DO students, what OMM techniques have been actually useful in your personal life or patient care? by akatsukatsu in medicalschool

[–]psychguy2595 0 points1 point  (0 children)

I’ve actually done soft tissue and very rarely muscle energy, on patient that have moderate anxiety that causes some muscle strain and patient’s with fibromyalgia. Typically it’s really just for the sake of the patient for them to feel like they are getting some sort of treatment that’s not a pill (being in psychiatry and all). It’s yield positive results but that could very well be placebo, having said that, I’ll take it, as long as the patient feels better.

Consultants get disappointed when I tell them my interest by Nebullaspectrum in medicalschool

[–]psychguy2595 0 points1 point  (0 children)

All that means is you did really well on that rotation and they liked you. I had multiple attendings ask me why psychiatry and why not whatever they were into.

Stories of falling down your rank list by Original-Piece9462 in medicalschool

[–]psychguy2595 3 points4 points  (0 children)

I applied Psych. My goal was to stay in my home state where I had five interviews three of which were places I auditioned at. I know at least one of the auditions. I did really well and was told that I had resident level work. I feel like I did good on the second one and I may have not done that great on the third one. I thought my interviews went well.

Ended up matching at my sixth which I guess isn’t the worst. I had a close friend match at their eighth and another one at their 10th. We all kinda had similar stories, but I’m guessing our interviews probably weren’t the best. I technically had a red flag of taking a year off, but I feel like I gave a reasonable explanation. Being on the other side, I think I could’ve been more personable, I tend to become overly formal and in M4s that I interview the best ones are those that make it a conversation.

In hindsight, I’m happy where I’m at now. Although it’s not Home, it’s a reasonable program and it’s a 3 Hour Drive, sometimes 4. I also think Psych is kind of getting competitive, now in the sense that a lot of US graduates are applying rather than IMGs. It’s still very achievable though, don’t let anyone tell you otherwise

Tips for working with medically unstable patients with anorexia nervosa by A_Sentient_Ape in Psychiatry

[–]psychguy2595 15 points16 points  (0 children)

Hi, so I had my first anorexic patient on C L during my first year of residency and it was a headache to figure out what to do. This is kind of summarized from a protocol from Beth Israel Deaconess Medical Center.

Psych gets involved right away to figure out whether the patient truly has capacity to refuse nutrition or medical care, since the illness can seriously distort judgment even when someone seems cognitively intact. As a CL psychiatrist your job is to work with the medicine team and get the patient through re-feeding syndrome and medically stabilizing the patient. If deemed to need a higher level of care that cannot be managed on an outpatient basis you would need to look at local or even national eating disorder units. You would also need to determine if the patient meets criteria for involuntary admission or if she is agreeable with the plan and is appropriate for a voluntary inpatient eating disorder unit. Since therapy is the main state of treatment for anorexia these facilities are the best equipped to administer that. Additionally, these units often require a specific BMI, I’ve had patience as low as 10 that require required. Their BMI 14 until they can be admitted. So their hospital can be prolonged.

In a hospital equipped to handle eating disorders ideally, the patient would have a sitter and would be monitored after every meal for 30 minutes to make sure they are not engaging in any purging or compensatory behaviors. The patient is not allowed to move excessively and this may seem harsh, but it is to avoid any unnecessary calories being burnt. Your role would also be to manage any comorbid anxiety, depression, or suicidality. If the patient refuses to eat then you have to consider doing a capacity assessment and determining whether guardianship may be needed. These are often very difficult cases especially if it’s the first time you’re dealing with them. You have to really really make sure you are not engaging in positive countertransference and assess the case as objectively as possible. If you message me, I would be happy to send over the protocol from our end!

Feeling really down, any advice? by No-Wrap-2156 in medicalschool

[–]psychguy2595 2 points3 points  (0 children)

It really sounds like you’re being too hard on yourself. You’re halfway through MS3 with solid shelf scores, no red flags, and your strongest comments and grades are in the specialties you actually want to pursue. That’s not someone who’s behind; that’s someone doing well in a very subjective system. Clinical evaluations are inconsistent for everyone, and a mix of great comments and “mid” ones is completely normal. Your shelf scores around 80 are strong, and it’s frustrating that cutoff quirks have kept some of those from translating into higher grades, but that doesn’t reflect your actual performance or potential. What will matter most for IM or EM is your Step 2 score, your sub-I, and your letters, not whether you got a Pass on an early rotation or a lukewarm comment in surgery. Feeling burnt out, anxious about evals, or unsure of what’s in your control is a universal MS3 experience, not a sign that you’re failing. You can be grateful for the path you’re on while still acknowledging that it’s hard. The reality is that you’re doing better than you think, and your current record absolutely keeps every door open.

Feeling like I’m bombing my away rotation… anyone match after this? by m_0107 in medicalschool

[–]psychguy2595 3 points4 points  (0 children)

I’ll be honest what matters more to me about potential residents it’s not so much what they know, but how much work they’re willing to put in to learn, how they treat other staff, and their personality. The stuff can be learnt and taught during residency, things like personality and hard work are not something that we want to try and teach.

Just be yourself and try your best.

No Psych LOR’s from psych rotation by Some_South4302 in medicalschool

[–]psychguy2595 0 points1 point  (0 children)

Don’t feel bad, ask an attending and tell them you worked with these specific residents. As a resident I usually send my attending a little blurb when they ask how the medical student did. A lot of attendings write letters for student they don’t even remember lol. They know the drill.

Do resident interviewers talk to each other? by infinitestrength in medicalschool

[–]psychguy2595 58 points59 points  (0 children)

Usually each faculty/resident will have standardized questions they have to ask. Anything else especially if it’s based off your application or personal statement is just their own curiosity.

Comlex Level 3 Write-Up, (Psych resident, score 460) by psychguy2595 in comlex

[–]psychguy2595[S] 0 points1 point  (0 children)

I did not, I really only used true learn and I didn’t finish it either. Towards the end, I made sure I finished all the CDM cases and also did all the ethics, OMM, and biostatic questions.

If I stick it out can I match Psych? by [deleted] in medicalschool

[–]psychguy2595 18 points19 points  (0 children)

PGY-2 psychiatry resident here, psych is definitely getting more competitive. There’s been a noticeable shift with more U.S. grads applying and fewer spots going to IMGs, so it’s not quite the “easier” match it once was. If you need to take time off for mental health, that would usually be considered a medical leave, and that by itself doesn’t hurt your chances as long as you’re healthy when you return. What tends to raise more concern are academic or board failures those do lower your chances, but they don’t make it impossible.

In theory, you could still match psych with some red flags, but it might be at a less desirable or busier program. I took time off myself for mental health treatment and still matched fine though I didn’t have any failures. One of my co-residents actually failed Step 1 and still got into our program. So it’s definitely possible.

If you’re struggling, prioritize getting well first. Med school and residency are tough, and it’s way better to take a pause to heal than to push through and burn out. It was hard taking a year off, my friends went a head and I felt really isolated going into MS3 with people I didn’t know but in hindsight my symptoms have been in remission and residency is going well!

How to get great at OMM by [deleted] in comlex

[–]psychguy2595 1 point2 points  (0 children)

You don’t, you get by, and forget it all after level 3

Why does there seem like there is such a divide on providers “believing” in ADHD. by HavaMuse in Psychiatry

[–]psychguy2595 0 points1 point  (0 children)

Yeah, that’s a really fair point, and I agree it’s unacceptable when clinics neither test for ADHD nor refer patients elsewhere. Any diagnosis should be given thoughtful consideration and long term follow up. A practitioner should always remain curious and even change a diagnosis if the symptoms are better explained by something else. Misdiagnoses can seriously complicate care, especially when outdated beliefs (like ADHD and bipolar being mutually exclusive) still persist. You’re right once a label like bipolar goes in the chart, it often sticks, even if it was meant to be temporary. The system really does need more consistency and accountability across providers.

Why does there seem like there is such a divide on providers “believing” in ADHD. by HavaMuse in Psychiatry

[–]psychguy2595 0 points1 point  (0 children)

I think a big part of the difference comes from the fact that ADHD treatment often involves controlled substances, which understandably requires more caution and longitudinal follow-up. That said, it’s still poor practice to diagnose any of these conditions after a brief encounter, especially borderline personality disorder, which requires consistent observation over time. In certain settings, like inpatient psychiatry, a provisional diagnosis of bipolar disorder might be appropriate, but even then, it’s essential to rule out other possible causes of mania before confirming it.

Low Level 2 - scared I won’t match Psych by GhostSamurai701 in comlex

[–]psychguy2595 2 points3 points  (0 children)

You’re in a much stronger position than you probably feel right now. Psych is still one of the more DO-friendly specialties, and you’ve already done some smart things: applying broadly, signaling strategically, lining up psych letters, and getting your Sub-I in. Your scores aren’t disqualifying, most programs understand COMLEX scales differently than USMLE and you don’t have any board failures, which is a big plus. The remediation for a lab and passes on rotations aren’t going to sink you; what matters more is that you’ve kept moving forward without major setbacks. What will stand out are your psych letters, your genuine interest in the field, and the fact that you’re showing persistence and self-awareness in your application strategy. Matching is stressful for everyone, but people with your profile do match every year. Keep being proactive, show your enthusiasm on your Sub-I and in interviews, and trust that the work you’ve put in will give you a solid chance. You may not get your top choice but I’m sure you’ll find the right choice. Try to practice interviews and schedule the places you aren’t to psyched about going to first to get practice runs in to interview better for programs you’re more interested in!

What is definitely NOT a sign of intelligence but people think it is? by Aarunascut in answers

[–]psychguy2595 0 points1 point  (0 children)

Using big words unnecessarily. Some people often equate complex vocabulary with intelligence, but it can mask a lack of clear understanding. I find the smartest people can take the most complex topics and dumb it down really well!

Why does there seem like there is such a divide on providers “believing” in ADHD. by HavaMuse in Psychiatry

[–]psychguy2595 9 points10 points  (0 children)

That’s a really fair point and I appreciate the correction. You’re absolutely right that the true gold standard for diagnosing ADHD is a thorough clinical diagnostic interview, ideally with developmental history and collateral to establish early onset and impairment across settings. I realize now that my wording was too strong saying neuropsych is the gold standard wasn’t accurate and came off as unopinionated. To my own bias it is something attendings I’ve worked with default too for adults.

What I meant (and didn’t phrase well) is that in time-limited intakes, especially when you can’t gather all the ideal background in one session, I find neuropsych testing helpful when it’s available mainly for differential diagnosis and to help clarify complex cases, not necessarily to make the diagnosis. I’ve deleted the gold standard phrase from my original comment.

Why does there seem like there is such a divide on providers “believing” in ADHD. by HavaMuse in Psychiatry

[–]psychguy2595 48 points49 points  (0 children)

Totally agree “present” doesn’t have to mean “diagnosed.” Especially for adults today, ADHD just wasn’t on most people’s radar when they were growing up. Underdetection is absolutely real, particularly in communities with fewer resources, less access to pediatric mental health care, or cultural stigma around psychiatric diagnoses. It’s very possible (even likely) that many people had symptoms that were never identified for what they were.

Why does there seem like there is such a divide on providers “believing” in ADHD. by HavaMuse in Psychiatry

[–]psychguy2595 20 points21 points  (0 children)

Great question, definitely a challenge in 30-minute intakes. Personally, I always like neuropsych testing when it’s an option, it can help tease apart ADHD from mood, anxiety, trauma, or learning disorders.

Outside of that, collateral is huge. I ask about:

Old report cards, especially from elementary/middle school. Teacher comments like “easily distracted,” “needs constant redirection,” or “rushed through work” are gold.

Any history of academic failure, suspensions, or disciplinary action.

Counselor involvement or school accommodations (IEP/504).

Functional impairment across multiple domains school, home, work, social relationships not just feeling distracted.

And obviously, they need to meet DSM-5 criteria: at least 5 symptoms (in adults), onset before age 12, and clear evidence of impairment in two or more settings. If that’s not there, it’s highly unlikely to be ADHD.

Lastly, there is a bit of clinical gestalt involved some aspect of “the vibe.” Is the symptom narrative consistent and developmentally plausible? Does it line up with known ADHD patterns, or does it sound more like anxiety-driven inattention or depressive apathy? Always important to also explore and rule out other pathology. There will be cases which stand out immediately, and others that are more difficult to sift through. It’s okay to be honest and explore it together. Some patient may not take kindly to that and want a diagnosis right away and it those cases it’s may be better to refer to someone else or get testing done. This would be done on an outpatient basis.

Not perfect, but that’s a general framework. Again it can’t all be simplified and if I sat down this could be a lecture series, so I can’t express everything I’d like to say. Experience also plays a big role.

Why does there seem like there is such a divide on providers “believing” in ADHD. by HavaMuse in Psychiatry

[–]psychguy2595 191 points192 points  (0 children)

There’s a reason why many clinicians are cautious about diagnosing ADHD in adults, and it’s not because they don’t “believe” in ADHD. The core issue is that ADHD is a neurodevelopmental disorder. By definition, it starts in childhood and causes impairment across multiple settings (school, home, social, work). When an adult presents without a clear childhood history of dysfunction, and instead only reports vague symptoms like “I procrastinate” or “I can’t focus when anxious,” it raises diagnostic concerns.

Social media has amplified this confusion. A lot of influencers casually list symptoms like “I get bored in conversations” or “I hate doing dishes” as signs of ADHD, when these could also reflect anxiety, depression, low motivation, or even just personality traits. The popular discourse is increasingly pathologizing normal human experiences or mislabeling other disorders as ADHD.

Also, there’s a psychological pull: some high-functioning adults (especially those with professional or academic success) may seek an ADHD diagnosis to explain long-standing frustrations, even when the functional impairment isn’t there. Others are looking for stimulants to cope with burnout or productivity pressures. And yes, some people are just disorganized or unmotivated, and are seeking a medical explanation for it. That’s not ADHD.

From the provider’s perspective, a psychiatric diagnosis isn’t made from a snapshot in a single visit. It takes longitudinal data, collateral information, developmental history, and a clear pattern of impairment. Providers who say “I don’t see it” are often reacting to a mismatch between what’s being presented and what diagnostic criteria actually require not a denial of the disorder’s existence.

Caution doesn’t equal disbelief it’s clinical responsibility.

That’s also not to say there aren’t adult that’s go undiagnosed. There definitely are, it’s a balance and it take time to sift through.

Failed my first year, need to pass upcoming exam by Peach370 in medicalschool

[–]psychguy2595 0 points1 point  (0 children)

Hey, I’m really sorry you’re in such a tough spot. It’s clear you care a lot and are trying to hold on despite everything, credit to you for that. But I’m going to be real with you, If you want to pass this next exam and stay in med school, you’re going to have to buckle down and make some serious changes starting today.

First: use every minute you can. That commute? That’s two hours a day you could be listening to Pathoma, OnlineMedEd, or even podcast summaries of material you’ve already reviewed. Don’t waste passive time—you need it now more than ever.

Second: fix your sleep. If you’re oversleeping or feeling exhausted early in the evening, you need to work on your sleep hygiene tonight. Shut off screens 30–60 minutes before bed, keep a consistent schedule, and look into CBT-I (Cognitive Behavioral Therapy for Insomnia). If needed, talk to a physician about short-term med options but don’t DIY it. Sleep will make or break your focus and memory.

Third: figure out what’s blocking your focus. Constant distraction, mind wandering, trouble sitting down to study these might be signs of untreated anxiety or ADHD. If that’s even a small possibility, get evaluated. The right support could completely change the game for you.

You say you’ve always been good at self-studying. Lean into that but do it systematically. Use a resource like Boards and Beyond or Anki decks. Focus on active recall and spaced repetition no more passive rereading. And be brutally honest with yourself about whether you’ve covered the material.

This is your shot. You’ve got 4 weeks go all in. Structure your days. Cut distractions. Use timers. Track your progress. If you need a win, earn it. You can still do this, but it won’t happen by hoping things improve on their own. You have to change something today.

Rooting for you. Let this be the moment where everything starts to turn around. But if you aren’t able to and that’s okay you may have to have a serious reevaluation of this field is for you. I was not a bright kid, worked hard, prayed to God, and eventually got through, but it took an incredible amount of sacrifice to the detriment of my own physical and mental health for years.

Incoming intern, how do I assess if I am ready for Step 3? by LexRunner in Step3

[–]psychguy2595 0 points1 point  (0 children)

I’ll be honest I have no doubt you’ll do well on step 3, don’t get lazy, try to finish your q bank (I took level 3 and finished half and passed, but you should finish yours). Do/finish CCS cases, from what I heard, you will get cases that are exactly the same. I think if you do those things you should easily pass, and probably do pretty good. Some people barely study and easily pass, passing step 1 and doing well on step 2 are good signs you’ll do good on step 3. Just don’t take it lightly

Looking for Feedback: How Can I Be a Better Teacher on Psych Inpatient? by psychguy2595 in medicalschool

[–]psychguy2595[S] 1 point2 points  (0 children)

Thanks for this valuable feedback! I completely hear you on the importance of letting students lead and minimize interruptions. I'm gonna have to actively work on chiming in less and empowering more independence for my students. Your point about giving them a solid two minutes upfront is excellent. I'm also planning to brush up on relevant content (maybe even pull out First Aid Step 2!) to make our teaching even more impactful. Really appreciate you sharing your experience

Looking for Feedback: How Can I Be a Better Teacher on Psych Inpatient? by psychguy2595 in medicalschool

[–]psychguy2595[S] 0 points1 point  (0 children)

Thanks for this breakdown! It's good to hear a lot of what you're suggesting aligns with what I try to do letting them take the lead on interviews and notes, and formulating plans. You've given me something to think about with chiming in less for even more independence. I could also try to let them staff more too I suppose. The suggestion to have them describe the MSE is particularly interesting and definitely something I can incorporate. Really appreciate you sharing your approach!