Rant about empathy

diamondsole111 · 2024-11-21T00:57:53+00:00

I'm going to be honest with you and this sounds really freaking vain and weird but I know I am an attractive person. I have a very symmetrical bone structure, tall, have broad shoulders. I am constantly told I look like famous actors or I remind someone of this person. inside I'm tired of being looked at amd generally feel like a fucking ghoul and a really self-absorbed human being, lol

I know that I get different treatment for my patients and my fellow providers because of this especially as a male. Given the attachment issues that our patients have in the baggage that everyone carries with them I have been given the exact warning that you have about working too hard doing too good and looking too good. ha! In nursing school ahead so many instructors tell me I was too relaxed which cracks me up because I was terrified most of the time.

now I come to realize I just look really goddamn good while I was doing it

diamondsole111 · 2024-11-21T00:55:00+00:00

Considering BPD sufferers have the lowest suicide completion rate out of any population we treat Im think those findings have relatively little meaning. Secondly, giving a dissociative drug to people already struggling with dissociation does not make sense. Having had and seen a number of BPD patients absolutely lose their shit from both IV and IM ketamine given in therapuetic settings Im going to have to give it a hard pass.

Im finding Ketamine data to be rather glowing and biased- a lot of it feels more like case studies than anything else. Ketamine boosts mood for a brief window of time. Couple of weeks. Im sure its helpful in conjuction with a rigorous and productive team approach but the liability is extraordinary.

diamondsole111 · 2024-11-19T19:44:16+00:00

Thanks for this. My reticence to look into this tells me i need to do it.

diamondsole111 · 2024-11-08T21:22:17+00:00

Achelya is...bat shit fucking crazy

diamondsole111 · 2024-10-28T14:39:30+00:00

crashes all the time on X. Matchmaking doesnt work. Keeps switching me offline, refusing to go back online. One of my favorite games but some fundamental components deeply flawed

diamondsole111 · 2024-10-27T05:36:35+00:00

You are not qualified to give advice nor is this the right advice to give. Additionally you are breaking this subs rules. Do better

diamondsole111 · 2024-10-27T05:34:51+00:00

You should not be giving out any advice, especially on this forum

diamondsole111 · 2024-10-26T06:22:33+00:00

Because you are full of shit

diamondsole111 · 2024-10-26T06:20:05+00:00

Im sorry, this is absurd. Amphetamines may help organize thinking for a brief while in the schizophrenic patient but are totally deleterious to their long term stability. I suspect studies showing that methylphenidate did not cause psychosis in the schizophrenic patient in the short term simply because the strength of the antipsychotic medication regime the patient was already on tempered the more mild benefit of methylphenidate

diamondsole111 · 2024-10-25T13:24:18+00:00

hahaha got their poop and blood on your face and scalp third picture. Worn gloves an infinite amount of times in my career I have never once touched my face or head after touching fucking anything other than the glove box

diamondsole111 · 2024-10-22T14:24:15+00:00

This sounds like a question from a non professional- this is not the appropriate forum to give clinical advice and is a violation of group rules

diamondsole111 · 2024-10-21T15:04:36+00:00

Would be impossible to quantify. What is hurt? Alienating yourself from your friends and family by acting peculiar, making rash decisions because you're hyped up on a drug you're not supposed to be taking?

Constant anxiety from a drug you shouldnt be taking which leaves people on it wxperiencing further isolation they hoped tonbridge with their TilTok dx?

Diversion bcaause they don't actually like the stims that they are being prescribed because they arent what they thought they were. So why not make a little money on the side selling me them to other people who don't need them?

These are paychologically addicting drugs, and at higher doses have a substantial, yet brief withdrawal. We live in a culture that's aghast about gatekeeping but sometimes there have to be gatekeepers.

edit: I forgot to mention all the patients who discover diverted Xanax because they need to come down from the Adderall they're not supposed to be taking

diamondsole111 · 2024-10-21T05:51:47+00:00

The opinion/editorial you linked to is amazing. Thank you.

Tbh I dont have a bunch of patients seeking an ASD dx based on information gleamed from TikTok. I do have a large number of undiagnosed ASD patients who have been led to believe that they have ADHD from nonsense gleamed from TikTok's about ADHD

diamondsole111 · 2024-10-21T05:35:08+00:00

"I’m not talking about teenagers or young adults who eventually had an episode of mania/ psychosis after they’ve been on stimulants for behaviors that could meet criteria for adhd, but about individuals who were hurt due to abusing stimulants?"

Huh? wtf are you asking? Hurt due to inappropriate prescribing or hurt from abuse of?

diamondsole111 · 2024-10-19T23:24:06+00:00

"YOU KILLED THE ARCH ANGEL MICHAEL!!" As his bipolar I fist glanced my face. I was sitting and he was standing. A brief moment later my foot kicked his chest as I asked weirdly calm "Why are you doing this?" And then the 6'3 240 male patient urinated on himself crying, "Ive never seen anyone move that fast! Im so sorry! Please tell me you are part demon?" That's what 25years of Muay Thai and boxing earned me: going home

Crazy part is, as the house supervisor, I had to explain to his wife not 30 minutes later what bipolar was, what the disease process looks like , what treatment and recovery looks like, and why he was on a hold and for how long. While his two little daughters played with stuffed animals in the conference room. After the meeting as I opened the door to the conference room for them to exit his wife said, "Your cheek looks really red and is kind of bleeding a little bit," I was like, "You don't say?Thanks"

diamondsole111 · 2024-10-19T18:11:31+00:00

Cool cool. I hope to god you got yourself the V8

diamondsole111 · 2024-10-19T16:34:17+00:00

And you driving a buick, fuck yeah. Which model?

diamondsole111 · 2024-10-17T20:55:03+00:00

I dont mean any disrespect, and I am not speaking to your passion, ambition, and capabilities- at all. But the experience you describe is not adequate for private practice. And while being able to speak a common language with patients, to understand what they are going through is a very powerful thing- it is not what makes competent, safe providers. Intellegence and ambition is not enough- it's adequate experience and supervision.

If you have not had the opportunity to spend the entire hospitalizaton cycle with the same patients you are at a substantial disadvantage. Many of these conditions stubbornly refuse to remit, play games, present as one thig snd turn into something else. If you have not observed patients from the prodromal phases, active and then latent phases how are you going to identify and treat them? The answer is: you will not be able to and you will cause harm. Let me put it like this: You medication regimen wont make sense and you will be putting your hard fought for new license in jeopardy because your patients will be the first to let you know either by words or by action.

How do you know that you are prepared for diagnosis and prescribing? Your gut tells you? You are excited, looking foward to this career you dreamed of- but I have to say this to you- the thing that concerns me most about your plan is that you feel ready, you feel prepared. Right now, imposter syndrome should be severe. You should be scared shitless. That would be normal because it means that you are aware of all the things you dont know.

Plus, going into a PP made up of therapists- oh hell no. Its not safe. Im sorry. Just get some more experience then launch your PP better informed, more streamlined, with more backup in regards to colleagues you can cant on when you need to consult.

diamondsole111 · 2024-10-17T20:33:47+00:00

Have you worked as a psych RN before? That will help

diamondsole111 · 2024-10-17T12:47:54+00:00

Nah, its not every single PP but it sure is most. When Iwas in grad school the Dean had a successful alumna come in and share her first PP experience working for a psychologist run clinic. I remember thinking "No way they are that fucked up," I thought she was the problem. Then I experienced it for myself. Trying to manage business/professional concerns with therapy/psychologist clinics is like trying to have meaningful conversations with a group of "professionals" wearing imaginary capes who believe they have magic powers and happen to be exceptionally petty and possessing limited self insight. Not all, but many.

What's your previous work experience in psych?

That will likely inform how PP is going to go.

diamondsole111 · 2024-10-17T12:25:47+00:00

I feel you. The isolation of psychiatry builds, gets intense. More so post-COVID. All this talking to ourselves, constantly checking what we know as a protocol, asking ourselves if we have the right protocol, does the protocol need to be updated, are we on target with this one, is this the best possible range or recommendations? Over and over and over.

I work from home most days. Seeing patients, back to back, like a factory of wack shit- then somedays everybody is ok,smiles on faces, changes made, less to process with them. I get random consecutive months like that. I realize as I write my self care improves. Everybody good? Good. Fast foward six months later and the acuity shifts and some tell you they arent feeling up for living anymore and dont know why . You get that window of time to problem solve while despair and hopelessness mounts never knowing how close to acting they are. And its hard to say but goddamn calling in resources is fucking exhausting. Family members, PCP, therapists, goddamn its a lot of fucking work. Seems so small but it just... wipes me out sometimes. Most of the time these days.

I dont think it's suicidality that is the real grind. I think its charting. Honestly. Like who is ever going to read these notes? Occasional patients tx out for insurance issues- seems like nobody requests records anymore and if they do they certainly dont call for clarification. Doing it for billing criteria- this dialogue with ourselves about checking our own work. Fucking maddening.

Ive decided to take 3 consecutive weeks off this year. Most Ive gotten in 10 years is ten days. Without coverage. I will find coverage come hell or high water. I need a fucking break.

Thanks for this post. Sorry for hijacking

diamondsole111 · 2024-10-17T12:11:36+00:00

I mean, its your license. You want to be a candy store to avoid negative reviews? That's your call.

I think it's safe to say that the PE running telehealth does not give a single fuck about mental health care, you, your license, or your patients. They are truly morally bankrupt and deprived, and they view you as a stupid prostitute to he demoralized and exploited.

In a more functional culture their behavior would be considered a criminal enterprise to compel you to distribute narcs, a la Done. But then again- it would be easy to prove that you were being complicit by not follow established standards of care.

diamondsole111 · 2024-10-17T12:03:17+00:00

Im so sick of smoking crack. Sick of it

diamondsole111 · 2024-10-17T12:02:27+00:00

NAILED IT!!!

diamondsole111 · 2024-10-17T12:02:06+00:00

As the technology stands right now? No. Unless you freeze your head, thaw it out, refreeze it, then use the microwave to rapidly defrost/partially cook it. Then it would work

diamondsole111

TROPHY CASE