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The Medical Thread: We're experts on everything else; why not?

Many in the medical field look down on mental health, and their clout and representation in state houses and Washington dwarfs that of ours. Their needs have come before ours for a long time now, and I don’t see that changing anytime soon.
 
FadeToBlack&Gold said:
There's a reason that in med schools psychiatry is known as the specialty for average students who couldn't get into better residencies.
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Unfortunate. Mental health is quite important, and frequently under-diagnosed in the general population. Persistent, elevated stress leads to all kinds of physical ailments. Sound mind, sound body. But, the way our healthcare system is set up, we’ll stay the little b-tch stepchild we are, probably for my career.
 
OTOH you have dermatologists, whose residency programs are extremely competitive and hard to get a spot in without top grades. Probably because they make a sh*tload of money once they're in practice. ;-)
 
FadeToBlack&Gold said:
OTOH you have dermatologists, whose residency programs are extremely competitive and hard to get a spot in without top grades. Probably because they make a sh*tload of money once they're in practice. ;-)
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And don't forget, Dermatology offers a lifestyle without nearly as many emergency calls and far more flexible hours. These are major reasons the residency positions are so competitive and difficult to obtain and also why so many women who graduate medical school try to get into a dermatology program. Many can balance raising children while still maintaining a dermatology practice either part or full time.
 
And the Doc chimes in with what I was going to post. I can remember many a time where no one was available for a consult after hours. How many derm emergencies are there? I know there are some but not many.


I worked in Family Practice beginning in the late 80s. I actually had patients that were booted out of the 'institutions'. It was awful and unconscionable. Some of these patients had lived in the same place for decades. They formed bonds with staff and other patients that they lost and were thrown into unsuitable situations with no support and no skills. I had one lady I rounded on in a nursing home who was mourning the loss of her 'family' for yrs after she had been transferred. Heartbreaking.

psych said:
Unfortunate. Mental health is quite important, and frequently under-diagnosed in the general population. Persistent, elevated stress leads to all kinds of physical ailments. Sound mind, sound body. But, the way our healthcare system is set up, we’ll stay the little b-tch stepchild we are, probably for my career.
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All of this!!

Anyone in Family Practice who has even one working synapse agrees with this sentiment wholeheartedly. Worse than under-diagnosed. In my experience we knew there was an underlying condition but it was literally impossible to get the patient in to see psych- there were not enough providers, insurance didn't cover or under-covered, many times the places that were covered were >30 minutes away and only had availability in the middle of the work day. It wasn't treated so they were in to see us constantly because when you can't from without you cry from within.

I taught health assessment to nursing students for a couple of yrs and one thing I pounded into them was it is imperative you look at the whole pt. You can't ignore psychosocial issues and be successful in helping the patient.

If they ever treated all the psych stuff much of the other specialties would stop making so much money.
 
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I don't have a long history in healthcare but I've been steeped in it from the IT/operational side for the last 4+ years, and I totally agree with regards to mental health. It is improving, at least here in MA, but not quickly. Most of the slowness is related to the healthcare staff itself - we have a miserable time hiring and keeping behavioral health folks (docs, therapists, social workers, etc.).

One of the requirements put on my new big company (not Partners/MGB, but the other big eastern-mass healthcare company) when we formed was a CoCM (Continuity of Care Model) program that is a big, big step in identifying patients with mental health problems and getting them the help they may need. It's been incredibly successful, even during the pandemic, but like I said the staffing has been a major, major problem.
 
For my Mental Health and Health Care Policy class, I have to write a 4 page single-spaced policy brief. I was going to do Medicaid funding, but instead I'm doing mental health and how our current joke of a system led to a significant gap between the haves and have nots.
 
Swansong said:
I don't have a long history in healthcare but I've been steeped in it from the IT/operational side for the last 4+ years, and I totally agree with regards to mental health. It is improving, at least here in MA, but not quickly. Most of the slowness is related to the healthcare staff itself - we have a miserable time hiring and keeping behavioral health folks (docs, therapists, social workers, etc.).

One of the requirements put on my new big company (not Partners/MGB, but the other big eastern-mass healthcare company) when we formed was a CoCM (Continuity of Care Model) program that is a big, big step in identifying patients with mental health problems and getting them the help they may need. It's been incredibly successful, even during the pandemic, but like I said the staffing has been a major, major problem.
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The pressure on Behavioural health Providers is ridiculous. They are underpaid, overbooked and many times work with time constraints- X visits and then not covered or unbelievable barriers trying to get reimbursement to work. Many of the larger practices treat them like sh1t- poor pay, overbooking. Can't begin to count the number of times I have seen Providers make lateral moves between practices. Unfortunately that leaves a gap in care- the pt needs to start with a new provider because most of the time insurances are not compatible b/w practices. That means they are wait listed to see a new provider and causes all sorts of disruption and trust issues.

When I was first in Practice this wasn't as bad. The whole HMO thing started the downward spiral and it has progressively gotten worse. Insurance forces people into suboptimal treatment with restricted list of Providers that rarely have openings, restricted coverage- x visits a yr with no consideration for what would be appropriate, putting rules in about meds that require inappropriate protocols. My favorite- they wanted me to prescribe a new start anti-depressant to be filled for a 90d supply because if they didn't continue for 90d we lost a boatload of $$- no chart review. If 90d wasn't billed then ding! This specifically goes against all recommendations.
 
Les-you knew I would read what you write. There are many dermatologic emergencies. But they really are medical emergencies that may have a dermatologic component and thus are often managed by a general medical physician or an ER doc. if they wait for a dermatologist to arrive sometimes the emergency just gets better before the consultant gets there! (which really is perhaps the most desired outcome)
 
DrDemento said:
Les-you knew I would read what you write. There are many dermatologic emergencies. But they really are medical emergencies that may have a dermatologic component and thus are often managed by a general medical physician or an ER doc. if they wait for a dermatologist to arrive sometimes the emergency just gets better before the consultant gets there! (which really is perhaps the most desired outcome)
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I did. I couldn't recall anything that was handled that got a Derm out of bed. I was trying to think of something that only a Derm would handle - there has to be something- and was coming up blank. I was waiting for you to refresh me.
 
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