TRANSCRIPT
In this lesson, I am going to teach you how to become a psychiatrist. The first thing that you’re going to need to know how to do is to diagnose your patients. So let us start with a connect the columns exercise.
In column A, we have a list of symptoms. These cover a majority of the patients’ problems that you will face. First, I’m feeling, I don’t know, lost in my life, sad, lonely, like it’s all meaningless. If you connected it correctly, it goes to major depressive disorder.
Next, we have, I don’t know if there’s anything wrong with me exactly, though I do get anxious about the state of the world in general. That one is generalized anxiety disorder.
Then we have, I keep hearing a voice in my head, a man’s voice, and he says the words hollow and empty and thud. That one goes to schizophrenia.
And then we have, I stopped taking my iPrEx and I feel pretty strange now, and my last psychiatrist said I was bipolar. That one connects to bipolar disorder.
And the final one, I know you’ll probably label it borderline, but I just think a lot of the psychiatry is, that’s clearly a sign of borderline personality disorder.
Now, once you have come up with a proper diagnosis for a person, then you have to figure out what code to give them. Then what you can do is you can bill. So for the first, we have borderline personality disorder. What code goes with that? It is actually F 60.3.
And which code goes with generalized anxiety disorder? It’s a little tricky. It’s F 41.1. And schizophrenia, that most difficult and complex of disorders, it is F 20.0.
And now we have major depressive disorder. If you guessed F 33.1, you are correct. And finally, we have bipolar disorder. If you said F 31.6, you are correct.
So now let’s move on to what some might consider to be the most important part of psychiatry, and it’s definitely the most difficult part. This is how to treat people.
So in column B, we have a list of potential treatments. We have individual psychotherapy, socialization groups, exercise and sleep maintenance, olanzapine, an anti-psychotic which is also known as Zyprexa, and finally dialectical behavioral therapy.
Well, since I’m trying to be brief for this and I don’t want to waste a lot of your time, let’s just cut to the chase. You’re never gonna get in trouble if you just make sure, regardless of somebody’s diagnosis, just put them on olanzapine. Just prescribe them olanzapine. It works for everything. That’s why we have the term off-label.
Yeah, we can talk about some other things that might help afterwards, but since we are biologically trained practitioners, we’ve been trained in science, we’ve been trained in the brain, we know that it’s most effective to treat people with brain interventions. And you can explain to them they have chemical imbalances.
Yeah, even though there’s not a lot of scientific evidence proving that there are chemical imbalances in the brain, it’s very hard to study brain chemicals. Don’t worry about that. Don’t worry about the science, really. People don’t care about that. The medical field doesn’t care about that. The main thing is you tell them there’s science behind it because that will get them to take their medication.
So let’s move on. Now that we’ve got everybody on iPrEx, what do we do if the Zyprexa doesn’t work? In column B, we have a whole new list of medical interventions. First, we have risperidone, known as Risperdal. Then we have re-piprazole, also known as Abilify. As a president, which is also known as Geodon. We have haloperidol, Haldol, and finally we have quetiapine, also known as Seroquel.
Well, the answer here is probably not exactly what you’d expect, so listen carefully. Actually, you can give any of these to any of these diagnoses. If the Zyprexa doesn’t work, and you’re really not gonna get in trouble because very, very rarely do people actually sue psychiatrists and win anything. And of course, remember you have malpractice insurance. So if someone does sue you and gets away with it, you’re not gonna lose anything anyways.
Yeah, your rates are gonna go up, but it’s pretty unlikely, and you’re gonna be making so much money it’s not gonna really make a difference anyways. The other thing you can also do is you can give multiple different ones of these drugs and throw in Paxil. You can throw in Zoloft. You can throw in Prozac. Lots of combinations. That’s the basis of being a psychiatrist. Remember, always give more drugs. You never get in trouble if you give more. You can give people three drugs, four drugs, five drugs, and you can also combine that with electroconvulsive therapy, shock therapy to the brain.
So now I’m going to go into the multiple-choice section of how to be a psychiatrist. What do you do if patients are feeling unpleasant side effects from their psychiatric medications?
A. Instruct them to be patient, to continue taking the medications and to wait. B. Tell them that their mental illness is causing them to misperceive their feelings. C. Do you prescribe another psychiatric drug to combat the side effects? D. Point out that these side effects are much less of a bother to society than are the symptoms of their mental illness, and thus the prescribed treatment is actually effective. E. Tell them their 15 minutes is up and they can bring up the question next month in their next 15-minute appointment. Or F. Any or all of the above is correct.
Well, if you guessed F, you are right, and you are well on your way to becoming a psychiatrist.
So let’s jump into the next multiple-choice question. What do you do if someone wants to withdraw from their psychiatric medications? Because a lot of times you end up with patients who don’t want to take their drugs.
A. Do you explain to them that they are mentally ill and not in a position to know what is in their own best interest? Or B. Do you consider raising their dose? C. Do you consider hospitalizing them? D. Do you explain to them that their feelings are wrong and that this is just their mental illness speaking? E. Switch them to an injectable form of the medication so they actually can’t get away with not taking the pill and they actually have to come in once a month and take it. Or F. Do any or all of the above?
Well, if you picked F, you are correct. Any of these is right. All of them are right, and that’s part of what’s so wonderful about being a psychiatrist. You’re actually never wrong.
So this leads us into the final multiple-choice question, and this relates to what happens if you get a patient who comes to your office and has an anti-psychiatry attitude. Those kind of people are out there, and you have to know how to deal with them.
So what happens if you get a patient who has read Robert Whitaker’s book, Anatomy of an Epidemic, and they start using that book to argue with you about the proper treatment for their problem?
The first answer to the question is A. Do you ignore them? Do you not engage with a treatment-resistant client? Or B. Do you take a deep breath and you roll your eyes? Or C. Do you smile as you explain to them that you have several scientific degrees, whereas Robert Whitaker, who has no scientific degrees, is merely a biased journalist? Or D. Do you consider raising their dose of antipsychotics, as that will likely make it difficult for them to read, think, and concentrate; therefore, they won’t be able to argue with you anymore? Or E. Do you refer them to a different psychiatrist? Or F. Any or all of the above?
Well, if you guessed F, you are correct. Any of these is okay. All of them are fine. You’re never going to get in trouble if you do any of these, and you will be able to be an effective, successful, competent psychiatrist.
So there you are. You don’t learn these lessons. You’ve been very good students. Now go forth, and I wish you a good career.
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