{"id":32952,"date":"2017-05-19T01:00:39","date_gmt":"2017-05-19T05:00:39","guid":{"rendered":"http:\/\/quotulatiousness.ca\/blog\/?p=32952"},"modified":"2017-05-09T08:33:15","modified_gmt":"2017-05-09T12:33:15","slug":"qotd-outpatient-psychiatry","status":"publish","type":"post","link":"https:\/\/quotulatiousness.ca\/blog\/2017\/05\/19\/qotd-outpatient-psychiatry\/","title":{"rendered":"QotD: Outpatient psychiatry"},"content":{"rendered":"

Now I am halfway done with my residency. I will be switching to outpatient work. Everyone who sees me will be there because they want to see me, or at worst because their parents\/spouses\/children\/friends\/voices are pressuring them into it. I will be able to continue seeing people for an amount of time long enough that the medications might, in principle, work. It sounds a lot more pleasant.<\/p>\n

I have two equal and opposite concerns about outpatient psychiatry. The first is that I might be useless. Like, if someone comes in complaining of depression, then to a first approximation, after a few basic tests and questions to rule out some rarer causes, you give them an SSRI [Selective serotonin re-uptake inhibitors]. I have a lot of libertarian friends who think psychiatrists are just a made-up guild who survive because it\u2019s legally impossible for depressed people to give themselves SSRIs without paying them money. There\u2019s some truth to that and I\u2019ve previously joked that some doctors could profitably be replaced by SSRI vending machines.<\/p>\n

The second concern is that everybody still<\/em> screws it up. There\u2019s an old saying: \u201cDoctors bury their mistakes, architects cover theirs with vines, teachers send theirs into politics.\u201d Well, outpatient psychiatrists send their mistakes to inpatient psychiatrists, so as an inpatient psychiatrist I\u2019ve gotten to see a lot of them. Yes, to a first approximation when a person comes in saying they\u2019re depressed you can just do a few basic tests and questions and then give them an SSRI. But the number of cases I\u2019ve seen that end in disaster because their outpatient psychiatrist forgot to do the basic tests and questions, or decided that Adderall was the first-line medication of choice for depression \u2013 continues to boggle my mind. So either it\u2019s harder than I think, or I\u2019m surrounded by idiots, or I\u2019m an idiot and don\u2019t know it yet. In which case I\u2019m about to learn.<\/p>\n

Still, if it\u2019s a disaster, it will be a different<\/em> type of disaster.<\/p>\n

Scott Alexander, “Reflections From The Halfway Point”, Slate Star Codex<\/em><\/a>, 2015-06-29.<\/p><\/blockquote>\n","protected":false},"excerpt":{"rendered":"

Now I am halfway done with my residency. I will be switching to outpatient work. Everyone who sees me will be there because they want to see me, or at worst because their parents\/spouses\/children\/friends\/voices are pressuring them into it. I will be able to continue seeing people for an amount of time long enough that […]<\/p>\n","protected":false},"author":1,"featured_media":35193,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[66,41],"tags":[243,906,139],"class_list":["post-32952","post","type-post","status-publish","format-standard","hentry","category-health-science","category-quotations","tag-medicine","tag-mentalhealth","tag-psychology"],"jetpack_featured_media_url":"https:\/\/quotulatiousness.ca\/blog\/wp-content\/uploads\/2016\/06\/favicon.png","jetpack_shortlink":"https:\/\/wp.me\/p2hpV6-8zu","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/posts\/32952","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/comments?post=32952"}],"version-history":[{"count":1,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/posts\/32952\/revisions"}],"predecessor-version":[{"id":32953,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/posts\/32952\/revisions\/32953"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/media\/35193"}],"wp:attachment":[{"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/media?parent=32952"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/categories?post=32952"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/tags?post=32952"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}