Psychiatrists aren't real doctors

[Anonymous]

Okay, so the title is blatantly false. Yet this is a long-lived misconception that many people have. I have an idea that might just make psychiatry be taken more seriously…use physical examination and medical tests more often! That’s right…I think people will feel more like they went to the DOCTOR and not to the *psychiatrist* if they were actually examined physically!

Please don’t feel insulted if you’re a psychiatrist reading this. Or an ARNP or PA. I need to rant to get this off my chest.

What, you say? Physical examination is pointless? I’ll believe my patient if he says he’s having palpitations with his medicine? No, stupid, listen to my heart! (Well, you can’t be stupid and have an MD, but that just felt right in this rant.) While you’re at it, take my blood pressure. (It’s weird that I think I might be better at manually checking my own blood pressure than you, the MD! My only education was the Internet…fascinating how I could figure it out.) Pulse ox might help you see if I’m hyperventilating, and it counts the heart rate for you, so use it too! With 4 simple medical instruments (stethoscope, pulse oximeter, pressure cuff, and sphygmomanometer), you can make me feel like I saw a doctor and not just a psychiatrist! Not only that, but you can check for medication side effects and anxiety.

If you REALLY want to examine me physically, check my skin! You might just see if I’ve been cutting, shooting up drugs, purging by sticking a finger down my throat, or otherwise harming myself. (Not only that, but you might be able to tell me if I need to see a dermatologist for skin problems…added value!)

Weighing me will help you see how my weight changes with treatment. Maybe I’m obese and your treatment might just help me get motivated to lose weight and become healthier. Or the little kids on stimulants aren’t growing. It’s a good indicator of what may be going on.

If the patient has money or good insurance: Imaging and EEG can rule out some neurological conditions. A sleep study can see if the patient gets adequate sleep. An ECG is a wonderful tool to monitor cardiac function when using potentially cardiotoxic drugs, especially stimulants, SNRIs, and neuroleptics.

You never know what you’ll find. If you find a physical problem, refer the patient and the ensuing improvement in physical health might rub off in mental health. If you go one step further and treat the physical problem, I might just think you’re brilliant and wonderful and probably have no doubt in my mind that you’re a doctor!

Why let that knowledge studied in 4 years of medical school and year of internship during residency (or ARNP/PA: 2+ years of MS/BS/RN studies plus clinical hours) go to waste?

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[Curlymoe115]

Psychiatrists spend a lot of time observing your physiological reactions in their office. They do not usually do invasive testing because presumably you were referred by your physician before you got to this office. At least that is how it works in Alberta. My doctor did put me on the scale so we could judge the difference in weight gain or loss with the new medications. He also sends me for a lot of blood tests to check blood saturation levels. Mine works in the University Hospital so he has access to equipment to order other tests normally done at the hospital but usually they would refer you to a neurologist or other internist to get these done by the specialists in the field and would then get a report just like your family doctor does. I went for a sleep study and all it determined was I did not have a life threatening apnea. This was done over one night, in my own bed, while hooked up to the machine. Although I woke up many times during the night, and did have a few hours of wakefulness they determined that I did not need a sleep machine so no follow up was done. Their recommendation was sew a tennis ball in my pajama back so I did not roll onto my back. Good enough. But at least then they know that my wakefulness is not brought on from my gasping for air in my sleep. The other problems and anxieties are what brought me to my psychiatrist in the first place.

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[Anonymous]

Wow Curlymoe…sounds like psychiatry is of higher quality in Alberta than down here in Kansas. Of course I’ve been referred by physicians to psychiatry. Yet it seems like once they put me on medication, and I complain on follow-up about some purely physical side effect, there’s just no help out there for managing them. It’s summer, which already feels hot as hell. It doesn’t help when they want me on a combination of Effexor XR + Concerta, with noradrenergic side effects like sweating, flushing, and feeling hot. I swear I can now empathize with women going through menopause…and I’m a man! 27 years old at that…long before women even start thinking about menopause!

Part of it is that I could stand to lose more than just a few pounds. Okay, I’m morbidly obese, as in BMI > 40. But yet I can’t stand being really hot, hotter than the average person, just doing chores around the house. So how am I even supposed to tolerate exercise? The combo already has me feeling like I’m going to have a heart attack *at rest*…it’s so bad that I cold-turkeyed the Effexor without telling my ARNP. I called his clinic the last time I had chest pain on the combo and they didn’t really do anything. Now, I think, despite the fact that cold-turkeying off of Effexor is highly discouraged, I can at least tolerate chores without feeling like I’m going to die of a heart attack.

Not only that, but Effexor is highly analgesic. It literally hid from me a massive sinus headache! I can tell the difference between a tension and a sinus headache, trust me, after 11 years of suffering from allergies. But this was the most massive sinus headache I have ever had! Aleve, Flonase, and rinsing my nose with salt water are all helping.

Normally one wouldn’t complain about analgesia…but seriously, it has hidden MRSA and now sinusitis from me. Thank goodness I’ve had other signs to count on about these serious issues, otherwise I might have been dead from a massive infection.

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[Anonymous]

One issue is all the physical assessment you just mentioned = 10 + minutes. totally not cool when the appointment length is 20minutes and you have no medical assistant. Blood pressure for stimulants every few visits. If mentioned issues, then superficial examination or refer.

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[Anonymous]

True – yet it seems that most of the time, they don’t want to admit what their drugs do to people, especially in combination.

Sure, I probably need an antidepressant on top of a stimulant. Yet Effexor XR + Concerta = sweating, palpitations, and just that plain nervous gut feeling at rest. Uh, I think the combination had something to do with it…especially since I stopped the Effexor XR and feel much better physically!

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[Anonymous]

There are a subset of people in which the effexor could augment the concerta. However, I can see them also causing synergistic side effects in others (you). Psych meds are rough in that experiences are variable between people. but there are definitely guidelines, pharmacology knowledge, common responses, and getting to know a patient’s unique chemistry (by unfortunately some experimentation).

glad you are feeling better now.

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[Geoduck]

Kansas, eh? LOL! Me too. Yes, it is dang hot!!!

In the US, in most offices during any medical visit (excluding psychiatry), blood pressure is taken by the nurse prior to the doc coming in (while he’s with another patient), so it’s not a time waster. Nurse takes it every single time for every visit, even for a splinter in the toe. My dentist has now even taken to doing this, even for my regular cleanings. Plus, a visit to a psychiatrist is usually an hour, not 20 minutes, so if they really wanted to, a psychiatrist could at least get a good vitals check.

If you’re near Lawrence, I know a guy. He’s a family doc, but actually spends time both giving me an exam and listening to me for as long as I need, too He actually listens much better than the mental health specialists that I’ve seen.

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[Geoduck]

Not that there is anything wrong with a good psychiatrist….just wanted to clarify.

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