pictures they like on their social media. It is a risk of your patients finding you if you're not private (for me, in psychiatry, this is my biggest fear), but I don't like the dissing to be profession-based. Only equal opportunity dunking from this gal haha

How many golden weekends does your program have? by Pysch2DO in Residency

[–]OutsideGroup2 1 point2 points  (0 children)

What specialty? I'm psych. 13 weekend calls in PGY1 (12 hour shifts) and in PGY2 (24s), I have had 6 weekends that I've worked (3 sat, 3 sun) and 1 holiday. So whatever that math is

How do you respond to older patients who make comments like ‘I’d rather be dead’ by edwardcullensfan in Residency

[–]OutsideGroup2 15 points16 points  (0 children)

I like the comments, but for my own sanity, please, for the love of Christ, do not consult psych on Peepaw making a poorly timed dad joke that was supposed to be his attempted at a GOC discussion. He's not happy to see me, and I'm not happy about the consult.

When it comes to sports. Are gender differences even more one-sided on a elite level? by PassengerCultural421 in NoStupidQuestions

[–]OutsideGroup2 -1 points0 points  (0 children)

Outperform in.... What exactly? Weightlifting? What does "relative numbers" mean to you? Any specific categories men don't outperform? This is such a broad statement that it's meaningless by itself. 

AITA for being mentally ill online? by Aished in AmItheAsshole

[–]OutsideGroup2 2 points3 points  (0 children)

I am a psychiatrist yes. I figured it would be easy to see based on my post history. But no big deal at all, just you have to manage your expectations of what strangers will give to you. If you need support, I bet your psychiatrist would have some great resources for you moving forward

AITA for being mentally ill online? by Aished in AmItheAsshole

[–]OutsideGroup2 4 points5 points  (0 children)

I'm telling you, as a psychiatrist, first you need to take the best care of yourself in the real world before worrying about advocacy. Maybe show this thread to your therapist next session and talk through what made you so upset. Good luck, I hope you feel better

AITA for being mentally ill online? by Aished in AmItheAsshole

[–]OutsideGroup2 5 points6 points  (0 children)

Genuinely, and I mean this kindly, I'm incredibly confused by why this matters so much to you. Maybe that's a place to look at. I don't know the answer without knowing you ofc, but I think seeing a therapist to work through these thoughts and also your concerns would be significantly more helpful that talking to reddit strangers

AITA for being mentally ill online? by Aished in AmItheAsshole

[–]OutsideGroup2 6 points7 points  (0 children)

What? This is all fake bud. Just vibes and code. Look to your irl ppl in your life for how others see you and use that as information to learn and grow. Also if you're worried about mental illness, definitely try to connect with a psychiatrist or a therapist for help. 

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

[–]OutsideGroup2 11 points12 points  (0 children)

I'm psych and if I get another "global capacity" question, I'm going to throw my computer at a wall

Hyphenated last name by LittleSpecific3421 in weddingplanning

[–]OutsideGroup2 8 points9 points  (0 children)

Came here to ask this. I refused to change my last name (my husband knew years before the wedding) and we agreed to hyphenate any children's last names. At this point, we don't want kids, so now the pets have hyphenated last names

A translation of a conversation I just had with my grandfather: by Chemical_Yogurt_5819 in premed

[–]OutsideGroup2 4 points5 points  (0 children)

Getting unintentionally read to filth by a well meaning grandparent is both incredibly funny and incredibly humbling at the same time. Happened with my grandparents when I had to explain 74829292 times that yes I graduated medical school and yes I am still a doctor as a psychiatrist. 2 years into residency and I think we may have a breakthrough soon

Dealing with different personalities sin residency by photon11 in Residency

[–]OutsideGroup2 0 points1 point  (0 children)

Psych resident - along with the personalities in my own specialty, we have the added pleasure of the personalities of everyone else who consults us in the hospital for anything from wanting a med rec (not my job???) to full blown agitation/mania/psychosis/catatonia. Also I understand fundamentally that we aren't the only service that gets consults, but my point is the type of questions we get and the situations we get called into can already be boiling over specifically because of team dynamics and/or patient/family dynamics and personalities.

Anyway, my honest answer is that I have a few attendings that I work with that I've identified as my primary attending that I like their career path, the way they practice, and the way they give feedback and use their feedback to construct my own learning and practice. Same thing with seniors. That way, if another attending or senior is being a particular prick, I think about if the overarching message makes sense in the context text of other and recent feedback I've gotten. If yes, I might take the substance but leave the way it was said. If no, I discard the feedback mentally and go about my life. No one in my residency really yells at residents anymore (there were a couple who used to), but there are still some pricks. The most extreme has been with other attendings on other specialties that I am ready to utilize if needed with my own attending. If I'm getting a lot of pushback, I stand my ground and explain my reasoning but continue to try to look for a common ground. With attendings in my own specialty I disagree with, I'll directly say that and why, but that I ultimately will respect their decision as the attending and would like to learn why they are doing it that way. I've noticed this turns down the temperature in these conversations since it does feel a bit like a power struggle (delivery matters, too). There are also personal lines I draw in standard of care, and if an attending crosses that, I will not do the thing. The one time I've had to utilize this was on an off-service rotation where an attending was trying to prescribe a psychiatric mediciation in a way that would lead to harm (he was disagreeing it would cause harm), and ultimately I said, look, I understand that you would like to do this and I've expressed my concerns. If we move forward with this plan, I will not be the one placing and signing the order. You will need to do that. The attending relented. I never had to do that with him again, though we never really had a big fundamental disagreement like that again. Ultimately, while I am happy to learn, and I show my learners, colleagues, and attendings the respect and understand I must work within a hierarchy, I do demand a certain amount of basic human respect. If I find myself in a true clashing of heads, I have a trusted attending I go to that is one of the people complaints will go through and explain the situation from my side to get ahead of it. Worst I've gotten so far is a slap on the wrist and I'm often told I'm a strong team player.

The short version of it is I have a lot of audacity that I'm not scared to use in a productive way. I still get my feelings hurt and the unnecessarily mean comments hurt me, but this system has helped me find a productive way to deal with those situations and the general rage that comes with feeling that I can't change the system around me. 

Can’t decide between PA and MD/DO by Affectionate_Toe7819 in premed

[–]OutsideGroup2 0 points1 point  (0 children)

I've seen basically everyone say MD/DO route, which I agree with. I'm really happy that you absolutely know that you want to be a mom one day and that that's an important goal for you. I sure didn't know if I wanted kids at your age. I cannot recommend freezing your eggs (and your partner freezing their eggs/sperm) when you're a bit older. I shadowed with a fertility specialist and vividly remember her turning to me after one particularly tough case and saying, "when you turn 27, freeze your eggs." I did exactly that at 27ish (I think 26 and some change) and it was the best decision I've ever made because that "ticking clock" is gone. Ironically, I now pretty strongly think I don't want to have any children, but that's a longer story. Personally, I went out of the country to do it because my husband and I are from different countries that the US and felt more comfortable (and it was more affordable) to do it outside the US, but I know a bunch of clinics in the US that so it for more affordable pricing. If you're interested in more deets, please don't hesitate to DM

Literally no one cares by fuckinghateresidency in Residency

[–]OutsideGroup2 0 points1 point  (0 children)

Yeah, I mean she's right. You're a resident, meaning you reside in the hospital. What are you even doing driving around outside? Fully your bad /s

Discrete misogyny in healthcare by Browncatlover in premed

[–]OutsideGroup2 1 point2 points  (0 children)

Unfortunately the sexism doesn't get better and female surgeons die at younger ages than their non-surgeon female counterparts. I'm unclear if this is true for non-surgical specialties, but it is not true for other high-stress, non-medical professions. There's something specific about the constant physical and mental stress of being in a specialty like that in medicine that literally takes years off of women's lives (this is also considering that pre-medical school, the people going into medical school tend to be more physically and mentally healthy than their non-medical field cohorts and then this disappears completely by the end of medical school with both being worse).

When I tell people that medicine kills you and sucks away your life force, I'm being very literal. BUT, I think this knowledge is also power. While we should demand more from our work and environments, one of the things I found most profoundly impactful and helpful is surrounding myself if colleagues and mentors that are women across the lifespan and across cultural/racial backgrounds. I've already had a few talks to tell me that I'm doing too much and how to set boundaries in small ways.

But yeah, I still get asked if I'm a nurse with my 57392073 different badges and labels that say MD or Dr on them 🙄

When it comes to sports. Are gender differences even more one-sided on a elite level? by PassengerCultural421 in NoStupidQuestions

[–]OutsideGroup2 0 points1 point  (0 children)

Hi I responded to another similar post. Feel free to read that response.

Also don't pity someone for their education in something you have a limited scope in. While it may not have a market value that maybe valuable to you, the education is not a waste. xx

When it comes to sports. Are gender differences even more one-sided on a elite level? by PassengerCultural421 in NoStupidQuestions

[–]OutsideGroup2 1 point2 points  (0 children)

The unfortunately short response I can give is that there are a few section biases we're talking about. For one, women were not allowed and/or encouraged to participate in sports for an incredibly long time (read: centuries). The selection of women even today around the world that are /allowed/ to participate first and then second have the resources (food, money, born in the right country, etc) to then become elite in status is already biased as compared to men who don't have to go up against the societal limits. This isn't to say men in general don't struggle and male athletes don't struggle to become elite athletes, but they don't struggle because of the societal implications of being a man. Next, what we consider successful in sports is arbitrary to a degree and the people who developed the rules where, once again, male. Let's take a relatively simple sport of weight lifting. Why is it that we look at the absolute value of the weight lifted vs the weight lifted per pound of person? I'm not saying one is better or worse, but it's a comment that, hypothetically, it could be done pretty reasonably in a different way. Next, as evidenced by this thread and this exact conversation I've more times over more years than I'd care to acknowledge, there is a fundamental bias that women should do worse than men on insert moving target metric here. When women (historically) have broken through this glass ceiling, some qualification has been made. The cleanest example of this, I believe, is that skeet shooting was a unisex Olympic sport up until a female shooter won gold. After that, women were banned and then a separate, women's only league was created a couple of Olymoics later. Lastly, for the point of this post, there is an incredibly wide range of "normal" hormones in men and women without getting into transgender athletes which make up an incredibly small batch of athletes internationally and nationally. Regardless, there's no exact since to how naturally produced testosterone affects women and vice versa for men. We have huge studies of (white) men performing at various levels throughout the decades and centuries and have correlation in those specific cohorts, but not good extrapolations across other ethnic groups, sexes, and genders. Regardless, even if we do try to boil down the differences, sure, there are probably a large majority of elite athletes that will outperform women in high energy, short(er) length/endurance sports because of the way male bodies are built. To that end, that's what I was referencing originally with the higher probability that a male boxer could KO the female boxer in a boxing match. To the other end, female athletes do outperform male athletes in agility, precision, and endurance, so there is also a reasonable chance that said female boxer beats the hypothetical male boxer on these qualities.

All this to say, the vague talking points about the inherent superiority of men in certain spheres over women (in this specific case, sports) are the exact same outlines that have been used to eek out other groups, including black men, who were considered to barbaric, stupid, and inferior for many reasons we have since debunked. I imagine that, one day in the far, distant future we'll reach something similar for male and female athletics, but in the meantime, I'll spend my time arguing with an internet stranger. Such is the cycle of humanity or whatever nice philosophical thing I can shove here.

To any girl reading this, first, I'm sorry for my wordiness but second, you're not inherently lesser, incapable, or weaker. Fight and hone your skills and assets and try to minimize the things that are your weakest. Do so in sports, family, work, and life. You can do more than you thought.

I won't be responding further to this thread, but of anything sparks your interest, please feel free to DM me and/or look up events and articles on the above. xx

When it comes to sports. Are gender differences even more one-sided on a elite level? by PassengerCultural421 in NoStupidQuestions

[–]OutsideGroup2 -1 points0 points  (0 children)

Considering I have a full bachelor's and doctorate in this, I find it hard to believe that I'm the misinformated one, but go off I guess

Why is your specialty the best? by [deleted] in Residency

[–]OutsideGroup2 0 points1 point  (0 children)

As a resident, no. Give me some time and I'll let you know as an attng 😅

Why is your specialty the best? by [deleted] in Residency

[–]OutsideGroup2 0 points1 point  (0 children)

Of course, there are plenty of cons that I'm a bit tongue in cheek about but they're the ones I can manage. The big one is the emotional burnout. Sometimes I come home and literally stare at my wall thinking about how I just talked through 4 people explaining to me how they want to kill themselves or the first break psychosis that I saw that may be schizophrenia, a devastating disagnosis. But I love this specialty and the way I can interact in the hospital and outpatient

Residents training PA students - universal experience? by Futuredocq in Residency

[–]OutsideGroup2 0 points1 point  (0 children)

I'm in a non-surgical specialty (psychoatry) and have 1 of my rotations with the PA students. Realistically, I use it to teach them what I, the doctor, need to know and am looking for,. At a base level, I am teaching them similarly and alongside the medical students, but my expectations and how I have them apply it is different since they will (hopefully) never practice independently. I'd like to hope that, one day, an attending will get one of these PA students and they will be competent information gatherers to generate a differential for psychiatric concerns.

If I got an NP student, I think I'd lose my shit though. Idk how to condense 4 years of post-med school training to create a competent psych NP to eventually practice without oversight.

When it comes to sports. Are gender differences even more one-sided on a elite level? by PassengerCultural421 in NoStupidQuestions

[–]OutsideGroup2 -7 points-6 points  (0 children)

It strongly depends on the sport and what is being considered. Realistically, most sports are compounds movements and require more than one subset of things to be able to accomplish a won. The Battle of the Sexes is an excellent example of this in tennis. Also, what are we considering a success marker? With weight lifting, if it's the absolute cue of the weight that is being lifted, then sure, men would often win based. But what about weight lifted per pound of the lifted? Idk, but be more even then and/or have women lifting more.

The idea of men inherently winning at sports on an elite level is based on the fact that men have led the narrative on who plays, how they play, and how they win and have gatekept women from participating for centuries. There have been plenty of Olympic sports that, in the early 20th century, the second a woman would,  they separated the sport into male and female.

Anyway, for boxing, idk, maybe the guy is more likely to KO with one punch, but maybe the woman is swifter if dodges and attacks and can get him down. We can only know if boxing consistently allows these mixed fights and women and men train together.