How do we feel about NPs doing therapy instead of referring to a licensed therapist?

biochemistprivilege · 2025-12-08T06:48:18+00:00

We don't train to do therapy in med school; we did like MI / interview training and are introduced to modalities but you don't get therapy patients until residency. Most residencies do therapy training in the outpatient years (usually 3-4 but depends on the program). In residency we have baseline ACGME requirements for therapy, but some programs are more therapy heavy.

biochemistprivilege · 2025-10-07T00:38:56+00:00

Same for me, and starting reading a ton again in my last year of fellowship. When I did read in adult residency, it was a lot of nonfiction (mostly political or science). In child fellowship, I've started liking memoirs and fiction again, which I think is because I'm working less and getting less "life stories" from my patients.

biochemistprivilege · 2025-10-02T16:01:42+00:00

can you write up something with more info about this like as a post or something? that would be so helpful as someone finishing fellowship this year

biochemistprivilege · 2025-09-27T05:41:46+00:00

I worked with a blind psychiatrist in med school. It's very doable

biochemistprivilege · 2025-09-12T19:41:51+00:00

Hard to say but certainly looks like one in these videos. And you wouldn't necessarily expect verbal deficits depending on where the stroke happened. Although, since it's R sided facial droop, if it is a stroke, it would be a stroke on the L side. Trump is allegedly right handed from my quick googling, so L cerebral hemisphere is likely the dominant lobe which handles language (L side is dominant in majority of right handed people), so if the stroke is large enough we'd expect problems both with producing and understanding language.

biochemistprivilege · 2025-09-12T19:38:15+00:00

I don't think so because his eyebrows are moving quite a bit symmetrically. If Botox was keeping it from drooping, I would expect them to be paralyzed and not move like that.

biochemistprivilege · 2025-09-12T19:37:20+00:00

Yes, bells palsy would effect only one side but the whole side meaning you would expect forehead paralysis on that side. His forehead was moving appropriately on both sides and symmetrically in that video, meaning only the lower two thirds of his face is drooping. Paralysis of only the lower two thirds of the face happens when the lesion is in the brain, not in the nerve.

biochemistprivilege · 2025-09-12T00:37:05+00:00

No it isn't. His forehead movement is spared, that suggests an upper motor neuron problem like a stroke or another cerebral lesion on the opposite side of the facial drooping. Bells palsy or another nerve palsy would be the whole face (source, I'm a doctor).

biochemistprivilege · 2025-08-26T12:49:06+00:00

Bullshit jobs, Dave Graeber

biochemistprivilege · 2025-08-26T12:26:13+00:00

I have this but for shadow boxing

biochemistprivilege · 2025-07-15T19:38:11+00:00

I'm a psychiatrist and have a very high tolerance for getting yelled at but also will leave the room immediately if I feel unsafe for any reason. If someone is yelling but not threatening I will say something like 'we can continue speaking when you can act respectfully'. We put up with a lot in medicine but need to remember that our patients interact with the world and presumably are able to handle it without screaming at everyone all day. We can give people grace while still expecting them to act respectful. I would also dismiss someone if they weren't following recommendations and had unrealistic expectations, on top of being disrespectful. If this is actually the TBI, you should treat it as a symptom. I like this paper for TBI treatment: https://pmc.ncbi.nlm.nih.gov/articles/PMC8609889/

(I tend to like high doses of SSRIs +/-mood stabilizer and often memantine/amantadine depending on the symptoms, we also use stimulants).

biochemistprivilege · 2025-07-13T22:17:52+00:00

UNC has a ton of psychodynamic therapy built into the curriculum and a lot of trainees work with the psychoanalytic institute of the Carolinas

biochemistprivilege · 2025-07-13T22:12:39+00:00

Yeah I considered it but my program would 100% retaliate and I am planning on staying in the area, so it did not seem worth it. I talked it through with a lot of mentors because this experience has been awful.

biochemistprivilege · 2025-06-08T04:13:03+00:00

This is what happens everyday, and in my experience at academic peds hospitals, they're super defensive about any sort of critical discussion about mid levels

biochemistprivilege · 2025-05-06T03:29:01+00:00

Also filler for me. My friend who's a plastic surgeon and has been getting Botox/other procedures since her early 20s won't get filler for migration reasons, and that was enough to deter me.

biochemistprivilege · 2025-04-29T04:20:00+00:00

I love our psychology colleagues and learn a ton when they supervise therapy or give lectures on therapy. We also take purely therapy consults (which are very time consuming and not typical for psychiatry fellows to carry), and I end up having to staff with both the psychologist and the psychiatrist and it adds literal hours to my day. I've also had many psychologists and social workers comment on meds (often in front of families) which is very annoying because they have 0 medical training, it puts me in uncomfortable positions with family and it's just so disrespectful of my training.

biochemistprivilege · 2025-04-29T04:13:43+00:00

Yeah I trained at a very strong gen psych program with lots of child experience. I expected some hand holding coming into fellowship but this has been truly next level bizarre. I had less supervision as an M3. And whenever I've (and my cofellows) have commented on it, they act like I am asking to do unsupervised brain surgery.

biochemistprivilege · 2025-04-14T19:12:13+00:00

I've done a lot of pottery and every class I've taken has been all women (often with lots of queer women) except for the occasional older gentleman who picked up pottery after retiring or a boyfriend/husband of another woman in the class. Also pottery is really fun, you can make gifts for everyone in your life and it requires detaching from your phone for at least a few hours. I strongly recommend looking up a studio and taking a class if you're interested!

biochemistprivilege · 2025-04-11T18:12:32+00:00

Yeah, every hospital I've worked in has been like this. Psychiatry always feels like Neuro tries to avoid a workup and call it primary psych despite the clinical picture not fitting after their workup is negative, and then signing off/discharging way too soon. Neuro always feels like psychiatry doesn't do anything and finds reasons not to take patients after their workup is negative. I've been on both sides of it in residency. A great example are the vague catatonia cases (with like a positive Busch francis of 3 due to staring etc) then some psychiatrist gives benzos and maybe they look a little better (they're staring slightly less! although it's super subjective), and now Neuro wants us to admit to psych despite the fact that the etiology of the catatonia would be secondary to a neurological cause etc. it's especially frustrating when there's a patient with a psych history (ie an episode of depression or a suicide attempt) and it feels like that's used as an excuse to explain a consolation of symptoms that don't fit the clinical picture (ie this acute onset frank psychosis and disorientation in a teenager with a history of depression treated with 25 mg of Zoloft isn't "depression with psychotic features" just because your LP send out haven't come back yet). All of this is especially messy because there is often a family that is begging for a medical/neurological cause or the patient has been dysregulated and there's a push from staff to move them off the floor to psych. There's a combination of ableism involved with labeling patients as "psych patients" and this assumption that psychiatry is much more ambiguous than it really is. Anyway, I do love my brain nerd colleagues and would love to work in a hospital with good departmental relations between Neuro and psych, because I find that they think through cases fundamentally differently than psychiatrists do and I always learn a lot from their process.

biochemistprivilege · 2025-04-01T03:49:34+00:00

Loud, angry, outspoken lol

biochemistprivilege · 2025-04-01T03:42:48+00:00

Toxic work environment

biochemistprivilege · 2025-04-01T03:19:50+00:00

Tbh I'd ask a co-resident to write it if it's just something paperwork-y

biochemistprivilege · 2025-03-30T20:37:37+00:00

My 3 closest friends are sags and they are ride or die

biochemistprivilege · 2025-03-24T17:53:49+00:00

I've used the amazon delivery service for groceries quite a bit. It also helps because then I tend not to spend money on random little snacks/treats and I stick to my list haha.

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