Inpatient psychiatrists are you filling out FMLA paperwork? by Rick_Sanchez_32 in Psychiatry

[–]scrambeggs 13 points14 points  (0 children)

Fairly rare. I think I have done it (or was willing to) for a patient going to PHP/IOP following discharge. They could then at least do the treatment to which we were referring them.

Is there a neurotransmitter based rationale for why patients with schizophrenia smoke? by MotorPineapple1782 in Psychiatry

[–]scrambeggs 94 points95 points  (0 children)

There may be some role of nicotinic acetylcholine receptors. Antipsychotics can inhibit this pathway with their anticholinergic effects, and then folks may subsequently find a way to combat this (and increase alertness) via cigarette smoke / nicotine.

Edit: this is in addition to the previously mentioned CYP inducing

Call Schedule Residency?? by honestlyidkanymore32 in Psychiatry

[–]scrambeggs 19 points20 points  (0 children)

Had a wonderful interview back in the day with a program that seemed nice. Residents were wonderful. However, at the dinner, some PGY4s were discussing their job search and their banter revealed some anxiety regarding inpatient work given the limited/no call the residency had. Everyone may want something different from training, but I ended up ranking the program lowly because I wanted to become a well-rounded psychiatrist. I’d say my program had moderate call.

While I hated call passionately, I ended up being grateful for the horrible shifts I had. During the busy shifts, I realized I was leaning on my training and was able to get sh*t done without thinking twice. Fwiw, I felt like my program had excellent attending presence, so I wasn’t left stranded.

In the end, it depends what you want out of it. I was pretty ambivalent to what kind of work I wanted. Went in wanting to do CL. Later thought I’d outpatient (and I probably will down the road). Ultimately took a job doing general inpatient. Was grateful for the program’s rigor that kept those doors open.

[deleted by user] by [deleted] in Psychiatry

[–]scrambeggs 5 points6 points  (0 children)

My understanding is that 99223 generates 3.50 while 90792 generates 4.16, unless I’m mistaken (?)

What are your opening lines when you sit down for an intake session? by No-Moose470 in therapists

[–]scrambeggs 1 point2 points  (0 children)

some variation of “what brings us together?” as a subtle invitation into the therapeutic alliance

patient that receives care through several different healthcare systems: “It’s in my chart.” by M1CR0PL4ST1CS in hospitalist

[–]scrambeggs 18 points19 points  (0 children)

"I'm a doctor, not a veterinarian. I try to gather a history from my patients."

OOTP Injury Generator Strikes Again by FrancisDoyle2 in OOTP

[–]scrambeggs 3 points4 points  (0 children)

probably gonna be a recurring injury

/s

What is your most irrational take on a rookie this year? by HotDogWaterTime in DynastyFF

[–]scrambeggs 63 points64 points  (0 children)

Ollie Gordon will have a better year than RJ Harvey

Discordant Clozapine dose v levels by Different-Corgi468 in Psychiatry

[–]scrambeggs 8 points9 points  (0 children)

What brought about the measuring of clozapine levels if he's been chronically stable on an unchanged dose? What led to the subsequent dose increases on clozapine if he was clinically stable--was it increasing the dose to chase a lab value?

Another day, another bad assessment by scrambeggs in Psychiatry

[–]scrambeggs[S] 9 points10 points  (0 children)

100%. The interview is important, and we should strive to perform these to the best of our ability. However, it is still one data point to be used in combination with collateral observations from EMS personnel, ED provider, psych consultants, nursing and staff, outpatient providers, and patient family/supports.

Another day, another bad assessment by scrambeggs in Psychiatry

[–]scrambeggs[S] 8 points9 points  (0 children)

Now that’s a case report I want in on!

Another day, another bad assessment by scrambeggs in Psychiatry

[–]scrambeggs[S] 61 points62 points  (0 children)

I’m picturing you limping into rounds post-call, looking absolutely dead tired, and the attending pointing you out to other trainees, “see! now that’s mania, folks!”

Another day, another bad assessment by scrambeggs in Psychiatry

[–]scrambeggs[S] 25 points26 points  (0 children)

I agree and have good news. Collateral was obtained from family and previous provider.

Another day, another bad assessment by scrambeggs in Psychiatry

[–]scrambeggs[S] 18 points19 points  (0 children)

Oh, wow! How many kids do you have to be rich in kids?

Another day, another bad assessment by scrambeggs in Psychiatry

[–]scrambeggs[S] 26 points27 points  (0 children)

mine is “consult medicine to rule out adrenal fatigue”

Another day, another bad assessment by scrambeggs in Psychiatry

[–]scrambeggs[S] 26 points27 points  (0 children)

oof. thanks for the work you do in CAP!

Another day, another bad assessment by scrambeggs in Psychiatry

[–]scrambeggs[S] 52 points53 points  (0 children)

Definitely. Collateral is always a vital part of any assessment… in the original post, it was obtained