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Post by Admin on Jun 4, 2019 16:52:39 GMT -4
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Post by Ashley Fox on Jun 5, 2019 8:30:28 GMT -4
Until I started this rotation, I was blind to the shortage of psychiatrists that currently exists and just how limited one's options for mental health care are. The article, "Overwhelmed in the ER: a mental health crises" puts real numbers on paper that paints a clearer picture about these shortages and limitations that I've been hearing throughout this rotation. It demonstrates how lacking psychiatric care is all around and some of the effects that this is having on the wider society. I think this article left me with more questions than answers, however.
Some of my questions are:
1. I note that the article was written just over one year ago, I wonder how things look today in comparison? Have there been any changes as a result of the ER physicians advocating for change? Have things become even worse?
2. There seems to be a big push for ER staff education and a better triage process to improve psychiatric evaluation and to improve care standards of these patients in the ED. In a few of my rotations, I have heard of about conflict between physicians of different specialities or subspecialties performing procedures and such that "belong to the other specialty" (i.e. conflict between colorectal surgeons and gastroenterologists over who should be performing colonoscopies). Would psychiatrists feel as if their "toes are being stepped on" if EPs are taking on more responsibility with psychiatric patients in the ED?
3. What does this crisis look like in pediatrics? In the past month, I have been told by one Pediatric ER physician and one psychiatrist that pediatric psychiatry is the way to go "to write your own ticket".
Whatever the answers to these questions, it's clear that we are letting our psychiatric/mental health patients down.
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Yasmeen Charafeddine
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Post by Yasmeen Charafeddine on Jun 5, 2019 9:00:03 GMT -4
All three of these articles demonstrate one of the biggest problems in healthcare through different lenses. There is no doubt that there is a MASSIVE shortage of physicians across the country and within mental health and psychiatry, that shortage is even more apparent. Since the beginning of my third year, I’ve noticed that nearly half the patient’s I would see in the ER had a psychiatric problem and when looking through a patient’s history it quickly becomes clear that a number of combined variables is causing this countries mental health problems to get subsequently worse.
First, it is incredible difficult to find mental health care due to the shortage of psychiatrists and mental health experts. Second, there aren’t nearly enough properly set up facilities for patient who need long-term psychiatric care, leading to many psych patients ending up on the streets and in situations where they are unable to care for themselves properly. Third, short-term inpatient psychiatric wards offer only a band-aid to attempt covering up the larger mental health problems - hand-waving a patient back to the streets once they’re immediate problem is dealt with, due to the financial stress long-term care puts on a hospital. These second and third issues lead to a not all that surprising phenomenon of psychiatric patients bouncing in and out of short-term inpatient care, which is an ineffective solution to the larger problem at hand. Fourth, psychiatric medications aren’t always effective and more advanced treatments can be too expensive for the low-income patients who need them. All of these problems and more are not only apparent in psychiatry, but also appear to be worsening with time - and this discussion only involve the adult side of psychiatry. It seems pediatric psychiatry has these problems to an even larger scale. It also seems that these problems exist in various forms throughout every specialty of medicine now.
The question I would propose is: how do we even start this large-scale of a problem? Does the mental health system, dare I say the ENTIRE health care system, need a huge overhaul? Or are there smaller solutions that can be implemented without compromising physician health/life or patient care?
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Post by Tyson anthony on Jun 5, 2019 10:13:34 GMT -4
For me I would just really like to hear the doctors side of things on the first article. As the victim is the one who wrote it it's too biased to form an opinion off of without hearing the doctors side of things. The 1013s are important to know as well as the others surrounding it but I'd like to know more about why it was said they are being abused. And I think its safe to admit that mental health care is in a crisis in every state not just Georgia and it just seems to be getting worse. They mentioned how they are trying to integrate mental health care with ERs to help speed up the process but how well does it really work? I think a lot of these problems are fundamental flaws in how the medical system works though. Plus there is just a huge shortage of physicians including psychiatrists so its hard to fill in the gaps
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Post by Julia Brown on Jun 5, 2019 10:14:13 GMT -4
All three of these articles bring up pertinent issues in regards to the mental healthcare system. I thought the “Day My Shrink Tried to Get me Shot” brought up some issues that many of us will likely come across in the future as we practice. The question is when do you decide when a person is a risk to themselves or others enough to call it in and report it? In this case it was from the eyes of the patient, so it’s possible they were discussing their suicidal thoughts in more detail to the psychiatrist than we are clued in to with this article. However, judging by the article even though the patient may have been actively suicidal it didn’t appear that they had an immediate plan or means to do it. Also, if the psychiatrist felt they were concerned about the safety of the patient, then I think this is something that should be addressed immediately before the patient left the office. It made no sense for the patient to return home, receive prescriptions, take them for a day or two, and then had police arrive at the door. It a patient experiences this, they are unlikely to ever seek mental health professionals for suicidal thoughts in fear of this exact situation happening. I think the physician responsible has to be 99% sure that they’re making the right decision before they call this in, because in doing so will only terminate any patient-physician relationship there was, and it may prevent us from catching a suicide attempt in the future due to lack of communication with any healthcare professional.
The second article goes into more detail about 1013s and calling these in. I think that having a 1013 is necessary, however I believe it’s something that has to be used with great caution. Also if overused then we are only contributing more to the crisis of lack of healthcare facilities, use of resources in transporting these patients and so in that we see in that final article.
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Tanyaradzwa Chasara.
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Post by Tanyaradzwa Chasara. on Jun 5, 2019 14:54:34 GMT -4
The article " Day my shrink tried to Get me shot" provides an interesting view into the patients perspective beyond the what usual physician encounters within the confines of the normal physician patient relationship. It also highlights the importance of embracing the biopsychosocial model of practice in which all facets of the patients life are taken into consideration prior to the initiation of treatment. the precipitant to this patients Mental health episode was his medical scare with cancer, with this in mind it is appropriate to question whether this whole ordeal could've been prevented had the initial physician managing this patients medical issue had taken a more empathetic approach, and addressed every aspect of this patients health, beyond the surgery itself.
This article also highlights the importance of caution when prescribing medications - it is clear that the patient was potentially over medicated, whether that was due to the new providers inexperience can not be established as this article is only provides a onesided view of this encounter. None the less it serves as a cautionary message about overmedicating patients.
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