Calling All Would Be Forensic Psychiatrists...&...Wiki Your Diagnosis

Over on our Shrink Rap News blog, ClinkShrink has a post up on how to find the perfect Forensic Psychiatry Fellowship. She'll walk you through what to look for and how to apply. If you have the makings of an amazing forensic psychiatrist, please do apply to Clink's program.

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Over on Thought Broadcast, SteveMD has some ideas about how to improve on the process of creating DSM-5. He proposes a DSM-wiki. This one made me giggle out loud:

Patients could also upload their own experiences, in YouTube format. Their videos would be cross-referenced to the relevant diagnoses and/or medications. Videos with the most “hits” could win a prize. Maybe we can link terms to their Urban Dictionary entries.

We could add clips from Hollywood movies depicting particular disease presentations. We could add links to Amazon.com to purchase relevant books (and use the Amazon Associates revenue to help manage server costs). We could include a Skype plug-in that would allow users to chat with other people logged on at the same time. We could even sell space to advertisers like Groupon (“10 sessions of psychotherapy for the price of 5 in Chicago!!”) or, for those over 21, porn sites (targeted specifically to readers of the “Paraphilias” entry).

Social media is the future, and the APA really needs to get with the program! An animated GIF logo. An MP3 theme playing in the background of each page. A Flash-based interface (sorry, iPad users). The APA could even create new, edgy slogans for itself and for the DSM. For instance, it’s not DSM-5 anymore, it could be “D5M-ph!\/3″. It’s not just a “living document,” it can be the most 4w3soM3 social media psychiatry destination on the planet! OMG!!!!!!1!

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Finally, don't forget to submit your hot-to-trot Grand Rounds Submission with a pic. Roy's coals are hot and he's ready to cook!

Submissions are due on Sunday by Facebook on our Shrink Rap Book page, Tweet to ShrinkRapRoy, or email us at Shrinkrapblog at g mail dot com

Taxi!

ClinkShrink wrote about her taxicab driver in New Orleans and how a psychotherapist had changed his life in a single session. Psychobabble (a medical intern, soon to be a psychiatry resident...I think), wrote and told us about her experience with a kind cab driver who listened to her problems and provided free psychotherapy during a taxi ride to an exam after her car had been towed after she'd been on call (...Talk about a bad day!) You can read more Here! And welcome to the psychiatric blogosphere, Psychobabble.

This all reminded me of the essay/personal statement I wrote when I was a fourth year medical student applying to residency. I wrote an essay about the different experiences I'd had that influenced me to want to go into psychiatry. I had a bunch of experiences-- I'd known I wanted to be a psychiatrist or psychologist fairly early on, and I'd done rotations at other hospitals and had gotten a Mellon Fellowship at the University of Pittsburgh's psychiatry department one summer. I thought I looked good on paper.

I showed the essay to my adviser, he read it, looked unimpressed, and said, "It looks like everyone's essay." Great. What else did I have to say for myself? I did what I had to do. I bought a bottle of wine and went home to the typewriter (those were the days).

The essay that emerged began by saying that if I wasn't going to become a psychiatrist, I would be a taxicab driver in New York City. I rambled a bit, talked about what the experiences I'd had, said nice things about taxicab drivers and finished it up. I don't have a copy of the essay, it was long ago filed and lost, and it probably wasn't as interesting as I thought it was. My adviser liked it better, and oh, it made for some funny looks at my interviews. Thanks for the memories, Psychobabble.

My Three Shrinks Podcast 28: Can You Hear Me Now?

[27] . . . [28] . . . [29] . . . [All]

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Sorry for the sound quality again this week. We were outside, and I really did put the mic closer to Clink and Dinah than to me. We'll try something a little different next time.


July 9, 2007: #28 Can You Hear Me Now?


Topics include:

• Panetti v. Quarterman. Clink talks about a hot-off-the-press, landmark Supreme Court case about competency to be executed and death penalty cases for people with mental illness. She also refers to the Ford v. Wainwright case. "It's a hint that, down the road, we will probably not have a death penalty for mentally ill people, just like we no longer have a death penalty for juveniles or mentally retarded people."
  
  
• Dinah goes back to Podcast #27 and refers to Dr. Kay Redfield Jamison's book, An Unquiet Mind, talking about therapists' disclosure to patients about their own mental health issues (which was blogged about here).
  
  
• On Being a Female Intern. Clink rants against DrCrippen's (NHS Blog Doctor) rant about part-time doctors (mostly mothers): DrC: "You need to grow up a little. You can’t expect to pop into the hospital to do occasional clinics at a time of your own choosing in between school runs, parent-teachers association meetings and back packing holidays. Life is not like that. Being a hospital consultant requires commitment, dedication and long hours. There is generous provision for paid maternity leave. What more do you want? ... If you won’t do the hours, you can’t have job... Just because you are a girlie, you can’t expect medical training to be turned on its head."
  
  
• Physician Stress & Burnout. This discussion transitions into talk of a 2004 article (IC McManus, et al.) on physician stress and burnout, finding that the consequences of physician training stress has more to do with how one handles stress in general.
• iPhone Apathy. Roy mentions his iPhone post. Who cares?
  
  
• iTunes Reviews. Clink asks our listeners to do more reviews of our podcast, and we offer to mention the next 3 reviewers (good or bad) on our next podcast (whoopee!).
  
  
• Sex Change Operations in Prison?. Clink talks about a recent case of many thousands of dollars being spent litigating a case of a prisoner requesting a sex change operation.
  
  
• Pristiq. Desvenlafaxine (a metabolite of Effexor or venlafaxine) is up for final approval at the FDA (I misspoke in the podcast... Pristiq is not an extended release of Effexor, but rather a metabolite of it).
  

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Find show notes with links at: http://mythreeshrinks.com/. The address to send us your Q&A's is there, as well. This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening.

My Three Shrinks Podcast 16: Encyclopedia of the Weird

[15] . . . [16] . . . [17] . . . [All]

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ClinkShrink here. I volunteered to help Roy by editing one of our podcasts--heaven help me, I did the best I could. Be patient, I'm using Windows. This is podcast number 16 which was actually podcast number 14 taped about a month ago and taken out of order for no particular reason.

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April 17, 2007
Topics include:

• First up are the Top 25 Crimes of the Century, a topic that could only be mine. It's a Time article that lists some of the most infamous or unusual crimes, but I have a couple bones to pick about their choices. Roy and Dinah just think I'm weird for even knowing this stuff. [Listen in to find out Clink's favorite crime. -Roy]
• Next we answer a question from Driving Miss Molly regarding how much and what kind of preparations psychiatrists do before their patients' appointments.
• Finally we do the Shrink Rap blog rollcall, where Shiny Happy Person deals with medical training in the UK and under the NHS, Roy flirts with the Girl with the Blue Steth, and Intueri talks about bipolar disorder in kids.

Find show notes with links at: http://mythreeshrinks.com. This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com.

Thank you for listening.

UK Doctors Protest NHS Fiasco

This whole British MMC thing is just out of control. If you've been following along on some of the UK blogs in our blogroll (like the Psychiatrist Blog or Trick-cycling or DrCrippen) then you know about how the government has set up this new system, akin to the US "Match", to connect young doctors with training sites. However, they've really botched it, and it seems more like the military, where you go where you are sent. Yesterday, twelve thousand junior doctors marched in protest about this crappy system. It is amazing that this many docs got together to do this. It says a lot about how messed up this is.

"They fear the Government's Modernising Medical Careers (MMC) scheme, designed to speed up the training process to become a consultant, will split families, drive some doctors abroad and force others to leave the profession.

Some 30,000 are competing for 22,000 posts allocated under a computer-based system, plagued by technical problems, that critics say takes scant account of the suitability and experience of candidates.

Concerns about the new system, which was introduced in January, came to a head after The Daily Telegraph gave a voice to angry and dismayed junior and senior doctors."

My Three Shrinks Podcast 9: My Three Chromosomes

[8] . . . [9] . . . [10] . . . [All]

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We decided to listen to Sophizo's suggestion and set up an email address for listeners to send questions to, and we will answer a couple in each podcast (starting with Podcast #11). We won't be able to answer them all, and we will not be able to answer any personal clinical questions. Send an email to mythreeshrinksATgmailDOTcom.
Also, feel free to go to iTunes and write a review (we had one, but it disappeared). We now have over 300 regular listeners (wow!), so maybe someone has something to say about us (maybe even something nice).
Last request: Dinah is only up to mid-season 2 in Lost, so she requests you post no spoilers for her on our blog, or she will be Positively Lost.

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February 4, 2007:
Topics include:

• AJP: Genetics of depression. Two related articles in this month's Green Journal are from the GenRED study (Genetics of Recurrent Early-onset Major Depression). The Levinson article reports significant linkage for an area on chromosome 15 in 631 families with recurrent early-onset major depression ("early onset"=<40 yrs old). The Holmans article reports results of a genome scan in 656 families, finding significant linkage in areas of chromosomes 8, 15, and 17.
• Mandatory screening for depression? Clink conducts a thought exercise.
  
• Blogs & Identity. We talk about Dr. Anonymous' recent troubles after Fox News brands his one of 5 great medical blogs, and our feelings about blogging behind anonymous names (or not). See Dr A's post on the Myth of Anonymous Blogging. Moof's post is also worth reading on this topic. (We suspect his video blog may have given away his identity.) We look forwards to the congressional hearings on who leaked his identity and how high up this thing goes.
  
• Whither Public Psychiatry? Where have all the public sector psychiatrists gone? The number of HPSAs (Health Professional Shortage Areas) have decreased, while there seems to be less physician trainees who accept partial payment of their educational costs in return for a pledge to work in a HPSA after completing their training. But, Maryland has the most psychologists per capita in the US. (Search for Maryland psychiatrists at mdpsych.org.)
  
• Questions for us? Email at mythreeshrinksATgmailDOTcom. We'll answer some starting with Podcast #11 (in two weeks).

Next week: Biochemical effects of chocolate on mood (we really mean it this time). Also false positive drug tests, and children of psychiatrists.
Last week's musical snippet was from the 1986 release, Modigliani (Lost in Your Eyes), from their eponymous album by Book of Love [lyrics].

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Find show notes with links at:

http://psychiatrist-blog.blogspot.com/2007/02/my-three-shrinks-podcast-9-my-three.html
This podcast is available on iTunes. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening.

technorati tags:speed, genetics, depression, GenRED, chromosome, blogs, podcast, public, psychology, psychiatry, psychiatrist, AJP, article

Blogged with Flock

Lifestyles of the Shrink Rappers

[posted by dinah]
It suddenly got very quiet here at Shrink Rap. I think ClinkShrink's geek roar has drowned everyone out. I'm wondering if she even noticed that I'd claimed her post as my own. As I've said, "Dream on."

So this is dedicated to Jessica, a 3rd year medical student, who commented on one of my recent posts. Jessica writes:

Hi, I am a 3rd year medical student that will probably go into psychiatry. I
enjoy your blog a great deal.This post contained a lot of new info for me - when
I tell people my intended field, they say, "Well, at least the lifestyle is
good." I had no idea that you were expected to be available by phone within 30
minutes 24 hours/day. I had always heard that psychs told their patients to go
to the ER if there was an emergency. Or if they were faculty at a learning
institution, to "page the on call psych resident." Also, can you comment on
psychs not having secretaries, and group v. solo practices? Thanks, Jessica

Thank you, Jessica, we Rappers (or Shrinksters) always like hearing that our blog is enjoyed. I've been thinking about your questions since I saw them and this is what I come back to.

When it comes to choosing a medical specialty, go with your heart. There is no other way. Psychiatry is so different from everything else that it needs to call you, even if just a little. If nothing or everything calls you, think long and hard about it, visit docs in their offices, talk to everyone you can, and hey, visit a blog or two!

In my eighth grade English class, we were assigned to do a research "career report." One classmate ventured into New York City and met with Chuck Scarborogh-- he wanted to be an anchorman. Newton (Now NJ), I am pleased to report, is now a newsman with Eyewitness News, and apparently I'm not the only member of Mrs. Garelick's class to have a podcast.
I wrote about how I was going to be a psychiatrist. What was I thinking? At that point in my junior high school life, I'd never met a psychiatrist and I'd never even met anyone with a mental illness. The best I can figure is that I liked teeny bopper magazines and thought it would be cool to be one of the "experts" who got quoted about human behavior. I found a book on Freud's theories in the library and thought this was really weird stuff. I did not, I repeat, did not, have penis envy.

In med school, I had several profs express concern that I was wasting my life. One suggested I would be more useful to society as a cosmetic surgeon. During internship, a cardiology fellow told me he'd wanted to be a psychiatrist but instead he had his own psychotherapy and realized that was what he was looking for. That actually is a good point: if you're looking for answers to your own problems, get a shrink, don't be one, at least not for that reason alone. Many people told me that in psychiatry no one ever gets cured. They were wrong.

But what if you wrote your career report on becoming a ballerina, and now you're in the throes of a medical education, having survived organic chemistry and MCAT's, trudged through biochem, anatomy lab, and 4:45 AM cardiothoracic rounds (do they still do that?) and nothing is screaming your name? I'm not sure what to say, I haven't been there. Process of elimination, maybe. If it's lifestyle you're looking for, I think dermatology is low on crises. There are many ways in many specialties to gain some control over your time: if lifestyle is important, stay away from trauma surgery, OB, and most other surgical subspecialties.
For what it's worth, though, I agree, psychiatry can include a good lifestyle, though easy hours won't bring in the big bucks, but you can have time to spend with your kids and your blog.

Seriously, though, I was unaware of the AMA dictate that psychiatrists be available for emergencies within 30 minutes. Every shrink I've mentioned this to has gotten a bit anxious and no one has heard of this (except Wise CoveringDoc). Even Camel who carries a "Life or Death" line with her was not pleased. This little-known statement applies only to emergencies (not availability on demand for anything your heart desires), doesn't define emergencies (I don't think, hmmm, I've never actually read it having learned of it 3 days ago) and emergencies in private practice are not that common, at least not in my practice. The one time I was called with what was truly an emergency-- a patient on the brink of a suicide attempt-- I answered the phone, thereby being immediately available, not even a one minute wait, and the caller went through with the attempt despite my wise counsel (I did call 911, the caller did survive). I'm not losing sleep over this one, though it did occur to me yesterday that I'd left my phone in the car while I was at the gym for a one-hour work out and if someone had an emergency at the beginning of my workout.... oy...I stayed on the stairmaster.

Solo versus Group: I've done both. I was in a group for 7 years, I liked it, I left when the logistical issues of office space got to be difficult. The group had 3 billing secretaries, I've done better on my own. I've never wanted secretaries to schedule me, though they do in the clinics where I've worked, and usually it's fine.

I'm actually a pretty good secretary, if I do say so myself.

I hope this helps.