So a wrote a longer post about this but it got deleted and I don't have the patience to do it again. TLDR - People "out there" saying one or two injections and it auto tapers and you never have WD or cravings or use ever again everyone should be on the shot tomorrow. Never rx'ed myself. Heard very mixed reviews, but would love to hear more from people with more experience... submitted by /u/medicated1970 [visit reddit] [comments ..read more

For practicing clinicians, what is your least favorite part of your job? Why? submitted by /u/Sad-Register-1621 [visit reddit] [comments ..read more

Hi All! I’m hoping to crowd source some info or wisdom here. I am the rising outpatient chief for my psych program, and as I prepare the rising PGY3s for outpatient year, am talking with my year and above co-residents about advice they wish they were given when they began their third year, given how different the pace, responsibility, and approach outpatient is compared to inpatient, and therapy really beginning in earnest. What are the tips, wisdom, etc you would give to someone starting their outpatient year that would give them the best ability to minimize stress, enjoy their learning, and ..read more

I’m currently an international medical resident due to start a new job in California that will sponsor the H1b visa. To start the visa process, I was told I need to obtain my California license first, which requires an ITIN or social security number. I’m not eligible for either as I never filed taxes in the US for an ITIN, and I need my visa to be approved before obtaining a social security number. I’m stuck in a loop and can’t get one without the other. The lawyer appears to be confused too. This seems like a gross oversight of the process and I’m wondering if anyone else has experienced thi ..read more

Will Medicare / Medicaid reimburse a PGY-2 psychiatry resident with their full physician license for psychiatry services rendered? Will commercial insurances? As I approach the end of PGY-1, I’d like to start a weekend practice seeing patients. Just wondering if I should bother credentialing with Medicare / Medicaid and with commercial insurances or will it be futile without my board cert. submitted by /u/feelingsdoc [visit reddit] [comments ..read more

This is what I see in my addiction colleagues at least.... Opiate dependence - You have to get on MAT and probably stay on it for life. It's serious business. Benzo dependence - Here is a week of inpatient, and/or maybe a month of a longer acting benzo, and then you need to straighten up and fly right. Or maybe just figure out on your own how to cut that sh*t out. Is this just my little group? submitted by /u/medicated1970 [visit reddit] [comments ..read more

Hi all, new psych attending here so just getting my footing. ? I have a patient I diagnosed with intermittent explosive disorder. Seems to clearly meet criteria with significant rage and impulsivity issues. Since childhood. Comorbidities include ADHD and BPD so obviously some overlap of symptoms here. I have never treated IED in adults (or in children when I did my child psych rotations either for that matter). Wondering what people like to use for treatment. For now I’m going to try an SSRI then was thinking topiramate or valproic acid if ineffective. Any tips or resources including treatmen ..read more

Bit of a vent, i guess, but also a question. Curious if anyone knows why other clinicians insist on a signed release of information from a mutual patient to discuss their care? Unless I'm mistaken, HIPAA explicitly says that one is not needed to discuss a mutual patient. Has anyone had success telling them that a release isn't actually needed? I guess I feel like I bit of an "ahcktually..." guy if I did that. In my case, it is most often a situation where the patient has explicitly told both parties that they should talk to each other (so not like I am just cold calling some office claiming t ..read more

My school does not have many medicine Sub-I spots and so I wanted to be sure if I did really truly need one and how I could figure out whether or not the program requires it (I couldn't find it on their websites). If I couldn't bag a Medicine Sub-I, would a Cardiology Sub-I or medicine elective be an okay substitute? submitted by /u/ChroniclerOfSuccess [visit reddit] [comments ..read more

Hey, does anyone have some Case studies on Ganser Syndrome, or even general thoughts surrounding it? From what I can ascertain it's either facetious or a disassociative disorder. Also pseudo hallucinations: what even are they? Information on the causes of the latter isn't great but, eh. Any help would be stunning submitted by /u/bloodfloods [visit reddit] [comments ..read more