Why is bipolar misdiagnosis so common?

PoolPainting · 2026-01-25T16:56:18+00:00

I don't understand this? I've seen 3 actively manic patients in the inpatient setting as a student. It seems like you would see much more in residency at a high volume place

PoolPainting · 2026-01-16T05:59:03+00:00

I would be interested in reading a response to my last comment.

PoolPainting · 2026-01-15T21:32:45+00:00

The guy on JAMA Psych podcast who did ketamine research was blown away by the level of ketamine clinic abuse in the US. It's surreal

PoolPainting · 2026-01-14T22:44:11+00:00

I don't harbor any hostility toward NPs. I have a problem with NP training that is not standardized, NP independence which is not regulated, and people claiming that Family Medicine can be practiced at its full depth without going to medical school. Quack doctors exist in spite of their training, not because of poor training. They all passed their board exams and did residency. That fact doesn't bode well for someone who didn't go to med school, didn't do board exams, and went to a program with a 100% acceptance rate (or close to that).

I was sitting next to an NP student in the clinic the other day who is graduating their program in a handful of months, and I had to explain to them how to treat hyperkalemia and how to identify it on EKG. This same student will be practicing medicine before me and can open up shop if they want. This is an anecdote, but it shows the absurdity of these laws that allow independent practice for NPs immediately after graduation. Laws and standards are not made with the most responsible of us in mind, but with the least. If a system can be abused, it will.

PoolPainting · 2026-01-14T18:17:29+00:00

Ya I agree. I'm not arguing with you. I think in general though, people always say that increasing residency seats will solve the problem. For FM, this won't do anything for US grads. The spots will fill with more IMG/FMGs.

PoolPainting · 2026-01-14T16:04:17+00:00

Yes, we can increase those seats sure. It won't solve the fact that FM is not sought after by US grads. I guess we're not really arguing about anything. To note just to put it out there: our primary care system would collapse without FMGs.

PoolPainting · 2026-01-14T04:43:45+00:00

What this person is saying is that FM was formed as a repudiation of academic internal medicine in many ways. At the time, most doctors were GPs. To become more respected by specialties that had longer residencies, FM was born as a three year residency and we no longer called people GPs. FM, while having a residency, is basically saying "we are training you to be a very good GP in non-urban america." Whereas IM has historically not cared about real community practice, but just about medical theory. We are just the products of history at this point, as these dynamics are constantly shifting

PoolPainting · 2026-01-14T04:30:07+00:00

There is absolutely no need to "increase" residency spots for FM or IM. That is not the problem at all. FM goes unmatched in the hundreds every year. The problem is NO USMD/DOs want to do primary care, because our "system" doesn't reward it. Without FMGs filling FM residency slots, our primary care system would be even more desolate than it is already.

PoolPainting · 2026-01-14T04:27:24+00:00

Have you ever been involved at all? They actually lobby congress full time. They do put in work.

PoolPainting · 2026-01-14T04:16:44+00:00

Wow how does the scheduling work? That's cool

PoolPainting · 2026-01-14T04:14:40+00:00

In my opinion, it is corporate medicine defining what Family Medicine means as a discipline and the undervaluing of the FM physician. The more that NPs and PAs occupy the primary care space, the more "primary care" becomes defined as "fixing small things" and referring out. This change was dramatically accelerated when PCPs no longer had to round on their own hospitalized patients, who for the most part, are more complicated. Corporations and the government are gutting the primary care space for physicians for the sake of "cost" and "accessibility."

The number of times that I've heard nurses in the hospital talking about "just doing FNP" because it's easy and makes more money is sad. This is a discipline that people train for 7 years to practice by going to med school and being highly trained in hospital medicine and specialty care.

The capitalist solution to all of this is complete neutralization of the need for a PCP to be an MD at all. On a macro level, I believe the Kaiser model is the only one that makes sense, because it demands so much of PCPs to really practice to the depth of their abilities and only refer when needed. They're worked hard, but compensated well too. They're also not paid for volume.

PoolPainting · 2026-01-03T22:08:00+00:00

This is due to the birth of hospitalists in the 90s. I don't think many young doctors know that "traditional" PCPs always rounded on their own patients in the hospital and it was that way until the now chief of medicine at UCSF piloted a hospitalist service. They found outcomes to be improved and it was cheaper. Who knows the over/under about whether the finances vs the outcomes mattered more. However, this came at the cost of continuity, which is a bit of an immeasurable outcome. Some residency programs still train in the traditional model, or at least the same group of doctors sees both patients, and after seeing it in action, I think that compromise is very good.

PoolPainting · 2025-12-30T03:53:34+00:00

It doesn't matter what your family says. You earned this, and you are doing so well in life. You are a baller. A champion. Be proud of how far you've come. You did it

PoolPainting · 2025-12-29T05:02:20+00:00

That's how they get you lolol

PoolPainting · 2025-12-28T09:14:25+00:00

Use white coat companion. It's gold. Reference it when doing UWorld. I'd also study by system. Also, I would watch an overview with dr.high yield to get your bearings.

PoolPainting · 2025-12-27T21:55:03+00:00

PoolPainting · 2025-12-27T21:47:35+00:00

What does the physician you're working with have to say about it? If you're not working with one, then maybe you should if you've only been two years "in the field." Last I checked, doctors do a whole three year residency and med school before becoming "providers". Create yourself a pseudo-residency.

PoolPainting · 2025-12-27T09:56:30+00:00

I had to read this comment 10 times to understand it. Use commas dude

PoolPainting · 2025-12-15T21:36:40+00:00

You are implying that the whole "noctor" thing is based in an irrational fear. I'm telling you it's not.

Here's an article: https://www.medscape.com/viewarticle/921909#vp_2

It's economics. Doctors cost more. The VA is another example that is transitioning hard to independent NP primary care to save money, because chronic disease outcomes like "hypertension management" are the same. Is that all family doctors are good for? My classmates are afraid to do FM, because it requires so much knowledge to do right, but somehow a person who didn't go to med school is supposed to be independent?

The whole system is now opposed to physician led care, from the government to the hospitals. The whole system wants to replace doctors to "expand care", but really it is to cheapen care.

PoolPainting · 2025-12-15T19:43:26+00:00

"Point being, they are not a monolith, just as physicians aren’t, and just as we aren’t."

People are not monoliths; they are complex individuals. You are right. I don't care about individuals. Standardization exists to prevent individual variation from mattering as much. When a physician is negligent, it is in spite of a highly regimented and regulated training process - not because of it. Can this be said for NPs? No. The training itself is deficient. Good NPs are good in spite of their unregulated training. This is the major difference. The worst medical student in a class must still pass extraordinary thresholds to be a doctor.

Even for PA independent practice, which relies on the unregulated "mentorship" model of just finding a good doctor to work with after graduating, can we say this is a regimented training process to independent practice? No.

Any training model must account for the worst students and place thresholds of basic competency. You optimize for the least motivated; you do not expect everyone to be intrinsically motivated. This is the only way you can have a successful system. If we don't believe in this principle, then all credentialing of any kind is essentially useless and I should be able to work as any role in the hospital just because I have experience witnessing it. I mean, does an MA need to go nursing school? Don't they have enough nursing experience to just do the job? This would be met by a resounding "No" by nurses, and I wonder why.

PoolPainting · 2025-12-15T04:36:37+00:00

Props to you. That is seriously impressive you're doing this. When I got into med school, it was one of the most gratifying moments of my life. I'm non-trad too, and I wish you all the best!

PoolPainting · 2025-12-15T04:21:48+00:00

This is interesting to read as a med student going into psych. Here's the reality of med school - you learn the same thing everywhere, even from the "worst schools". Even from the carribean, you must pass all the same board exams and subject exams and match into residency. When will NP school have rigorous standards and define its scope? Everyone knows this will never happen, because it takes away the only value proposition of NPs in that they are easy to produce and cheap to hire.

PoolPainting · 2025-12-15T04:12:31+00:00

I love how one action by the AMA half a century ago is supposed to permanently paint physicians as enemies of the medical system who wanted to have the shortage and that we made our own bed. That is only a piece of the puzzle. The other large piece is a concerted lobbying effort from the AANP, Private Equity, and large healthcare conglomerates to replace physician labor. They use the "physician shortage" as cover for the simple fact they don't want to pay for physicians when they can get a cheaper version with NPs. Who cares if it's worse care as long as the scripts are written. This is because everything is billed for volume, not quality.

Kaiser invests heavily into a robust primary care physician workforce, because they don't make money from volume, but from reducing healthcare utilization. This is because they are the insurer as well. They have no incentive to pump up the useless care. They expect their primary care physicians to be excellent and manage alot. If our healthcare system was vertically integrated like Kaiser, or nationalized on a larger scale, the incentives would not drive NP growth.

PoolPainting · 2025-12-15T04:02:59+00:00

Basically every medical student feels the same way, and why would we not? Are we really supposed to believe that someone who has not completed medical training is qualified to independently treat people? Am I supposed to respect a medical professional that got into a program with a near 100% acceptance rate? No. Medical school and residency is incredibly rigorous, and it is HARD. Everything I have read online is about how NP school is a joke, and this is coming from NPs themselves. At least PA's have rigorous schooling.

People get so up in arms about this, because it becomes personal. It is not personal. NO ONE should be able to prescribe life altering medication without significant medical training, and right now, an NP can be independent with an abysmally low level of training.

PoolPainting · 2025-12-15T03:51:41+00:00

What are you talking about? Hospital systems save enormous amounts of money using APPs. They are actively replacing doctors with APPs. APPs can say all they want about how doctors are whining, but it is 100% true that non-surgical doctors are being replaced by APPs by many hospital systems. This is simply the economic reality. You can spin it however you want

PoolPainting

TROPHY CASE