How to be a good psychiatrist, Daniel Mackler

 

In this lesson, I am going to teach you how to become a psychiatrist. The first thing you are going to need to know how to do, is to diagnose your patients. So we’ll start with ‘connect the columns’ exercise.

In column A we have a list of symptoms. These cover a majority of the patient’s problems that you would face.

First: I am feeling, I don’t know, lost in my life. Sad. Lonely. Like it’s all meaningless.

If you connect it correctly, it goes to… Major Depressive Disorder

Next we have: I don’t know if there’s anything wrong with me, 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 Zyprexa 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 this psychiatry is bullshit.

That’s clearly a sign of Borderline Personality Disorder!

Now, once you’ve 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 F60.3.

And which code goes with Generalized Anxiety Disorder? That’s a little tricky! It’s F41.1

And Schizophrenia. The most difficult and complex of disorders. It is F20.0

Now we have Major Depressive Disorder. If you get F43.1, you are correct.

And finally we have Bipolar Disorder. If you said F31.6, you are correct. 

Now let’s move on to what some might consider to be the most important part of psychiatry and is 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 antipsychotic which is also known as Zyprexa); and finally, Dialectical Behavioral Therapy.

Well, since I’m trying to be brief for this I, and I don’t want to waste a lot of your time. Let’s just cut to the chase. You are never gonna get in trouble if you just make sure ___ 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 is most effective to treat people with brain interventions.

And you can explain to them, they have chemical imbalances. Yeah, even if there is not a lot of scientific evidence proving that there are chemical imbalances in the brain, it is very hard to study brain chemicals. Don’t worry about that, don’t worry about the science. People don’t care about that, the medical field doesn’t care about that. The main thing is you tell them there is science behind it, because that will take them to take the medication.

So let’s move on. Now we have everybody on Zyprexa, what do we do if Zyprexa doesn’t work? 

Column B. We have a whole new list of medical interventions. First, we have Risperidone, known as Risperdal; then we have Aripiprazole, also known as Abilify; Ziprasidone, which is also known as Geodon; we have Haloperidal, 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 diagnosis if 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 someone does sue you and gets away with it, you’re not going to lose anything anyway. Yeah, your rates are going to go up, but is pretty very unlikely and you’re gonna be making so much money, is not gonna really make a difference anyway.

Another 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 psychiatrist. Remember, only give more drugs. You never get in trouble if you give more. You can give people three drugs, four drugs, five drugs, anything you can also combine that with electro convulsive therapy. Shock therapy of the brain.

So now I’m gonna 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?

Well, if you guess (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 ______ and ____ 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 their medication, so they actually can 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 pick (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 are 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 antipsychiatry attitude. Both 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 starts using that book to argue with you about the proper treatment for their problem?

So the first answer to the question is

(A)   Do you ignore them. You do not engage with a treatment resistance client. Or

(B)   Do you take a deep breath and you do roll your eyes. Or

(C)   Do you smile as you speak 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 of all of the above.

 

Well, if you get (F) you are correct. Any of these is ok, all of them are fine. You are never going to get in trouble if you do any of these. And you’ll be able to be an effective, successful, competent psychiatrist. So there you are. You can learn these lessons, you’ve been very good students, now go for it and I wish you a good career.