As you know, I observe and assess several hundred psychiatric treatment plans each year as I am mock-examining psychiatrists preparing for their Psychiatry and their Child Adolescent Psychiatry oral boards. There is a small, simple concept to keep in mind during your presentation of the treatment plan that can help you avoid this common shortcoming.
Treatment Plan – Wrong Way & Right Way
December 10th,2009
Let’s start with the wrong way. The following is an efficient way of making your treatment plan weak, generic, and not optimized to help the patient. Drum roll, please ….
The Doughnut Interview
November 14th,2009
One type of interview error I run across among both adult and child adolescent psychiatrists preparing for their oral boards is what I call the ‘doughnut interview.”
Increased Suicide Risk from Antiepileptic Drugs
October 2nd,2009
Beginning in 2008, the FDA began notifying clinicians of the potential of antiepileptic drugs to increase suicide risk and earlier in 2009 issued a public health advisory notifying the public of this increased risk. Also, the FDA is mandating that manufacturers of antiepileptic drugs change the labeling of their meds, adding this risk to the Warnings section of the drug insert.
The Underutilized Anti-Depressant “Wonder Drug”
September 18th,2009
Today’s post is about an antidepressant augmenter that can lead to incredibly powerful responses and yet, that is NEVER used by a majority of psychiatrists. What drug am I referring to? It is T3 or triiodothyronine.
Patient On Methadone Using Lorazepam
September 1st,2009
Today’s post is my response to a brief case vignette of a psychiatry oral board exam patient. Today I address the drug abuse issues. I will leave the issue related to when and how to give an Axis II diagnosis for the follow up post. Let’s start.
Suicide Assessment: Fantasies That Increase Risk
March 6th,2009
Today is the second in a series on the suicide assessment. A factor that really increases a patient’s risk of suicide that is often not even on our radar is the nature of the patient’s fantasies regarding their suicide. Read more on this fascinating topic.
Suicide Assessment: Beliefs That Can Increase Or Decrease Risk
March 2nd,2009
Suicide assessments, to provide us any direction, need to be in-depth. Why? Because the suicide risk factors we’ve all learned about (e.g., living alone, abusing alcohol, even having suicidal thoughts) are poor predictive factors. So even after assessing a patient for suicide, we end up not knowing if and when that person will actually engage in a suicide attempt.
This state of affairs leads one to ask, “So what’s the point in conducting a suicide assessment at all?” The answer is that if we learn to conduct in-depth assessments, we can identify the factors that increase level of risk. We then can intervene to lower those risks, whether or not they would have led to suicide. In other words, even if we can’t predict future action, we can use the assessment to guide us to lower the risk. Today I start a series on different aspects of the suicide assessment. Today’s topic is on suicidal beliefs. The next topic is on suicidal fantasies.
“And Who Do You Have Sex With, Doctor?”
January 21st,2009
Those are the exact words I heard a patient say to an interviewing psychiatrist who asked the patient questions regarding her (the patient’s) sexual history. But that’s nothing to what came next. Do you know what the doctor said?
Formatting Your Initial Evaluation
December 31st,2008
For many years I conducted 2-4 new patient psychiatric evaluations a day. Despite having done hundreds of these evals, I still was left with a little bit of trepidation every time I saw a new patient. I always had the sense that this process was somewhat unpredictable, unpleasant, and stressful.
My attitude changed – I became much more confident – when I made the following change in how I formatted my initial patient evaluations. It’s a simple change, but it took me years to make. Why? No one ever taught me any better in residency. Read on to see if this change will work for you too.
