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is, well, while nothing is really perfect, one can hope and dream, eh?!

I find it so dishonest and disingenuous of the APA newsletter to be putting out all these articles in the past few months about how to identify and lessen burnout.  This organization has to be one of the biggest shit bags on earth!  They want to lecture us on how to give hope and faith to providers when the APA shits on those who do not suck on the fat ass of what the APA really reveals.  They just want to be relevant, and make money, and then give the most pathetic display of faux compassion and disdaining caring for the public…

Well, Bullshit to the APA, bullshit to the allied professions in general that work in mental health, and bullshit to the patients who think they either get the best care someone else’s money can buy, or worse, these patients think they can better without having to exert any real time and effort.  Oh, and forget noting Bullshit to the insurers and the politicians who have the most control over the treatment process.  Those assholes sold their souls decades ago, and if they had a single moment of candor to what they would genuinely say to the public about letting people access the true and needed care interventions to have a chance at better mental health, they would just get in the patients’ faces and say “forget you and die!”

But, the point of this post is simply this:  what would be the best qualities, the most desired characteristics of a position that would allow a psychiatrist to flourish, to be invigorated, to be full of passion and caring?

I’ll list as a start what I would want, and that would be in outpatient services:

* screen out almost all the primary substance abusers and major dementia patients.  We can’t help these people, because psychiatry was never set up to work with people who have such little hope and motivation for change as a pervasive majority of these two groups.   Sorry, that is an honest appraisal.

* patients who come to a mental health clinic HAVE to see a therapist if they are not able to see the psychiatrist for some structured therapy interaction.  How often and sustained this expectation has to go is open for negotiation, but, therapy has to be part of the process in over 95% of the patients who come for services.

*most of the paperwork demands asked for psychiatrists should be handled first by ancillary staff, not that such aides can complete it all, but, get through the tedious and repetitive bullshit that most of these organizations involved with the patients just dump on doctors to complete.  And, we the physicians have the right and ability to say “no” to fill out wasteful and sheer bureaucratic bullshit requests.

*patients who miss appointments either calling in last minute or not showing up at all will not be given much if any priority to be seen unless they can clarify or quantify why they did not attend, and for those on medications, will only get enough supply until the next appointment they make AND then attend.  Yes, there are exceptions, but, again less than 5% of the time.

* most collateral paperwork that is needed to help with the assessment and ongoing care needs should be equally obtained by the patients as much as the clinic staff.  In this day and age, patients seem to have more clout to at least set up the transmission of information, and they should accept such responsibility.

*Lab studies needed by psychiatrists should be ordered by such physicians.  We do not have to run by PCPs our lab needs, and when we are the prescribing doctors for lab needs expected for meds like Lithium or Depakote, or antipsychotic meds like Zyprexa or Seroquel, then we have to have those results in a timely manner.

*court cases are not referrals to any provider but to those with a genuine expertise or a willing interest to work with such patients.  As long as the courts present care as a punitive issue, I for one want NOTHING to do with this scenario.  Let the Legal system set up treatment facilities who can fully and effectively treat and communicate with the legal system that is trying to control the patient.

*patients who are legitimately on controlled substances HAVE to be seeing a therapist ongoing until either the therapist genuinely says the patient has completed the therapy process, or the patient goes off the prescription(s).  No exceptions, even with patients on ADD meds, I don’t care if they see a therapist every 3 months, it demands the accountability and responsibility such medications require.

*Also, patients on certain psychotropic medications HAVE to be followed by a PCP, again in an ongoing manner, as psychiatrists more often than not are not fully able to manage medical needs that will be minimized or just ignored until proven otherwise.

*while this next one is not an absolute, MOST patients over the age of 55 years old should not be on controlled substances, at least until less invasive and less complicated meds and other interventions are fully exhausted first.

*This one is probably a bit trite, but, I fully believe that patients who are brought in by support organizations like developmental programs, or residential ones, HAVE to bring patients on time consistently or risk being turned away to access the clinic.  And, these programs have to be fully prepared with ancillary and collateral information at the time the patient arrives, not have any illusion such information will be dumped, er, dropped off later to be completed or reviewed.

*these last two are pet peeves of mine, but, I think some might identify with them:

children under the age of 10 should not be allowed to be in attendance with their         parents unless the circumstances are so incredibly exceptional, and, the doctor has the     right to end the visit without the patient approval if the child is outwardly disruptive.

in community mental health clinics, blocks of time should be carved out to see chronic     patients so there won’t be a risk of chaos and disruption, as well as scattered no show   periods such patients are at risk to present.  That is NOT a segregated or discriminatory   request/expectation, but a way to maximize care and staff support.


Well, that’s a start, I will likely come back in a couple of days and add some more expectations and clarifications, but for now, read and digest.  Any and all input is genuinely appreciated and requested, but give some clear reasons why what I offer above is not a realistic or fair agenda as a provider.

Oh, and when is Spring coming to the East side of this country?!?!


addendum April 25 7PM:  Sorry to anyone who has been coming back to see if I added anything to this post for more reasons to find the perfect position in psychiatry, but, I had to endure more headaches to learn:

* Insist on weekly staff meetings to discuss clinical care issues, review cases, and to interact with staff outside barren hallways.  Administration thinks this is wasted time, and that shows why administration is wasted salary for care issues in the first place.  Coordinating and maintaining continuity of care makes for better clinicians.  Oh, maybe why administrative officials are so against the process?  God forbid we can improve peoples’ lives to a point they might not have to keep coming frequently, if in fact they can conclude they are better enough to stop coming!?!?

*Realistic breaks, as a start, one hour lunch breaks.  Come on, who really has the time to take a full half hour for a meal without prior patient care issues intruding into the beginning of the lunch break, much less being able to eat in peace for a half hour?  How many people watch non clinical staff get to go out every 2 hours for a 10 minute smoke break?  At my last assignment, I saw it, and frankly, it is obscene it is allowed for two reasons:  that is thirty minutes of paid time to smoke and take away time from one’s lifespan, and second, smoking is counter-productive to the message we are trying to send to patients to improve their lives.

*Close cases with authority, and stop letting administration use lame and pathetic excuses to NOT close a case simply because of PR.  Think about this for one moment, the people who are flirting with their care being ended are not compliant, concerned, consistent, nor committed people to expend time money and energy to continue offering services.  But, I have no flippin’ clue why so many administrative people are so hell bent to not let a patient be discharged.  Because I have plenty of CLINICAL reasons that aren’t obligated to concern about numbers and billable hours.  Sheesh!

*Document consistently and outwardly the endless insurance intrusions and efforts to direct care away from actually helping people improve.  I think it is only a matter of time a real interested, invested attorney or law group can figure out a way to show there is liability the way insurers are screwing the patients.  And once an insurer is successfully sued, for a shit load of money, I think there will be real fear to what these scumbags think they can continue to do to people.  Hey, At least it can protect providers to some level depending on what the clinicians are doing when these pathetic and ridiculous authorizations and denials are thrown at us!

*Finally, as alluded to above per break time, I think it is time for honest, concerned, and committed clinicians who do not smoke tobacco to show some real gonadal fortitude and be responsibly intolerant of tobacco use, PERIOD!  Frankly, I think working with patients who at least 80% smoke with regularity shows a level of hypocrisy and inconsistency that dampens our expertise, responsibility to the public welfare, and sells short the message we are allegedly selling in healthy choices and outcomes.  Smoking stinks, smoking sucks, and smoking diminishes a chance to improve physically and mentally.  Gee, now that is a revelation!

Well, that is likely the only addendum to this post, so I hope those who have been interested to what I offer to make psychiatric care for outpatient services at least have some chance to be actually enjoyed and appreciated!  People want to stop burn out, well, think about what you want at your job to actually wake up and want to go to work and make a real difference.  Not. Happening. Here. These.  Days!!!