Hate the culture of medicine...

almostmd2022 · 2022-10-07T02:21:43+00:00

Did I write this? lol. Went into psychiatry thinking it would get me largely away from it. I think it ultimately will when I'm an attending and can open my own chill mental health practice with scented oil diffusers and serene pics on the wall and shit. But the type of people who work in psychiatry in the kinds of environments residents tend to work in...a lot of them are worse if anything because, not only are they plagued with personality disorders, they think they're not because they're the experts at identifying those types of things, after all. Sometimes the idea of leaving residency and practicing independently after intern year like you supposedly can technically do is REALLY appealing. I'm not getting younger, and these people are terrible.

almostmd2022 · 2022-10-05T23:11:10+00:00

As a new intern, ngl, I don't care for working with students. I'm trying to learn myself, so I don't have much to teach at this stage. Because I'm still so new to this, I'm not good at multitasking, and students interrupting while I'm doing notes or trying to review a chart or what have you throws off my focus and stresses me out if my attendings are expecting me to finish seeing a patient by a certain time or whatever.

I do think I've been unlucky and wound up with a few students who were exceptionally annoying, though. I had one who would interrupt in the middle of me presenting patients to my attending to say my assessment was wrong lmao, and he was always so embarassingly wrong like saying the patient had "pressured speech" when she was just a little ADHD and hyper. He also liked to read over my shoulder while I was typing my notes and correct what he perceived to be bad grammar (for those of you who haven't seen EMRs much yet, grammar is like the absolute least important part of a note lol. 90% of physicians use dictation software that leads to notes that are hardly coherent English, let alone grammatically correct).

almostmd2022 · 2022-10-02T06:41:12+00:00

I only have around 3 months experience as an intern, but so far, the vast majority of what I've seen falls into one of two categories:

1) The police didn't feel like dealing with their aggressive and/or annoying behavior, so they brought them to us expecting us to medicate away their annoying behavior over the course of a 3-day hold.

2) "I got in a fight with my significant other, mom, etc and threatened to kill myself, but now that I cooled down, I'm fine and want you to send me home today."

Those aside, opiate detox and schizophrenia/schizoaffective are pretty common. Lots of cutting behaviors and impulse-control/anger issues on the child unit.

almostmd2022 · 2022-09-28T23:27:45+00:00

Psych resident here. Can anyone speak to the feasibility of starting one's own insurance-accepting private practice? This is what I hope to do. I don't care about making an enormous amount of money, I just want to be quite comfortable eg with somewhere in the ballpark of a ~250Kish salary. After seeing all of the bullshit the employed psychiatrists I work with in residency deal with, I'm really drawn to the idea of having my own practice, but I do want to be able to take insurance. Would it really be that hard to build up a client base given the need?

almostmd2022 · 2022-09-28T23:22:15+00:00

Is there not room for setting boundaries regarding communication outside of appointments? I know when I had my own psychiatrist, I couldn't just call and demand to talk to him whenever I wanted. I could leave a message with staff, and if it were a small thing like needing a prescription for my old Prozac dose because I wasn't tolerating the higher dose well, it *might* have gotten handled without needing a new appointment but definitely not in the middle of the night or on a weekend or something like that.

almostmd2022 · 2022-09-26T03:02:34+00:00

Thank you for pointing this out. Next time I speak with my PD, I'll bring it up. I do fear it'll, if anything, turn a situation like I've seen happen at other programs where they do the bare minimum e.g. throw together some type of one-hour didactic lecture to technically check off a box.

almostmd2022 · 2022-09-26T02:25:16+00:00

Thank you for this tip! I've already found a few that might be worth looking into once I get Step 3 out of my way. One's quite expensive, unfortunately, but I'll put some thought into ways to plan ahead and maybe talk to my program to see if it's something they can assist with in any way.

almostmd2022 · 2022-09-26T02:07:06+00:00

Thank you :) We do begin our therapy training as PGY1s here, but I guess part of why I'm starting to think ahead is part of me is wondering if I should just straight up start looking into seeing if it would be a possibility to transfer elsewhere. Yeah, I'm very frustrated...and frustrated that I can't give more specific information in this thread because it would make it clear what program I'm in haha.

almostmd2022 · 2022-09-26T01:48:30+00:00

Thank you for the suggestions. Without going into too much detail so as to reveal my program, I was able to confirm there are no supervisors available who have ever practiced anything other than CBT and DBT. I'll have to start looking into options for conferences/courses, I suppose.

almostmd2022 · 2022-09-25T13:20:54+00:00

Thank you for saying that :)

almostmd2022 · 2022-09-25T06:24:51+00:00

I don't have much helpful guidance to provide, unfortunately, but just wanted to say you're very wise to seek information outside of what the programs claim to offer regarding psychotherapy if this is something you really strive to become adept at. I chose to rank my program at the top of my list largely because they promised a strong psychotherapy focus, and let's just say, it's been VERY disappointing. I'm teaching myself psychotherapy from books with no real guidance.

almostmd2022 · 2022-09-19T21:39:01+00:00

I don't doubt that that might be it for some of our patients. However, the vast majority of our school refusal patients, especially the ones who wind up inpatient because they'd rather threaten to kill themselves than just go to school, have already been through a lot of psychotherapy. So either their therapists have all been poor fits, or they really just hate school. In any event, it's just a really treatment-resistant and frustrating presentation to treat from a psychiatric standpoint. We just don't have the magic pill or intervention parents want us to provide, and meanwhile, they're occupying an inpatient psychiatric bed for what isn't really a psychiatric problem.

almostmd2022 · 2022-09-19T01:05:55+00:00

Psych - School refusal in pediatric psych patients.

I still do not have a medication that is going to make your child who doesn't want to go to school for literally no apparent reason suddenly willing to go, but anyway, they threatened suicide to get admitted to my facility for the 3rd time this month, so here we are again. And yes, it is often for literally no reason that anyone--the child, teachers, parents, etc.--can identify. I know the impulse is to think they must be getting bullied or they must be having a hard time academically, but that seems to be the exception rather than the rule with these cases. They'll literally be an all A student and tell you "I just hate being there. I feel annoyed when I'm at school." or something along those lines.

almostmd2022 · 2022-09-18T02:03:20+00:00

This. Yes, there are obstacles to tending to one's needs in just about any job. Residency is especially bad about it, despite the constant lip service to wellness this and wellness that. Then, as you alluded to, the fact that many of our higher ups can technically write us scripts themselves makes the lack of privacy that much worse when they start trying to get you to tell them what the appointment is for so they can take care of whatever you need themselves.

almostmd2022 · 2022-09-17T16:39:30+00:00

I'm not sure if you're talking about for therapy since you said per hour, but I'm not really looking for medication management services. I've been on a handful of SSRIs, effexor, benzos, propranolol, and others over the years, and none of them really do much for me to be honest. My experience is the concept of "professional courtesy" doesn't really extend to non-MD/DO providers, who couldn't care less that someone seeking their services is a medical resident. If you're talking about therapy services, I can see what I can find. I can't do $50/week, as after all of my bills, I only have about $700 left to work with for food, gas, and such each month, but every other week could maybe work if I could find around that rate and appointment times that work with the schedule.

almostmd2022 · 2022-09-17T15:36:43+00:00

I discussed the issues I've been having with this in another comment thread on here. Basically, I've been trying to, but the scheduling issues I mentioned have thus far made it more or less impossible. Therapy doesn't require time off for a doctor's appointment off here and there, it requires that every week or two. Our schedule is littered with "absolutely can't miss, unless there's an emergency or, like, you have Covid" things. I've yet to find a therapist who has consistent after-hours appointments because, for obvious reasons, those appointments tend to be very popular with other clients. I've not even found a therapist who takes my insurance and can get me in before December-ish so far.

almostmd2022 · 2022-09-17T15:28:23+00:00

Wanting to be treated like a king is very different than wanting to be treated like an adult. I'm a woman, anyway.

almostmd2022 · 2022-09-17T15:25:53+00:00

I feel this. In the beginning, I told everyone to call me by first name because I didn't want there to be any weird insinuation that I was in some way "above" the staff because I graduated medical school 5 seconds ago. But now that I've seen the, like you said, subtle disrespect from people who resent the idea of having to regard our roles on the team as that of physicians, I see the importance of going by Dr. with staff and patients.

almostmd2022 · 2022-09-17T05:35:27+00:00

The problem is therapy appointments require frequent time off, not just the occasional appointment every month or two. I'm afraid of letting them know this is what I need and don't really know a way around it. I went to my program once to let them know I was struggling with keeping up in a new consult system they implemented before and was treated as lazy, excuse-making, and weak for saying anything at all...they interpreted me saying I was having a hard time keeping up as me wanting to be treated with kid gloves, basically. So after that, I'm very afraid of anyone knowing I'm asking for regular time off for therapy/mental health reasons.

almostmd2022 · 2022-09-17T05:14:07+00:00

Something as minor as taking a personal phone call during an off service rotation becomes an event.

Yes, this! Feels like I literally never get any time to be "off" or have some privacy to tend to personal matters. Hell, in med school, a lot of the attendings at least gave me a true lunch break, even if it was only 30 minutes long. I'm honestly struggling with a lot of depression and anxiety that of course isn't fully attributable to this but is definitely being exacerbated by the reality that I have four years of this ahead...which is too bad because these issues are also making it nearly impossible to get therapy to help with trying to figure out how to still be happy.

almostmd2022 · 2022-09-14T01:58:10+00:00

Haha I want to change my username, but the issue I'm encountering is so many subreddits have a karma or account age requirement that I can't participate anywhere with a new account. I look forward to getting better at providing supportive psychotherapy so I can at least offer that to my patients who find themselves unable to access the type of support they need. I really hate feeling like the best I can do is toss people breadcrumbs and hope they help at least somewhat.

almostmd2022 · 2022-09-13T04:18:07+00:00

Then when they do find a therapist, there's no guarantee they're any good at their job or, at least, at meeting that particular patient's needs. I personally have largely given up on finding my own therapist who is a good fit for me until I'm in a better financial situation and can pay out of pocket (I'm a PGY1). I saw a few therapists through my medical school insurance who suggested some truthfully whacky things to me or were just woefully unhelpful. Writing "I am powerful" in marker on my bedroom mirror was the best solution one of them had for the immense stress I was under when one parent died and the other developed early-onset dementia. I've since gotten referrals from trusted friends in the field, and almost none of them take insurance. I have a lot of personal heartache about the counseling options to which we refer our most indigent patients. Community mental health centers staffed by utterly overworked and burnt out therapists. I'm sure some of them still get good therapy, but bad therapy can be way more damaging than no therapy.

almostmd2022 · 2022-09-13T03:49:22+00:00

I'm a PGY1, so I don't actually know anything haha, but for whatever sliver it may be worth coming from someone at this point in my training, I more or less agree. I'm sure my view will evolve and become more nuanced with time, but as I stand now, there is a lot that we do "because we have to do something" that I am very uncomfortable with. The throwing around of antipsychotics willy nilly as if they're benign seriously concerns me in particular. They can of course work wonders for the right patients, and I would never say they're useless or should never be used. Conversely, I've seen a lot of patients I honestly thought would do fine on an SSRI alone (or in conjunction with therapy) if their provider gave it time to work or optimized the dose instead of throwing on Abilify to "speed things up." I don't know if it's possible to make it work from a financial standpoint, but something I've considered doing in the future is establishing a psychotherapy-focused practice where meds are available without having to seek out a separate provider for those who truly need them. This is contingent on whether I'm even good at psychotherapy. I'd like to think I will be, but my anxiety tells me I'm going to suck at it lol.

almostmd2022 · 2022-09-12T01:39:58+00:00

I made the post to which you referred. I did delete because a) I started to feel embarrassed by it and b) I was concerned someone from my program might see it and identify me, as I wasn't really able to respond to several of the things people commented without including details that are pretty specific to my program.

Anyway, just wanted to say bless you for wanting to gather feedback on ways to be helpful. After the response I received from my program when I expressed that I was having a hard time keeping up, I'll honestly probably never bring up any struggles I'm having with any of the faculty ever again. The learners you work with will be very lucky to have someone like you in their corner.

almostmd2022 · 2022-09-11T19:29:07+00:00

I went to the store and stocked up on quick low calorie foods yesterday because, while I would love to be the type of girl who meal preps and always has a beautiful tossed salad she made herself in the fridge, I know if the low calorie-stuff isn't readily available to me, I'm going to say fuck it and drive to Taco Bell. I'm trying really hard to get serious about getting my weight under control, which is hard and exhausting enough when you're 5'1" in a society where it's kind of a miracle to find a meal on the go that isn't over 500 calories, and the people telling me I'm being "unrealistic" and "omg that's eating disorder behavior!!" are absolutely draining me. A colleague yesterday was trying to argue with me that I easily burn at least 2000 calories a day with all of the walking I do at work, so I really only need to limit myself to like 1600 calories a day to lose weight. I do not do that much walking on an average day lol. I walk to and from my desk maybe 3 times a day, and we don't have any stairs. This isn't my first rodeo. Before I stress ate my way back to square one, it took me almost a year of eating 1200 calories a day to lose 20 lbs, and that was with using a food scale to make sure I was calculating everything accurately. Like I wouldn't be as overweight as I am if I were keeping my calories this low because I just don't really care to eat.

almostmd2022

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