Central Line Certification in use during Psych Private Practice

[NJWxMan]

Any thoughts? During my months of medicine, I find myself taking care of the sickest of the sick instead of working on ordinary issues that I would deal with on a normal psychiatry service (Hypertensive crisis instead of HTN management, DKA management instead of DM management). I consistently have 2-3 patients under my care that are R/O Sepsis on THE FLOOR. Some of which have been completely neutropenic. It's been a very disheartening month.

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[masterofmonkeys]

Yeah I know. Personally I love medicine, so I don't mind doing my own medical management on the psych floor.

But I wonder about the real educational value of 4 months of inpatient medicine, as opposed to maybe 2 months inpatient and 2 months urgent care. Which seems to make a lot more sense.

I did medicine really early in third year, and did family (outpatient) really late. And it was the oddest thing in the world for me to feel fairly confident in handling CHF exacerbations, HTN urgencies, etc, but be utterly confounded by sore throats and asthma management.

 

[kugel]

One of the things I looked for in a residency was the ability to make some choices about the Medicine training. My resid. required only 1 month inpt medicine ward and 3 months of "other" medicine, from which you could choose Inpt Med, ICU, Fam Med, ER and some other primary care settings.

In my ER rotation, I "cherry-picked" all the things the ER residents typically didn't want:
- abd pain for 3 months
- diabetic out of meds for a month
- ran out of HTN meds and my BP was very high at the drug store
- N/V
- drunk complaining of dizziness
- "migraine"

because I wanted to be able to quickly identify the difference between "sick" and "needs to be in an ER"

In Fam Med, I didn't let the attendings have me see all the "psych" or "problem patient" cases. I was there to learn as much about Family Practice as possible.

 

[Messerschmitts]

I did medicine really early in third year, and did family (outpatient) really late. And it was the oddest thing in the world for me to feel fairly confident in handling CHF exacerbations, HTN urgencies, etc, but be utterly confounded by sore throats and asthma management.

OMG I know exactly what you mean! Ha ha I am still a med student, but similar issue. I did internal medicine, then much later in year on my outpatient family medicine rotation I found it odd that I had no idea about the algorithm for routine diabetes management, when months earlier we were managing diabetic ketoacidoses and r/o MI's. It's a different world.

 

[billypilgrim37]

I just call the pharmacy a lot. What should I use for this ringworm? What should I use for this funky red eye? What should I use for this gaping ulcer which is draining the bile of Satan in a person with 8 abx allergies?

I owe the pharmacy a bottle of bourbon. Good bourbon.

 

[NJWxMan]

I just get really frustrated in my large, inner city, trauma center that I work at which NEVER has ICU beds, and hence, neutropenic fevers are a dime a dozen on the floors. I don't mind CHF, COPD, Pancreatitis, etc., but I do mind crashing patients and phone calls about questionable hypotensive events.

 

[masterofmonkeys]

One of the things I looked for in a residency was the ability to make some choices about the Medicine training. My resid. required only 1 month inpt medicine ward and 3 months of "other" medicine, from which you could choose Inpt Med, ICU, Fam Med, ER and some other primary care settings.

In my ER rotation, I "cherry-picked" all the things the ER residents typically didn't want:
- abd pain for 3 months
- diabetic out of meds for a month
- ran out of HTN meds and my BP was very high at the drug store
- N/V
- drunk complaining of dizziness
- "migraine"

because I wanted to be able to quickly identify the difference between "sick" and "needs to be in an ER"

In Fam Med, I didn't let the attendings have me see all the "psych" or "problem patient" cases. I was there to learn as much about Family Practice as possible.

unfortunately, the way the whole residency game is rigged, it makes more economic sense for our affiliated hospitals to put us on the inpt side where we can make a lot more money for the hospital. It's really quite hilarious to be making 12 dollars an hour after 8 years of schooling with the justification of 'needs more training' and then have 'needs to make the hospital more money' be the primary motivation...while still making less than the ward clerks and getting short-changed in the actual training and education area.

 

[billypilgrim37]

unfortunately, the way the whole residency game is rigged, it makes more economic sense for our affiliated hospitals to put us on the inpt side where we can make a lot more money for the hospital. It's really quite hilarious to be making 12 dollars an hour after 8 years of schooling with the justification of 'needs more training' and then have 'needs to make the hospital more money' be the primary motivation...while still making less than the ward clerks and getting short-changed in the actual training and education area.

It's also a guild issue. If they don't make you miserable now, you won't feel so entitled later! And then everybody's salary goes down as a bunch of willy-nilly residents graduate into practice!

If we were treated humanely, we might not feel like we were owed quite so much once we were done w/ residency. And if us young'uns are willing to work for less, the generation above us can't continue to reap the rewards of working in the golden age of insurance reimbursement.

 

[psymed]

Any thoughts? During my months of medicine, I find myself taking care of the sickest of the sick instead of working on ordinary issues that I would deal with on a normal psychiatry service (Hypertensive crisis instead of HTN management, DKA management instead of DM management). I consistently have 2-3 patients under my care that are R/O Sepsis on THE FLOOR. Some of which have been completely neutropenic. It's been a very disheartening month.

My experience has been very similar. We have been shipped off to an affiliated hospital for our IM rotation. This affiliated hospital doesn't have a Psych program of their own so we're considered part of the IM team which is fine by me. The irony is that I have heard that once you go over to Psych.......the Psych attendings, due to liability issues, prefer that we give consults for even simple medical problems like treating a UTI.

I just hate giving silly consults no matter which service I'm with. I feel bad for the resident on the recieving end. The other day I had to give a Podiatry consult for one dystrophic toenail. The patient was a case of spinal cord compression. Umm really??? He's had the funk nail for 11 years now. Does he really need to be seen as an inpatient?

 

[masterofmonkeys]

It's also a guild issue. If they don't make you miserable now, you won't feel so entitled later! And then everybody's salary goes down as a bunch of willy-nilly residents graduate into practice!

If we were treated humanely, we might not feel like we were owed quite so much once we were done w/ residency. And if us young'uns are willing to work for less, the generation above us can't continue to reap the rewards of working in the golden age of insurance reimbursement.

Absolutely. It's the 2nd dbag principle. Dbags are usually created, not born that way. And residency is enough to turn anyone into a dbag.

My 80+hr psych rotation (the second easiest rotation lol) has me ready to become a med-checker and work for a medical marijuana dispensary.

 

[psychotrope]

Any thoughts? During my months of medicine, I find myself taking care of the sickest of the sick instead of working on ordinary issues that I would deal with on a normal psychiatry service (Hypertensive crisis instead of HTN management,

who doesnt have a hypertensive crisis on the floor though?

Last year in med school I gave a presentation on hypertensive urgency/emergency during my ED rotation.......clearly I didn't read the right materials, because they looked at me like I was ******ed......

I mean year some hypertensive crisis pts are sick(ie the ones with arf), but the vast majority are just urgency patients(which I was told was a term to have no real meaning or relevance) who just need better outpatient management..........I mean if you randomly sample 100 overweight males between the age of 40 and 49 who currently do not seek regular medical care, you'd probably find that 40-45 of them suffer from "hypertensive crisis"..........

it's largely an outpatient issue iow...