Favorite and Least Favorite Parts of Your Job?

[OMSRealWeebHours]

What parts of your job do you like the most and least? And how often do these parts come up for you?

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[comp1]

I like starting to put people's lives back together when they are at their absolute lowest points. I like connecting people to resources they really need. I like to see people respond to medications. I think I see each of these most days, although major responses to medications are relatively rare and not the centerpiece of the job. I don't like seeing people utilize suicidal threats as a primary coping strategy for stress or to obtain goods and/or services. I also see this most days.

 

[OMSRealWeebHours]

I like starting to put people's lives back together when they are at their absolute lowest points. I like connecting people to resources they really need. I like to see people respond to medications. I think I see each of these most days, although major responses to medications are relatively rare and not the centerpiece of the job. I don't like seeing people utilize suicidal threats as a primary coping strategy for stress or to obtain goods and/or services. I also see this most days.

Do you work in Private Practice, a Hospital, or another place?

 

[Stagg737]

I'm C/L at a large academic center. Also do 5-6 hours of outpatient telehealth consults per week.

Favorite parts:
- Variety of presentations and having to stay up to date on my medical knowledge. We see some pretty cool/rare stuff, in the last few weeks I've seen a new case of Charles-Bonnet syndrome yesterday, AIDS psychosis in a patient in her 20's, voriconazole-induced psychosis, and cyclosporine-induced neurotoxicity.
- Working with really sick patients who we actually help acutely. Much of psych is just basic stabilization acutely and long term optimization and we don't "fix" a lot of patients. I actually get to do that with a decent number of our patients, which helps keep the burnout at bay.
- Teaching. I get to work with residents and med students who are on rotation with our service. I also get to teach some didactics with med students and run PBL groups. This isn't something I'd get to do to this extent in other settings, and it's something I love.
- On a more practical/non-psych note, I've got a nice schedule (3 weeks on, 1 week off/admin) with good pay for academia and solid benefits. I like all my colleagues and many of the other non-psych docs I work with.

Least favorite parts:
- Pressure from other teams to move patients to psych for non-psych or psych adjacent issues when the needed resources don't exist or are difficult to obtain in our area. Ie, dementia or ID patients with behavioral problems whose families can't take care of them.
- The involuntary process in this state. It could be a lot worse, but the people who screen for admission to the state hospital like to think their screens determine if an involuntary hold is valid and sometimes cancel court appointments and try to cancel a hold altogether, which they do not have the authority to do. Also, DAs in different counties have different policies and it isn't clearly outlined in state statute (physical location vs patient's county of residence to determine which DA gets involved is the typical debate).
- Outpatient clinic. I've always disliked outpatient, probably stems from my outpatient year in residency being the height of COVID and how awful that was. Maybe if I was in PP I'd like it more, but I doubt it as I have mostly free reign with how I run the current clinic.

ETA: Another thing I love about C/L is that I am up and walking around the hospital buildings. I'm not just sitting in an office sedentary for most of the day. Being in a position where I get some physical activity is not just better for general health, it keeps me from getting bored and burnt out from sitting around all day.

Overall I really enjoy my job. People like to crap on C/L, but I get opportunities here that I wouldn't get almost anywhere else. I do get paid less than some other docs, but it's still fair for the amount of clinical work I do (most of our outpatient docs are clearing $300k pretty easily for reference). Is it perfect? No, but minus the outpatient portion I the pros significantly outweigh the cons.

 

[psych_0]

Love:

• Responses to ECT
• Responses to IV ketamine
• Diagnosing BPD in patients who have failed 85 different meds and have been told they're schizoaffective bipolar type
• Responses to IV thiamine in alcoholics
• Having a backbone and discharging people clearly abusing the system for secondary gain
• 99% of my colleagues
• And who are we kidding, the ratio of pay vs amount of time spent working is incredible

Hate:

• When the ER admits ID/autism/Downs patients who cannot be controlled at home then act like angels in the hospital, dementia patients whose families expect you to force them into locked facilities indefinitely, and homeless who "just want to get off my feet for a few days"
• When the ER re-admits a person I discharged earlier in the day for "alcohol detox" after they were just admitted for 4 days saying they don't want rehab
• Dealing with delirium consults in any capacity when I cover the consult service
• As a dad, seeing first-break psychosis has become much more challenging for me. Same with very young <20y/o meth / fentanyl addicts. As much as we love to think "this won't be my kid," talking to very normal parents on the phone is a stark reminder that "yes, it very well could be my kid one day and there's not $h!t I can do about it."

 

[finalpsychyear]

I think clinically obviously seeing patients improve especially when medications are just a stepping stone to other healthy behaviors.

I think in about 5 years I'll slow my hours per week from 50 ish to maybe half that. Spending 1 hour per patient doing various types of therapy I am good at would be fun.

I don't really like the pace of work i have even though i still manage to have a life outside work but I want my " win the game" mode activated asap which could happen by 2030 if i keep at the pace then I'll go into some PT hybrid mode.

Of course I still haven't worked nights, wknds, or holidays in 8 years almost and half my work is from home so I can't complain too much. I've just always been the kid who tried to go into class finals knowing they could get a 0 or something of that sort so all the hard work was done beforehand. I view work and life the same way.

I'd rather be so ahead of the game that work is purely for fun and why not do that when your young and full of energy. I already feel my "stamina" for clinical work is not what it was 5 -7 years ago so i don't want to be kicking myself for not milking it when fully able to but obviously not killing myself. I am a bit jelly with docs who have 4 day work weeks or that type of set up!

 

[OMSRealWeebHours]

I think clinically obviously seeing patients improve especially when medications are just a stepping stone to other healthy behaviors.

I think in about 5 years I'll slow my hours per week from 50 ish to maybe half that. Spending 1 hour per patient doing various types of therapy I am good at would be fun.

I don't really like the pace of work i have even though i still manage to have a life outside work but I want my " win the game" mode activated asap which could happen by 2030 if i keep at the pace then I'll go into some PT hybrid mode.

Of course I still haven't worked nights, wknds, or holidays in 8 years almost and half my work is from home so I can't complain too much. I've just always been the kid who tried to go into class finals knowing they could get a 0 or something of that sort so all the hard work was done beforehand. I view work and life the same way.

I'd rather be so ahead of the game that work is purely for fun and why not do that when your young and full of energy. I already feel my "stamina" for clinical work is not what it was 5 -7 years ago so i don't want to be kicking myself for not milking it when fully able to but obviously not killing myself. I am a bit jelly with docs who have 4 day work weeks or that type of set up!

Ah, yes I understand the mindset of having everything set up so there's no real pressure later.

 

[Merovinge]

- Outpatient clinic. I've always disliked outpatient, probably stems from my outpatient year in residency being the height of COVID and how awful that was. Maybe if I was in PP I'd like it more, but I doubt it as I have mostly free reign with how I run the current clinic.

Overall I really enjoy my job. People like to crap on C/L, but I get opportunities here that I wouldn't get almost anywhere else. I do get paid less than some other docs, but it's still fair for the amount of clinical work I do (most of our outpatient docs are clearing $300k pretty easily for reference). Is it perfect? No, but minus the outpatient portion I the pros significantly outweigh the cons.

Do you do 1 off consults or a regular ongoing outpatient clinic for those 5-6 hours/week? I find 1 off consults to be one of the best parts of the field and given that you enjoy CL I would think this would be a similar experience for you.

 

[tr]

Academic medicine 55% research/45% clinic (outpatient subspecialty)

Favorite: data analysis, esp when something cool and new comes out of it. Getting notice of funding is up there as well

Least favorite: it's a tie between getting grant applications rejected and fighting the bureaucracy in our grants & contracts office to get them submitted in the first place

Middle of the road: clinical work - it's generally enjoyable, usually pretty manageable, never too extreme either way

 

[Stagg737]

Do you do 1 off consults or a regular ongoing outpatient clinic for those 5-6 hours/week? I find 1 off consults to be one of the best parts of the field and given that you enjoy CL I would think this would be a similar experience for you.

Bit of a mix. Clinic was previously run like a typical continuity clinic despite the fact that it's always supposed to have been for consults, so I inherited a few longer term patients. I've sent most back to PCPs, but there's 3-4 who will probably never get referred back for various reasons.

For new consults, I'd say about 1 in every 3 or 4 ends up as a one off consult where I see them and just send them back to PCP. I actually don't find these as enjoyable as they're usually either ones that are so straightforward I shouldn't have been needed in the first place or are complex enough that they need a long-term psychiatrist, which is not me. More recently I've been screening the latter out without seeing them and just telling the PCP they need to send them to the nearest CMHCs where they can establish for long-term treatment. Every so often I get a second opinion consult or an interesting non-psych condition presenting as psych (narcolepsy/parasomnias, hyperthyroid-induced mania, etc) where I get to point them to the right specialist. I do enjoy those.

More often than not though, I keep them longer than I plan to (3-5 f/ups) because I find something else that needs to be addressed before referring back to PCP. I'm pretty thorough with my initial eval and psych ROS, so I frequently uncover stuff that otherwise gets overlooked (usually PDs or PTSD). I'm also not a huge fan of these because doing a good initial eval takes time, and I'm paid based on RVUs, so it's probably the least efficient portion of my job when it takes into account F2F time along with writing a good note that the PCPs can use to treat them.

 

[Merovinge]

Bit of a mix. Clinic was previously run like a typical continuity clinic despite the fact that it's always supposed to have been for consults, so I inherited a few longer term patients. I've sent most back to PCPs, but there's 3-4 who will probably never get referred back for various reasons.

For new consults, I'd say about 1 in every 3 or 4 ends up as a one off consult where I see them and just send them back to PCP. I actually don't find these as enjoyable as they're usually either ones that are so straightforward I shouldn't have been needed in the first place or are complex enough that they need a long-term psychiatrist, which is not me. More recently I've been screening the latter out without seeing them and just telling the PCP they need to send them to the nearest CMHCs where they can establish for long-term treatment. Every so often I get a second opinion consult or an interesting non-psych condition presenting as psych (narcolepsy/parasomnias, hyperthyroid-induced mania, etc) where I get to point them to the right specialist. I do enjoy those.

More often than not though, I keep them longer than I plan to (3-5 f/ups) because I find something else that needs to be addressed before referring back to PCP. I'm pretty thorough with my initial eval and psych ROS, so I frequently uncover stuff that otherwise gets overlooked (usually PDs or PTSD). I'm also not a huge fan of these because doing a good initial eval takes time, and I'm paid based on RVUs, so it's probably the least efficient portion of my job when it takes into account F2F time along with writing a good note that the PCPs can use to treat them.

Do you get RVUs for 99417's? I do long evals as well (CAP) but atleast we get some benefit for 90 min evals with the 99205 +99417x2 or x3.

That makes sense why the work is less enjoyable when RVU based, I will say people having access to someone doing what you are doing is immense. Thank you for that service you provide.

 

[Stagg737]

Do you get RVUs for 99417's? I do long evals as well (CAP) but atleast we get some benefit for 90 min evals with the 99205 +99417x2 or x3.

That makes sense why the work is less enjoyable when RVU based, I will say people having access to someone doing what you are doing is immense. Thank you for that service you provide.

I do. Longest I've done added 7 99417 add-ons, which was nice for the extra RVUs but a lot less than I'd get doing inpatient consults or f/ups. I schedule my new evals for 60 minutes at the end of those days and I usually go over by 10-15 minutes, obviously varies a ton based on patient though.

As a dad, seeing first-break psychosis has become much more challenging for me. Same with very young <20y/o meth / fentanyl addicts. As much as we love to think "this won't be my kid," talking to very normal parents on the phone is a stark reminder that "yes, it very well could be my kid one day and there's not $h!t I can do about it."

I basically block this out, but 100% agree. Hardest cases for me now are first break psychosis and mania to a lesser extent, especially in the kids that are high functioning with bright futures who just fall off the cliff. I've had a couple of pre-med/early med student cases where you can tell those futures are just gone. Being a parent now I'm much more aware of how crushing it is for those families and it's scary.

One caveat to this is that for me, a huge percentage (maybe 75%+) of these cases the kids have either used marijuana for a while (as teenagers) or started using heavily in college. I used to be very laissez faire about cannabis use, but after being the psychiatrist in a large ER for a couple of years it's been eye-opening how common THC is involved with young, psychotic people (or just psychotic people in general) even without any other substances. It's completely changed my perspective on modern cannabis and how people use it.

 

[OMSRealWeebHours]

I do. Longest I've done added 7 99417 add-ons, which was nice for the extra RVUs but a lot less than I'd get doing inpatient consults or f/ups. I schedule my new evals for 60 minutes at the end of those days and I usually go over by 10-15 minutes, obviously varies a ton based on patient though.


I basically block this out, but 100% agree. Hardest cases for me now are first break psychosis and mania to a lesser extent, especially in the kids that are high functioning with bright futures who just fall off the cliff. I've had a couple of pre-med/early med student cases where you can tell those futures are just gone. Being a parent now I'm much more aware of how crushing it is for those families and it's scary.

One caveat to this is that for me, a huge percentage (maybe 75%+) of these cases the kids have either used marijuana for a while (as teenagers) or started using heavily in college. I used to be very laissez faire about cannabis use, but after being the psychiatrist in a large ER for a couple of years it's been eye-opening how common THC is involved with young, psychotic people (or just psychotic people in general) even without any other substances. It's completely changed my perspective on modern cannabis and how people use it.

What kind of stuff happens to the high functioning kids?

 

[Stagg737]

What kind of stuff happens to the high functioning kids?

Same as anyone else. It's just that much harder seeing someone with a bright future as a doctor, engineer, etc who has worked hard to get there suddenly be in a position where they may be lucky to live independently or hold down a job at a grocery store or Walmart. It's also hard to see their families who have provided so much support and had so much hope for their future watch their kids reduced back to the functional level of a child who will never thrive. Obviously, there is a spectrum of severity for psychotic patients, but most will not be able to hold down high-functioning jobs and will need at least some level of assistance for the rest of their lives just to get by.

 

[OMSRealWeebHours]

Same as anyone else. It's just that much harder seeing someone with a bright future as a doctor, engineer, etc who has worked hard to get there suddenly be in a position where they may be lucky to live independently or hold down a job at a grocery store or Walmart. It's also hard to see their families who have provided so much support and had so much hope for their future watch their kids reduced back to the functional level of a child who will never thrive. Obviously, there is a spectrum of severity for psychotic patients, but most will not be able to hold down high-functioning jobs and will need at least some level of assistance for the rest of their lives just to get by.

What usually triggers it? I know drugs were mentioned as a comparison, but are there any other factors

 

[clausewitz2]

What kind of stuff happens to the high functioning kids?

They are significantly more likely to attempt suicide, at least in the first few years after diagnosis.

 

[clausewitz2]

One caveat to this is that for me, a huge percentage (maybe 75%+) of these cases the kids have either used marijuana for a while (as teenagers) or started using heavily in college. I used to be very laissez faire about cannabis use, but after being the psychiatrist in a large ER for a couple of years it's been eye-opening how common THC is involved with young, psychotic people (or just psychotic people in general) even without any other substances. It's completely changed my perspective on modern cannabis and how people use it.

As an FEP person, so much this. I also am vaguely horrified at the prevalence of delta-8 and delta-9 and how you can buy them at gas stations. I am mostly a drug libertarian but I can understand the urge to ban.

 

[Merovinge]

As an FEP person, so much this. I also am vaguely horrified at the prevalence of delta-8 and delta-9 and how you can buy them at gas stations. I am mostly a drug libertarian but I can understand the urge to ban.

You would (not) be amazed to find how incredibly easily this is accessed by teenagers. I have had 12 year olds paying straight cash for delta 8 at smoke shops/gas stations. It is going to a huge issue for this generation of adolescents.

 

[Stagg737]

What usually triggers it? I know drugs were mentioned as a comparison, but are there any other factors

Any major stressor can be a trigger. Illness, drugs, emotional/psychological stressors, increased pressure/workload, etc. Sometimes nothing at all. It's usually nearly impossible to predict who and when it will happen to until it's already happening.

As an FEP person, so much this. I also am vaguely horrified at the prevalence of delta-8 and delta-9 and how you can buy them at gas stations. I am mostly a drug libertarian but I can understand the urge to ban.

You would (not) be amazed to find how incredibly easily this is accessed by teenagers. I have had 12 year olds paying straight cash for delta 8 at smoke shops/gas stations. It is going to a huge issue for this generation of adolescents.

Yep, will probably dox me even more than I've already doxed myself, but I'm in a state between 2 states where cannabis is legal where Delta-8 and Delta-10 are both legal. I'm also near one of those state lines and I saw a huge uptick in the number of younger people (late teens/early 20's) coming in floridly psychotic after the nearest state legalized marijuana a couple of years ago. Where I'm at meth and PCP have traditionally been the drugs that bring people to the ER, but more recently it's not uncommon at all for me to see someone come in psychotic with only THC popping positive on UDS.

 

[Merovinge]

Any major stressor can be a trigger. Illness, drugs, emotional/psychological stressors, increased pressure/workload, etc. Sometimes nothing at all. It's usually nearly impossible to predict who and when it will happen to until it's already happening.



Yep, will probably dox me even more than I've already doxed myself, but I'm in a state between 2 states where cannabis is legal where Delta-8 and Delta-10 are both legal. I'm also near one of those state lines and I saw a huge uptick in the number of younger people (late teens/early 20's) coming in floridly psychotic after the nearest state legalized marijuana a couple of years ago. Where I'm at meth and PCP have traditionally been the drugs that bring people to the ER, but more recently it's not uncommon at all for me to see someone come in psychotic with only THC popping positive on UDS.

Absolutely, I remember in med school we wouldn't even consider that substance induced psychosis if utox was only positive for THC (mind you this was around a decade ago). Since that time of course, THC concentration has moved from flower at around 10% to concentrate that is 90-100% pure and absorbed at a higher rate then as smoke. Not surprisingly, dosage of a substance does in fact matter, and the results are markedly different now than even just a decade ago.

 

[thelastpsych]

Favorite: interesting narratives - you'll see people from all walks of life, and have a chance to see a snapshot of all these existences, their struggles, their motivations, etc. Few jobs have an acess to this depth of human experience on a regular day (i.e most jobs nowadays are kinda repetitive, with very few existencial questions and motives).

Least favorite: secondary gain and malingerin, usually people that want to fake having a mental illness to avoid the need to face the hardships of daily life, especially having a job. This will vary wildly according to your setting, but it is always a drag.

 

[calvnandhobbs68]

Absolutely, I remember in med school we wouldn't even consider that substance induced psychosis if utox was only positive for THC (mind you this was around a decade ago). Since that time of course, THC concentration has moved from flower at around 10% to concentrate that is 90-100% pure and absorbed at a higher rate then as smoke. Not surprisingly, dosage of a substance does in fact matter, and the results are markedly different now than even just a decade ago.

Absolutely, along with frequency of use. Vaping once with your friends on Saturday is a world away from wake and bake every day before school and every night before bed.

But come on doc, it's all natural and makes my anxiety way better, can't you tell my parents I should be on medical marijuana so they can get me a card....is what some teenager will try to pull on me at least every few months.

 

[calvnandhobbs68]

Yep, will probably dox me even more than I've already doxed myself, but I'm in a state between 2 states where cannabis is legal where Delta-8 and Delta-10 are both legal. I'm also near one of those state lines and I saw a huge uptick in the number of younger people (late teens/early 20's) coming in floridly psychotic after the nearest state legalized marijuana a couple of years ago. Where I'm at meth and PCP have traditionally been the drugs that bring people to the ER, but more recently it's not uncommon at all for me to see someone come in psychotic with only THC popping positive on UDS.

Yes and this is again my railing against the "medicalization" to legalization and why there shouldn't have been this in between with it to begin with. The whole fake "medicalization" of broad spectrum cannabis products is now leading to people going "hey it's medical and good for you" when it gets legalized and just going wild on it. Rather than being able to put it in the same grouping as nicotine, alcohol, recognizing that it's legal but also not great for you to be doing all the time.

 

[Merovinge]

Yes and this is again my railing against the "medicalization" to legalization and why there shouldn't have been this in between with it to begin with. The whole fake "medicalization" of broad spectrum cannabis products is now leading to people going "hey it's medical and good for you" when it gets legalized and just going wild on it. Rather than being able to put it in the same grouping as nicotine, alcohol, recognizing that it's legal but also not great for you to be doing all the time.

I don't think the medicalization was driven by MDs much, it was largely just industry sponsored between some big VC/PE players, old school tobacco giants, and a few docs that were persuaded to argue in favor, AKA the Purdue pharma handbook. It's a science at this point of the people who stand to make big money.

 

[sloh]

I do. Longest I've done added 7 99417 add-ons, which was nice for the extra RVUs but a lot less than I'd get doing inpatient consults or f/ups. I schedule my new evals for 60 minutes at the end of those days and I usually go over by 10-15 minutes, obviously varies a ton based on patient though.


I basically block this out, but 100% agree. Hardest cases for me now are first break psychosis and mania to a lesser extent, especially in the kids that are high functioning with bright futures who just fall off the cliff. I've had a couple of pre-med/early med student cases where you can tell those futures are just gone. Being a parent now I'm much more aware of how crushing it is for those families and it's scary.

One caveat to this is that for me, a huge percentage (maybe 75%+) of these cases the kids have either used marijuana for a while (as teenagers) or started using heavily in college. I used to be very laissez faire about cannabis use, but after being the psychiatrist in a large ER for a couple of years it's been eye-opening how common THC is involved with young, psychotic people (or just psychotic people in general) even without any other substances. It's completely changed my perspective on modern cannabis and how people use it.

Do you know if long term cannabis use also affects IQ in adulthood?

 

[Merovinge]

Do you know if long term cannabis use also affects IQ in adulthood?

Longterm studies of adolescent cannabis use show "heavy" users (3-4 weekly, many of my patients get past that by Monday each week) lost around 7-8 iq points. These studies are still complicated even in countries such as Australia with the unified healthcare system to control for variables but that had been the gold standard. There is also seperate evidence that THC use in adolescents impairs both neurogenesis and neural pruning (research that came out of Canada with their unified health system) which would generate the above concerns.

 

[tr]

Absolutely, I remember in med school we wouldn't even consider that substance induced psychosis if utox was only positive for THC (mind you this was around a decade ago). Since that time of course, THC concentration has moved from flower at around 10% to concentrate that is 90-100% pure and absorbed at a higher rate then as smoke. Not surprisingly, dosage of a substance does in fact matter, and the results are markedly different now than even just a decade ago.

Wait really? The cannabis -schizophrenia connection was well recognized by the early 2000s. I'm looking at a review right now and it looks like the first two big longitudinal studies were in 1987 and 1990, with a whole bunch more coming out between 2002 and 2006. This is not something that's related only to newer, highly concentrated products. I'm a lot older than you and we definitely learned about this in med school (early 2000s for me).

https://www.sciencedirect.com/science/article/pii/S014976341100073X

 

[OMSRealWeebHours]

Any major stressor can be a trigger. Illness, drugs, emotional/psychological stressors, increased pressure/workload, etc. Sometimes nothing at all. It's usually nearly impossible to predict who and when it will happen to until it's already happening.



Yep, will probably dox me even more than I've already doxed myself, but I'm in a state between 2 states where cannabis is legal where Delta-8 and Delta-10 are both legal. I'm also near one of those state lines and I saw a huge uptick in the number of younger people (late teens/early 20's) coming in floridly psychotic after the nearest state legalized marijuana a couple of years ago. Where I'm at meth and PCP have traditionally been the drugs that bring people to the ER, but more recently it's not uncommon at all for me to see someone come in psychotic with only THC popping positive on UDS.

I see, I have been very high functioning most my life but have definitely run into some issues at a point (not psychosis or hallucinations or anything like that) . Luckily nothing irreversible or that serious, but I am glad I never touched those kinds of drugs or else I am certain my situation would be much worse/irreparable.

But yes, I have seen that often when it happens to people it seems to be a slow-build over time that may be brushed off, and then it's not recognized as a problem until something bad happens.

 

[OMSRealWeebHours]

Longterm studies of adolescent cannabis use show "heavy" users (3-4 weekly, many of my patients get past that by Monday each week) lost around 7-8 iq points. These studies are still complicated even in countries such as Australia with the unified healthcare system to control for variables but that had been the gold standard. There is also seperate evidence that THC use in adolescents impairs both neurogenesis and neural pruning (research that came out of Canada with their unified health system) which would generate the above concerns.

So it affects the brain that badly? That's pretty crazy how common place it is, there is actually a fairly popular dispensary near where I live.

 

[OMSRealWeebHours]

Wait really? The cannabis -schizophrenia connection was well recognized by the early 2000s. I'm looking at a review right now and it looks like the first two big longitudinal studies were in 1987 and 1990, with a whole bunch more coming out between 2002 and 2006. This is not something that's related only to newer, highly concentrated products. I'm a lot older than you and we definitely learned about this in med school (early 2000s for me).

https://www.sciencedirect.com/science/article/pii/S014976341100073X

That's wild, too. Interesting that quite a few people I know think it is relatively harmless. It honestly still is always surprising to me how much external factors can affect our brains and behaviors (a long time ago I just assumed outlook/thoughts were much more controllable than they are, and I didn't even imagine physical substances/external factors affecting the brain).

It is very freeing to have more knowledge about it so we understand ourselves, crazy so little is known about the brain too most people considering it is the organ that controls our identity and is tied to all our voluntary actions the most.

 

[calvnandhobbs68]

So it affects the brain that badly? That's pretty crazy how common place it is, there is actually a fairly popular dispensary near where I live.

I mean I'm sure there's a bar and/or a liquor store fairly close to where you live too...

 

[OMSRealWeebHours]

I mean I'm sure there's a bar and/or a liquor store fairly close to where you live too...

Probably, but this place is much closer than those, I think anyway

 

[tr]

I mean I'm sure there's a bar and/or a liquor store fairly close to where you live too...

What's crazy to me is that the most harmful recreational substances - tobacco, alcohol, and marijuana - are all legal, whereas the low-risk and potentially therapeutic psychedelics are still on the naughty list. What's up with that.

 

[calvnandhobbs68]

What's crazy to me is that the most harmful recreational substances - tobacco, alcohol, and marijuana - are all legal, whereas the low-risk and potentially therapeutic psychedelics are still on the naughty list. What's up with that.

Can't have those crazy hippies doing their magic mushrooms, they'll start protesting the Vietnam war and s**t.

 

[ObsequiousAplomb]

Wait really? The cannabis -schizophrenia connection was well recognized by the early 2000s. I'm looking at a review right now and it looks like the first two big longitudinal studies were in 1987 and 1990, with a whole bunch more coming out between 2002 and 2006. This is not something that's related only to newer, highly concentrated products. I'm a lot older than you and we definitely learned about this in med school (early 2000s for me).

https://www.sciencedirect.com/science/article/pii/S014976341100073X

In residency one of the very ancient attendings would tell a story about a patient who was crazy the first three months but completely stable over the next 9 months. So she eventually earned privileges to go home for the weekend. He eventually told her she would never be allowed to leave if she kept smoking pot on her home leave.


That story made me think the connection was understood considerably earlier than even you're saying.

 

[Merovinge]

Wait really? The cannabis -schizophrenia connection was well recognized by the early 2000s. I'm looking at a review right now and it looks like the first two big longitudinal studies were in 1987 and 1990, with a whole bunch more coming out between 2002 and 2006. This is not something that's related only to newer, highly concentrated products. I'm a lot older than you and we definitely learned about this in med school (early 2000s for me).

https://www.sciencedirect.com/science/article/pii/S014976341100073X

Now that you mention that, I think it would be related to the political leanings of where my medical school was. Some very intelligent attendings but also some local systematic bias. Good reason to talk about stuff on SDN where folks have such a broad geographic diversity of thought.

 

[Merovinge]

So it affects the brain that badly? That's pretty crazy how common place it is, there is actually a fairly popular dispensary near where I live.

Part of the reason is that it is confusing to the average adult (and maybe even the average adult physician) that adolescent brains are not equal to adult brains and that substances can have a vastly different short and long term impact depending on the stage of development. Humans in general are just awful at remembering how their brain functioned in the past, very few people really remember what it was like to have an adolescent brain come adulthood (or a childhood brain when they are in adolescent).

 

[FlowRate]

Reminded of this today.

My favorite thing is establishing a good therapeutic relationship with somewhat paranoid/anxious psychotic patients and eventually translating that positive therapeutic alliance into them being willing to actually try (and stick with) an antipsychotic--and the subsequent significant improvement in their lives.

I'm not sure if I have a singular least favorite thing. It's more like a bunch of small cuts. Middle aged adult ADHD evals, patients informing me of the leave they have unilaterally decided to take but need me to sign off on, pervasively anxious patients who make any med change/start/etc. into a needlessly long discussion or a back-and-forth by email, etc. None of them are all that bad alone, but multiple in a day gets tiring.

 

[esob]

People - for both answers