It hasn’t even been a week and I have another patient lying to me to get more benzodiazepines. I think it’s a combination of having a lot of anxiety about patient safety, and also having had a life-long pet peeve around people lying. I keep trying to remind myself that lying is a symptom of addiction, but that only gets me so far. I see so many patients talk about being “treated like criminals,” but I don’t know how someone can stay trusting in this role. It also makes me really hesitate to want to use benzodiazepines at all even in short term situations because I recently had a different patient try to manipulate me into giving him more beyond what we agreed on. At the same time, I don’t want to become that way. I think there are some people who can benefit from having a few PRNs per month. Looking for some sage advice here.

Hi all. Not sure what I’m looking for here. I’m a PGY2, and hate everything I think. Just got berated again on the inpatient unit for the 50th time, almost cried. I’m so sick of this. I’m so jaded towards the patients now. I don’t think I’d like outpatient either because it seems so boring and I don’t want to just feel like I’m handing out pills. I don’t see myself doing child or the other psych fellowships. And it feels too late to switch to another specialty. So at this point I don’t even know what to do. Does anyone here have experience doing a second residency? Is that feasible? That’s the only option that gives me hope at this point

I'm a master's-level therapist, and in my jurisdiction, diagnosis is restricted to psychiatrists and doctoral-level psychologists (probably for the best, lol). I've noticed that psychiatrists I've worked with seem fairly divided on whether to disclose diagnoses of ASPD or NPD.

Some feel that transparency is important and that patients have a right to understand their diagnoses. Others have told me they avoid disclosing these diagnoses or documenting them in the chart because there are few robust, evidence-based treatments available, and they worry that disclosure could damage the therapeutic relationship without offering much practical benefit. So they simply focus on treating symptoms.

I recognize that there is some evidence supporting approaches such as TFP, schema therapy, and MBT for NPD, but my understanding is that the evidence base remains limited, and these treatments are inaccessible to most patients anyway.

I'm genuinely curious how other clinicians approach this. Do you disclose these diagnoses routinely, selectively, or not at all? How do you weigh transparency and patient autonomy against potential stigma, effects on the therapeutic alliance, and the practical implications for treatment?

I can see arguments on both sides and would be interested in hearing how others navigate this.

Hey there! I am a third-year medical student exploring different specialties, and psychiatry is one that has really caught my interest. I’m hoping to get some perspective from practicing psychiatrists and residents about what the specialty is actually like beyond what we experience during medical school.

I have a few questions:

1. What makes someone a good psychiatrist? Are there certain personality traits, skills, or qualities that you think separate a good psychiatrist from a great one?

2.How satisfied are you with your career? Are you happy with your compensation, work-life balance, and overall quality of life? Has the specialty met your expectations?

3. What are the biggest downsides of psychiatry? What aspects of the job frustrate you, and what do you wish you had known before entering residency?

4. What do you find most rewarding about psychiatry? What keeps you interested and motivated in your work?

5. Would you choose psychiatry again? If you could go back to medical school, would you make the same decision? Why or why not?

6. What advice would you give a medical student considering psychiatry?

I’m trying to understand both the positives and negatives before making a career decision. I’m particularly interested in the long-term career satisfaction of psychiatrists and how the specialty compares with what you initially expected.

I’d really appreciate hearing your experiences and perspectives. Thanks in advance!

One of the units I cover is a detox unit and we get some treatment resistant cases of alcohol withdrawal.

A patient can be on 10-12 mg of Ativan during one day and still have elevated CIWAs.

In these cases the RNs ask me to prescribe Librium because the last doctor who worked there would do so but oftentimes their liver enzymes are in the mid 200s and I only have one lab draw to go off of.

If their CIWAs are still elevated would you give Librium.in cases where liver enzymes are 200 plus or would you hold off due to risk of liver toxicity?

launching a solo outpatient psychiatry practice and starting commercial insurance credentialing. my caqh profile is complete, but some regional payers are quoting several months for credentialing and contracting, and getting useful updates from provider relations has been difficult. between keeping attestations current, completing payer-specific applications, confirming network participation, setting up eft/era, and handling medicare enrollment where applicable, i’m wondering whether dedicated payer enrollment services are worth the cost.

for anyone who has opened a solo practice, did outsourcing the follow-up work actually reduce your administrative burden? i’m especially interested in how you tracked effective dates and avoided scheduling patients under contracts that weren’t active yet....

Recently, a supervisor recommended me this book on the subject of Paraphilias and its treatment. Can anybody tell me if this is a good book on the subject or not ?

Accepted to an MD program in the northeast (Tier 1 Research via USNews)

I have a strong research background in neuromodulation and am developing contacts in academic psychiatry in Boston, NYC, and SF

I am specifying this because I am interested in pursuing a private cash-pay practice that offers interventional services, with some days telepsych and room to scale the practice over time

I also want to involve myself in industry. Whether through hosting trials, biotech consulting, or equity, I am undecided

Practically speaking, what is the realistically attainable upper-end income on a model like this, after overhead is taken into account? I understand that initial time investment would be high

Separately, how drastically might the landscape change 10 years from now, in terms of therapies?

I expect personalized medicine and new stimulation protocols, but I was wondering if standardized treatment options could also be adopted in that timeframe (ie. transcranial ultrasound, psilocybin, etc.) like how TMS and esketamine are now

And as neuromodulation/circuit-based models progress, where is the line drawn between neurology and psych?

I have considered neuro and functional neurosurgery, but I prioritize work-life balance

I'd appreciate perspectives on any of these questions, especially from people combining clinical practice, neuromodulation, and industry work