I wonder if patients ever get access to information about themselves, like their presentation, which doctors know but parents often don’t. Doctor use a health link system to connect each other but the patient has little knowledge of this.
I'm curious if you have thoughts on other potential boundary issues: suppose an attending wishes to stay over inpatient to spend time in the milieu, or to have conversations (or brief psychotherapy) with patients? Most attendings I know inpatient work around 30-35 a week, would it be "wrong" or counterproductive if an attending wished to stay longer to provide more care, say 50 hours a week? Or if they came in on a weekend to check up on a particularly vulnerable patient that was responding well (rapport) with the particular physician?
I say, it is unlikely you would be compensated anything extra for your additional time there. Possibly a call room. Inpatient psychiatry Physicians are TYPICALLY given a salary.. amount of hours worked varies. Unless you are doing locums, then you get paid hourly. you will ultimately have to discuss that opportunity for overtime with Human Resources, at one one of the hospitals you plan on practicing at. You can get fired for too much overtime. That being said, physicians mostly focus on a linear, atomistic diagnosis -> treatment process. Checking up on a patient to see how they are doing is, typically, the responsibility of the floor staff. I am not a certified expert on anything, but a brief psychotherapy session, as you have described, is unlikely to yield very many good results with the majority of psychiatric inpatients within the allotted timeframe. Typically 3-10days for an inpatient stay. It wouldn’t have much of a psychological impact on them to see you a few extra times. If you were working in a state hospital, over the course of many years, those extra few hours would of course add up. Speaking from experience, it really depends on how much you are willing to deal with regarding the patients and productivity relative to time spent. It depends on the acuity of the patient and what they are expressing as their needs. A psychiatric liaison, or milieu counselor position in an inpatient hospital would be very beneficial for you to gain insight into your desired position. A liaison position typically requires a masters in social work, but I am almost sure the hospital you’re completing residency in would let you moonlight in some capacity, possibly as a liaison. They have much more responsibility than a milieu counselor. I do not know what you mean by taking care of the patients, ha ha, so you will have to elaborate on that if you wish. But since you mostly mentioned counseling and not follow up care, I would recommend you to look into becoming a milieu counselor. You will need year or so experience as a psych tech, and preferably a bachelors degree. Im sure you could get hired anyway, just by being a medical student if you fluff up your resume by just putting the number of hours on there youve spent practicing psychotherapy on it. People get hired to work in psych wards with nursing student as their credential all the time. Medical students typically just go on rounds with the attending & interdisciplinary meetings. But you could ask HR somewhere about a work opportunity.
A good way to rephrase this question to get an answer would be: “have you ever spent extra time with a patient, and is it usually beneifical? can prolonging a consult actually be beneficial? If so when?” These questions are short, concise and will provide you a clear answer.. now lets watch the video!
@@reddbendd I don't care about the finances, I'm interested in the autonomy. I work in psychiatry and am also a crisis counselor, I'm familiar with the system. My primary interest is in working with suicide survivors and SAD, but I also enjoy helping with psychosis and neurodevelopment disorders. There is already very little evidence to the efficacy of hospitalization for suicide patients, finding research on "spending more time" would be outside the realm of any present methodology. I would be interested in doing that research. What we do know is the #1 complaint of patients is "My doctor doesn't listen to me" or "They seemed rushed / didn't have enough time". I also strongly believe that a lot of progress can be made in brief periods of time. Especially if the critical juncture moving forward is hopelessness. This is the entire point of our hotlines, which are very brief interventions. You also seem to refer to a more traditional 'medical model' for psychiatry, which is ineffective as pointed out in the late 70s when the biopsychosocial model was introduced. I think the division of roles can be counterproductive Rapport is the main currency of healing for most patients, even schizophrenia (outside of state hospitals). A brand new tech playing cards with someone may have an infinitely bigger impact in their lives than a team of doctors, RNs, and LCSWs. Yes, absolutely, there must be a diagnosis and prescription, and a nurse to deliver the correct drugs, but everyone should be involved in emotional support, that way whomever the patient bonds with will be able to provide the therapeutic relationship and necessary words to help with their recovery. Many wards I've visited folks have never taken a single psychology class, and some of the nurses didn't know the difference between a clinical psychologist and a psychiatrist. I just want to be able to practice in the manner that I feel is most effective, and that involves more than a brief interview and writing notes and prescriptions. Especially for suicide survivors, which I feel there should always be a dedicated milieu for those suffering with psychosis / mania
@@reddbendd thanks but i've had conversations with the doctor before. I was specifically concerned about the appearance of boundary issues and hospital policy, rather than the efficacy.
I wonder if patients ever get access to information about themselves, like their presentation, which doctors know but parents often don’t. Doctor use a health link system to connect each other but the patient has little knowledge of this.
My current patients are able to access my notes about them.
@@goertzpsychiatry9340 , thats interesting.
It is made available to them, unless it is likely to cause harm to the mental state of the patient
The ending of the video is very funny. 😂❤
Patients do at times ask psychiatrists out.
I'm curious if you have thoughts on other potential boundary issues: suppose an attending wishes to stay over inpatient to spend time in the milieu, or to have conversations (or brief psychotherapy) with patients? Most attendings I know inpatient work around 30-35 a week, would it be "wrong" or counterproductive if an attending wished to stay longer to provide more care, say 50 hours a week? Or if they came in on a weekend to check up on a particularly vulnerable patient that was responding well (rapport) with the particular physician?
Thank you for bringing these questions up. They may be topics for a future video.
I say, it is unlikely you would be compensated anything extra for your additional time there. Possibly a call room.
Inpatient psychiatry Physicians are TYPICALLY given a salary.. amount of hours worked varies. Unless you are doing locums, then you get paid hourly.
you will ultimately have to discuss that opportunity for overtime with Human Resources, at one one of the hospitals you plan on practicing at. You can get fired for too much overtime.
That being said, physicians mostly focus on a linear, atomistic diagnosis -> treatment process.
Checking up on a patient to see how they are doing is, typically, the responsibility of the floor staff.
I am not a certified expert on anything, but a brief psychotherapy session, as you have described, is unlikely to yield very many good results with the majority of psychiatric inpatients within the allotted timeframe. Typically 3-10days for an inpatient stay. It wouldn’t have much of a psychological impact on them to see you a few extra times. If you were working in a state hospital, over the course of many years, those extra few hours would of course add up.
Speaking from experience, it really depends on how much you are willing to deal with regarding the patients and productivity relative to time spent. It depends on the acuity of the patient and what they are expressing as their needs.
A psychiatric liaison, or milieu counselor position in an inpatient hospital would be very beneficial for you to gain insight into your desired position.
A liaison position typically requires a masters in social work, but I am almost sure the hospital you’re completing residency in would let you moonlight in some capacity, possibly as a liaison. They have much more responsibility than a milieu counselor.
I do not know what you mean by taking care of the patients, ha ha, so you will have to elaborate on that if you wish. But since you mostly mentioned counseling and not follow up care, I would recommend you to look into becoming a milieu counselor.
You will need year or so experience as a psych tech, and preferably a bachelors degree. Im sure you could get hired anyway, just by being a medical student if you fluff up your resume by just putting the number of hours on there youve spent practicing psychotherapy on it.
People get hired to work in psych wards with nursing student as their credential all the time. Medical students typically just go on rounds with the attending & interdisciplinary meetings. But you could ask HR somewhere about a work opportunity.
A good way to rephrase this question to get an answer would be: “have you ever spent extra time with a patient, and is it usually beneifical? can prolonging a consult actually be beneficial? If so when?” These questions are short, concise and will provide you a clear answer.. now lets watch the video!
@@reddbendd I don't care about the finances, I'm interested in the autonomy. I work in psychiatry and am also a crisis counselor, I'm familiar with the system. My primary interest is in working with suicide survivors and SAD, but I also enjoy helping with psychosis and neurodevelopment disorders.
There is already very little evidence to the efficacy of hospitalization for suicide patients, finding research on "spending more time" would be outside the realm of any present methodology. I would be interested in doing that research.
What we do know is the #1 complaint of patients is "My doctor doesn't listen to me" or "They seemed rushed / didn't have enough time". I also strongly believe that a lot of progress can be made in brief periods of time. Especially if the critical juncture moving forward is hopelessness. This is the entire point of our hotlines, which are very brief interventions.
You also seem to refer to a more traditional 'medical model' for psychiatry, which is ineffective as pointed out in the late 70s when the biopsychosocial model was introduced.
I think the division of roles can be counterproductive Rapport is the main currency of healing for most patients, even schizophrenia (outside of state hospitals). A brand new tech playing cards with someone may have an infinitely bigger impact in their lives than a team of doctors, RNs, and LCSWs.
Yes, absolutely, there must be a diagnosis and prescription, and a nurse to deliver the correct drugs, but everyone should be involved in emotional support, that way whomever the patient bonds with will be able to provide the therapeutic relationship and necessary words to help with their recovery. Many wards I've visited folks have never taken a single psychology class, and some of the nurses didn't know the difference between a clinical psychologist and a psychiatrist.
I just want to be able to practice in the manner that I feel is most effective, and that involves more than a brief interview and writing notes and prescriptions. Especially for suicide survivors, which I feel there should always be a dedicated milieu for those suffering with psychosis / mania
@@reddbendd thanks but i've had conversations with the doctor before. I was specifically concerned about the appearance of boundary issues and hospital policy, rather than the efficacy.
Hi, Dr. Goertz. Longtime viewer here. I was wondering if you offer observerships or externships to medical graduates such as myself. Many thanks.
I appreciate your interest. At this point I am not offering that.