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My problems in psychiatry

19 posts in this topic

I challenge really hard before i conclude someone is psychotic and always think about secondary gain the patient could get from it.but feel why should I do it when I have psychiatrists around me who believe whatever the patient say.

I get really fed up when patient don't tell you about their ongoing drug use and then find out through CID work.I would strongly recommend Urine drug screen at the OP clinic (not for all)

I feel really angry when people in their 40s tell me they can never work for the rest of their life especially people with depression but ongoing drug use

I dont like the subjective variability between clinicians on diagnosis.The difference of opinion could even be between Schizophrenia and personality disorder with psychosis.It could make the staff grade doctor in a difficult situation between two consultants.

there could be more,but let me start this chain .

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[highlight].I would strongly recommend Urine drug screen at the OP clinic (not for all)[/highlight]

what about therapeutic alliance and wots ur DNA rate?

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There is nothing wrong with challenging a diagnosis, drug & alcohol use is rampent in UK and for most of our patients its there lifestyle.

We hv to work around these issues, people not goin to work and dont want to work is a big social aspect of psychiatry and not sure how many would like to employ psychiatric patients.

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My view is that Psychiatry is still underdeveloped.I have seen so many wrong diagnosis, mainly because of defensive psychiatry we practise.I think in the future there will be reliable biological markers or imaging techniques(?? like salivary cortisol levels, PET scan etc) to support your diagnosis, like in other medical specialities.

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It is understandable when people perceive diagnostic uncertainty, mental health and drug use, finacial (gain) and social aspects of psychiatry as problems.

I guess that is why psychiatry is challenging and as mentioned by a friend (earlier post), psychiatry continues to evolve and we as clinicians are learning (or adjusting our views with political and other influences) all the time.

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The role of physician will hit rock bottom if so called diagnostic investigations were to invented in psychiatrist. Why do we need such imaging/ expensive investigation when we have 4 diagnosis and 5 medication? It is not cost effective and there is no evidence.

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The role of physician will hit rock bottom if so called diagnostic investigations were to invented in psychiatrist. Why do we need such imaging/ expensive investigation when we have 4 diagnosis and 5 medication? It is not cost effective and there is no evidence.

Not sure I follow you. What are the 4 diagnoses and 5 medications? And what is not cost effective and lacking in evidence? The diagnoses, medications or the investigations?

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I challenge really hard before i conclude someone is psychotic and always think about secondary gain the patient could get from it.but feel why should I do it when I have psychiatrists around me who believe whatever the patient   say.

I get really fed up when patient don't tell you about their ongoing drug use and then find out through CID work.I would strongly recommend Urine drug screen at the OP clinic (not for all)

I feel really angry when people in their 40s tell me they can never work for the rest of their life especially people with depression but ongoing drug use

I dont like the subjective variability between clinicians on diagnosis.The difference of  opinion could even be between Schizophrenia and personality disorder with psychosis.It could make the staff grade doctor in a difficult situation between two consultants.

there could be more,but let me start this chain .

oh!

you need to think about everything you have said.

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I challenge really hard before i conclude someone is psychotic and always think about secondary gain the patient could get from it.but feel why should I do it when I have psychiatrists around me who believe whatever the patient   say.

I get really fed up when patient don't tell you about their ongoing drug use and then find out through CID work.I would strongly recommend Urine drug screen at the OP clinic (not for all)

I feel really angry when people in their 40s tell me they can never work for the rest of their life especially people with depression but ongoing drug use

I dont like the subjective variability between clinicians on diagnosis.The difference of  opinion could even be between Schizophrenia and personality disorder with psychosis.It could make the staff grade doctor in a difficult situation between two consultants.

there could be more,but let me start this chain .

:lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol:

I guess its time for you to think if you are in the right profession as I feel, it is reflected that you are not liking what you do..

hope you don't end up burning yourself at both ends

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[highlight]I challenge really hard before i conclude someone is psychotic and always think about secondary gain the patient could get from it.but feel why should I do it when I have psychiatrists around me who believe whatever the patient say.

I get really fed up when patient don't tell you about their ongoing drug use and then find out through CID work.I would strongly recommend Urine drug screen at the OP clinic (not for all)

I feel really angry when people in their 40s tell me they can never work for the rest of their life especially people with depression but ongoing drug use

I dont like the subjective variability between clinicians on diagnosis.The difference of opinion could even be between Schizophrenia and personality disorder with psychosis.It could make the staff grade doctor in a difficult situation between two consultants.

there could be more,but let me start this chain [/highlight].

Hi Bless,

I hope you have start to feel better after letting off the steam a bit. you raised a lot of issues in your post and as j said...i wondered if it will make more meaning if we take a minute or two to understand what those means to you as well as what you are really projecting into those words

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I challenge really hard before i conclude someone is psychotic and always think about secondary gain the patient could get from it.but feel why should I do it when I have psychiatrists around me who believe whatever the patient   say.

I get really fed up when patient don't tell you about their ongoing drug use and then find out through CID work.I would strongly recommend Urine drug screen at the OP clinic (not for all)

I feel really angry when people in their 40s tell me they can never work for the rest of their life especially people with depression but ongoing drug use

I dont like the subjective variability between clinicians on diagnosis.The difference of  opinion could even be between Schizophrenia and personality disorder with psychosis.It could make the staff grade doctor in a difficult situation between two consultants.

there could be more,but let me start this chain .

You really take pride in what you do in your job. That is the only reason I could think of driving your frustration or 'not in peace' with how you act or react to your job demands. Really this is all one needs in my view to achieve excellence as this is the most powerful force urging skilled professionals to do more.

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At tmes, i go through somewhat similar kin of emotions, but, i keep reminding meself that what can a single professional or just psychiatry alone can do to cure the whole 'system'. I am referring to people who would never want a 'drug holiday' even after being on antidepressants for decades, for obvious reasons. I hope u can understand what i mean......i am not willing to start an academic discussion :)

I could see a lot of borderline and other PDs being diagnosed as either bipolar or psycotic.

But despite all that, i wish to carry on, because even if i could save one life (suicidal because of 'geneuine' depression/someone at risk by virute of 'genuine' psychotic illness) out of a thousand....i think its still worth it.

Lastly, again, not a single person or profession can change the 'life style' of a whole nation or parts of the nation who are either 'spoiled' or are themselves willing to keep on playing the parasites.

I sometimes do discuss with my colleages about some 'alternative treatment' for a certain kin of patients......but i am afraid, for that, they will have to be sent to another part/parts of the globe :lol:

Although they r not going to like that, but, i can guarantee a significant Absolute Benefit Increase/ RBI when they return after a year. I wont expand on that any further....there are people out there who will definately understand what i am suggesting. ;)

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Lastly, again, not a single person or profession can change the 'life style' of a whole nation or parts of the nation who are either 'spoiled' or are themselves willing to keep on playing the parasites.

That's an overly pessimistic view. Of course we can! Doctors and medicine as a profession have been doing just that for many years. Look at the success of the drink driving campaigns in the 1980's and the effects of the smoking ban in Ireland and Scotland, and laterly England and Wales.

But the only way to effect change as an individual or as an organisation is to be actively aware of the issues and devote time, effort and energy towards their solutions. This is something that we all can all do, and should do as doctors.

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At tmes, i go through somewhat similar kin of emotions, but, i keep reminding meself that what can a single professional or just psychiatry alone can do to cure the whole 'system'. I am referring to people who would never want a 'drug holiday' even after being on antidepressants for decades, for obvious reasons. I hope u can understand what i mean......i am not willing to start an academic discussion  :)

I could see a lot of borderline and other PDs being diagnosed as either bipolar or psycotic.

But despite all that, i wish to carry on, because even if i could save one life (suicidal because of 'geneuine' depression/someone at risk by virute of 'genuine' psychotic illness) out of a thousand....i think its still worth it.

Lastly, again, not a single person or profession can change the 'life style' of a whole nation or parts of the nation who are either 'spoiled' or are themselves willing to keep on playing the parasites.

I sometimes do discuss with my colleages about some [highlight]'alternative treatment'[/highlight] for a certain kin of patients......but i am afraid, for that, they will have to be sent to another part/parts of the globe  :lol:

Although they r not going to like that, but, [highlight]i can guarantee a significant Absolute Benefit Increase/ RBI when they return after a year. I wont expand on that any further....there are people out there who will definately understand what i am suggesting[/highlight].  ;)

:lol:

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Although they r not going to like that, but, i can guarantee a significant Absolute Benefit Increase/ RBI when they return after a year. I wont expand on that any further....there are people out there who will definately understand what i am suggesting.  ;)

I am intrigued but can't determine what it is you are suggesting. I take it that it wouldn't be considered politically incorrect and hence you would feel unable to say it here. :-?

. . . Enlistment in the army? Holiday in a less priviledged land? A Turkish prison?

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I challenge really hard before i conclude someone is psychotic and always think about secondary gain the patient could get from it.but feel why should I do it when I have psychiatrists around me who believe whatever the patient   say.

I get really fed up when patient don't tell you about their ongoing drug use and then find out through CID work.I would strongly recommend Urine drug screen at the OP clinic (not for all)

I feel really angry when people in their 40s tell me they can never work for the rest of their life especially people with depression but ongoing drug use

I dont like the subjective variability between clinicians on diagnosis.The difference of  opinion could even be between Schizophrenia and personality disorder with psychosis.It could make the staff grade doctor in a difficult situation between two consultants.

there could be more,but let me start this chain .

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I challenge really hard before i conclude someone is psychotic and always think about secondary gain the patient could get from it.but feel why should I do it when I have psychiatrists around me who believe whatever the patient say.

I get really fed up when patient don't tell you about their ongoing drug use and then find out through CID work.I would strongly recommend Urine drug screen at the OP clinic (not for all)

I feel really angry when people in their 40s tell me they can never work for the rest of their life especially people with depression but ongoing drug use

I dont like the subjective variability between clinicians on diagnosis.The difference of opinion could even be between Schizophrenia and personality disorder with psychosis.It could make the staff grade doctor in a difficult situation between two consultants.

there could be more,but let me start this chain .

oh!

you need to think about everything you have said.

Absolutely

Why so angry?

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Hi Bless,

The problems you mentioned are perhaps problems of Psychiatry, not just yours. It is good you are questioning. As Daisee said there are perhaps many issues in your question.

It is not usual we wonder about secondary gain in Psychotic presentations. If you look hard there is in most if not all. I remember one of the papers given to me by my Psychotherapy supervisor few years ago which suggested there was help seeking in Psychotic patients before they got psychotic. Many of them seeked admission prior to becoming psychotic. The author wondered perhaps they had to breakdown to get into hospital. I will try to find it. I did not read it fully as it was years ago, I didnt understand it that well then. Perhaps there is secondary gain in most if you look hard, but I think we should only worry about the secondary gains that are obvious especially in the first interview. Sometimes perhaps allowing us to be taken for a ride is part of the assessment.

diagnostic constancy even for schizophrenia is only around 80% (someone correct me with evidence, dont know where I read it).

I am not sure if you had just seen a borderline patient prior to posting this. It could be that the patient was feeling intensely frustrated and helpless inside.

We work with high emotionally aroused individuals, that the emotions they put in us is like MRSA. It is unfortunate that nobody talks about this as much as they talk about MRSA. Talk to your consulant, talk in Balint Group or mys suggestuion would be to try individual psychotherapy for some time. It will give you some understanding of being on the other side of therapy.

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I challenge really hard before i conclude someone is psychotic and always think about secondary gain the patient could get from it.but feel why should I do it when I have psychiatrists around me who believe whatever the patient   say.

I get really fed up when patient don't tell you about their ongoing drug use and then find out through CID work.I would strongly recommend Urine drug screen at the OP clinic (not for all)

I feel really angry when people in their 40s tell me they can never work for the rest of their life especially people with depression but ongoing drug use

I dont like the subjective variability between clinicians on diagnosis.The difference of  opinion could even be between Schizophrenia and personality disorder with psychosis.It could make the staff grade doctor in a difficult situation between two consultants.

there could be more,but let me start this chain .

Don't you have Balint groups where you work? It might be a good idea to talk through these feelings that patients sometimes evoke in you.

All of us experience frustration from time to time, but you need to be able to metabolise your emotions rather than letting them make it difficult for you to trust your patients.

I agree that some of the people that we see can be manipulative, but you cannot start with the premise that everyone you see is taking you for a ride.

Also, a lot of the time, our frustration is a reflection of the same frustration that the patient in front of you is feeling about their own situation.

I agree with a suggestion that someone has made about therapy for yourself. It will help you to understand more about your own feelings, which we all need to do in order to do our job effectively.

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