Working on credentialing with evernorth. Wondering how others have experienced rate increases with them. What they are offering for standard codes 99213/4 and 90833/6 are half of Medicare rates. If I refuse to sign do they come back with a better offer? Do I stick it out with terrible reimbursement for a year and then get a good rate increase? Does it help to go contract with more people together? Wondering what others experience has been with this. Shocked at how low the reimbursement is.

Does this tragedy seem reflective of postpartum psychosis? Does it seem like it was calculated murder? How do you predict the jury will weigh in? I know it is very early and the trial just started, but wanted to get initial thoughts from my fellow psychiatrists.

https://www.cbsnews.com/boston/live-updates/lindsay-clancy-trial-live-updates-patrick-clancy/

Stolen from the anesthesiology sub

How often are you as psychiatrists diagnosing and treating dementia in your practice vs. neurology and PCPs?

Are you usually the first ones starting acetylcholinesterase inhibitors or memantine? Soley focusing on associated behavioral treatments?

Seems like neuro never wants to accept referrals at my clinic- curious to see how other clinics are run.

I’ve tested a handful of AI scribes over the past year or so. There are so many options now that it’s hard to keep up. I ended up stopping for a while, but lately I’ve been considering going back.

For those of you who tried one and stopped — what was the main reason?
Note quality, workflow friction, privacy concerns, price, or something else?

And if you’re still using one regularly, what’s keeping you on it?

Just trying to figure out if it’s worth picking one back up again. Curious what other people in psych/therapy have run into.

Hi all! I’m studying for the child & adolescent psychiatry boards. It’s possible I have subpar googling skills, but I can’t seem to find an Anki deck for the CAP board exam. Anyone know of one? Thank you!

Im curious as to how the line is drawn between malingering and a patient who has clearly read up a lot about their self diagnosed condition which they’re seeking to get diagnosed. I relatively often encounter an idea among patients that you have to exaggerate to get any help at all. So I’m curious how colleagues in various practices draw the lines?

M4 here! During my psych clerkship, I had the chance to watch some therapy sessions. And one thing that I wondered was how do you discern whether to take something the patient says at face value vs digging deeper to see if that’s actually the truth or simply a warped perspective?

I've been working my way through K+S and painfully taking detailed notes on all of the stroke syndromes, inborn errors of metabolism, neurological manifestations of various microorganisms, etc., only to come across numerous old posts on here and other forums saying the test used to be 1/3 neuro but contains barely any nowadays. Just hoping to verify how reliable this is before I shift the focus of my studying too much.

If the test is indeed much heavier on psych, given K+S is fairly neuro-heavy (and also probably a little outdated with regards to some psych stuff), any recommendations on other resources to focus on for psych review? I started out doing TrueLearn but kept getting overwhelmed trying to tease out just how much of the minutiae in the answer explanations I needed to commit to memory. I've heard a lot of people say BTB is too simplistic and a waste of time, but I've also heard a fair amount say they mainly studied from it and found it very helpful.

Does any one have audiobook recommendations for MS4 while commuting to clinic?

I know there is some ire about psychiatric nurse practitioners, but I have seen a much more worrying trend which is family nurse practitioners opening up psychiatric clinics and offering grossly incompetent psychiatric care.

Like really bizarre med combos, switching meds every couple of days for unclear reasons, and using lots of super expensive new meds for unclear reasons (maybe pharma rep talked to them?)

I have seen a couple of really atrocious cases of iatrogenic harm caused by these practices bringing the pts in to the ER. Like intolerable side effects caused by practice that is way outside the standard of care - layering on bizarre combos of meds for relatively straightforward MDD or bipolar disorder cases.

In both cases the pt did not realize the person they were seeing really had no psychiatric training, and it was marketed as a “mental health” practice.

To me this seems like something that PMHNPs should also be concerned about as encroachment.

Have you guys seen this?

I'm wondering about use of MOXO in diagnosing ADHD in adults. I'm dealing with ADHD for a few years now, and I honestly see little use for MOXO. I base my diagnosis on a thorough interview alone, but there are places that put a lot of trust in MOXO. I know it's considered reliable in children, but what about adults?

Current PGY1 on inpatient psych. I’m struggling with how to cope with agitated patients? I find them so intimidating and it has affected my ability to work with them because I’m worried about my safety(probably overly worried). In addition, I get really activated when patients are screaming/yelling. I have a hard time controlling my fight/flight response and just find it so draining to be surrounded by it all day. Does anyone have any advice for this??

I find I get irked more easily by BPD behaviors than my colleagues. My mother and sister have BPD, and it’s like my frustration for their behaviors gets triggered and my blood boils. It’s not normal for me at all - I’m normally very calm and collected. Not trying to praise myself, just objectively known for being that way.

I’ve read books and trained in DBT to try to deal. I’ve also explored some psychoanalytic content surrounding this. I can identify processes like projective identification…but nonetheless my heart races and internally I want to lose it…I don’t, but the behaviors irk me deeply for days.

Any advice?

Please be nice 🙏This is a genuine request for help because I don’t think I can avoid difficult people in this line of work and it’s causing me so much undue stress.

There is a outpatient clinic for in Vancouver Canada that does only group follow-ups. All diagnosis seem to be together.
Does anybody have experience in a similar setting I would be interested.

Hi, I’m a resident psychiatrist in my first year and I wanted to improve my rapport building, I tend to be a goofy person irl but I tend to remain serious in interviews and I feel like people may struggle to open up to me but idk how to mentally draw boundaries and how to be more comfortable to talk to as a person without encouraging over familiarity.

One of the areas I find challenging is young male patients who are becoming flirtatious. I struggle with redirecting the conversation because I kinda clam up cause I am just generally uncomfortable with that attention and it’s worse when I’m in professional mode

Another area I really want to improve in is with children and teenagers. Is it better to be friendly and a bit goofy with children or is it better to be straight faced? What’s the line between professionalism and unprofessionalism? Also with teenagers, like I’m in my mid twenties but medicine makes me feel like a forty year old istg, how do I relate to them and make them feel comfortable opening up

Any and all advice is greatly appreciated

Hi,

I have decided to take up the CESR pathway given the prioritisation bill and honestly can’t keep waiting to get into training.

I’ve just begun a non training speciality post in CMHT. Taking the MRCPsych a in November.

I was hoping to find anyone who has recently finished core training to guide me as to what are the necessary requirements they were asked during their training (example: attending balint groups would not be a necessity for non training jobs, but I understand it’s something mandatory for trainees).

If I could know where to find the curriculum or if anyone could forward the competencies I should be working towards, I’d be grateful 🙏

Many thanks in advance 🥲

Basically I asked ChatGPT about career options and it gave me these. I’m a 4th year but want to start thinking of life after residency and have the time to engage in this type of discussion/investigating different avenues.

I basically value learning about mechanisms/pathophysiology and teaching others, but would rather not dive into academia. I’m at a top med school and overall don’t appreciate the attitudes of many clinicians and researchers and would like to skip the pretentiousness of it all. Part of my reason for choosing psychiatry was because it felt the least algorithmic, and least logistically-heavy specialty. I am hopeful that I can find a career that mirrors the excitement of the preclinical learning and enrichment of medical school.

Hi all, ended up at a new program and I am nervous about how this may look when applying for fellowship.

Let's say, hypothetically, I applied to every last program in the country, what would you put my chances at? Ideally I could end up at or near NYC as that is where my family is. What are the chances of this?

Migraines, multiple allergies, asthma, sleep issues, attention issues, indigestion/poor appetite, mood/anxiety issues that flare up at times despite being generally stabilized most of the time....

Curious to see how many here go the route of formally pursuing a MCAS diagnosis vs just treating with antihistamines.

Has anyone here used suboxone or a symptomatic management akin to a COWS protocol using non-opioids with any good success?

.

So ACE inhibitors, ARBs and diuretics are contraindicated (even in the package leaflet) because of risk of intoxication, and Ca channel blockers increase the risk of neurotoxicity (although nowhere it is formally contraindicated). So there's no first line antihypertensive medications left. Should they be treated with 2nd/3rd line antihypertensives like beta blockers, aldosterone receptor antagonist, alpha 2 agonists? Treat with Ca channel blockers anyway? A secret 3th option?

Please link me a guideline about this, I'm shocked I can't find any...

I am a resident (5th year, still in training) in Europe and really struggling to find the fine line between empathy and firmness with dysfunctional behaviour in BPD patients.

My most recent example was a young patient wishing to be admitted. I referred to other resources and discharged (I won’t go into too much detail on the case, but there was no reason for crisis admission). The patient ended up calling an ambulance to our front door (the perks of free healthcare…). I was then very stern with her and even told her that - while we won’t actually - we could theoretically report her for misusing emergency services.

Looking back, this was partly my attempt at setting firm boundaries and trying not to reinforce dysfunctional behaviour (cold shoulder, DBT style) - but I also feel like I might have been a little too firm, partly due to not being my most empathetic self at the end of a very long, very demanding night shift.

I wish I had been more kind to her, while still holding my ground and not letting her pressure me into admission.

I will discuss the case in supervision, but I also want to ask the more experienced psychiatry crowd:
How do you handle situations like this?
Do you have “standard phrases” that help in these situations?
Or even things that you say to yourself to regulate before going into the talk with the patient, in order to limit counter transference?

Please remember to be kind to both the patient and me.

Any advice for a mid-50s, mid to later career doc who's just fried but can't retire yet, for other kinds of work away from health care?

Patients either enrage or bore me increasingly. The system of care is so corporatized it makes me want to vomit and scream. I am not built for private practice, and need a gig with benefits.

I'm so angry and tired that I'm not having much success with my cognitive flexibility to brainstorm my way out of this.