Congrats on finishing medical school, and most of your residency.
That said, I briefly read your post, and while I admire your optimism, and trust in the system; Psychiatry is currently trying to pull itself out of a deep hole of bad science, bad studies, faulty theories, etc.
I'm too tired to list my gripes with the Art of Psychiatry, please don't just set up shop somewhere and make a comfortable income.
Yes, set up shop. Yes, make a comfortable living. But, please there's a reason some doctors are prescribing offlabel, and taking more risks than what your being taught.
The tried and true methods are not working, or working so closely to placebo it's beyond ironic.
Seasoned Psychiatrists(with a conscious) are frustrated with the currently horrid cure rates, with the "tried and trued" traditional medications. They are tired of finding all those theories are not holding up. They are just tired.
Right now you are seeing the really ill. When you get out and set up shop. Most of you time will be seeing a patient every 15-30 minutes. Your patients will be a lot like you(come from a good homes, but they had a breakdown usually in their twenties, or thirties. So many will be high achievers, but stopped dead by a breakdown.). You will find so many medications just don't seem to work. SSRI's just might be the biggest scam perpetuated on the medical profession in part by Eli Lilly? Right now, you must have realized Placebo will be the best tool in your arsenal?
What I am trying to say is when you get out, and set up shop, most of your patients will come to you at the worst time of their lives. They will put a lot of confidence in your judgement. Many will be paying out of pocket.
I'm not going to give a soon to be doctor much advice, but question the studies. Don't just chalk up the non-responsive to statistics. I'm not saying you should take heroic risks in trying to get the patient functioning again, but be honest. I don't see anything wrong with--Patient, "The medication, and therapy didn't work as I expected, but you will get better with time!". Be honest about the results of your profession, especially when any chance of placebo cure is long gone. In other words, don't make the patients life worse because you picked a particularly ineffective speciality. Oh, yes you will probally find yourself surrounded with other Psychiatrists, and they will encourage you to keep your head up high, and keep that income up; Don't abuse that magical transference on the poorer patients. (I think you get my drift?)
I'll get hammered for this post, but as a former patient these are just my honest thoughts. Take care of your own health, and realize in the end--we are all in this mess toghther?
(1) Point me towards the studies that prove SSRI's are so much better than placebo in the sickest patients. I really want to change my mind, but when I read the literature-- it's almost like they just can't admit they were fooled? Plus--take away tri, and hetro-cyclic drugs--the arsenal of cures goes way down, along with patient count? There's a strong reason to protect anti-depressants?
(2) "Eli Lilly, the company behind Prozac, originally saw an entirely different future for its new drug. It was first tested as a treatment for high blood pressure, which worked in some animals but not in humans. Plan B was as an anti-obesity agent, but this didn't hold up either. When tested on psychotic patients and those hospitalised with depression, LY110141 - by now named Fluoxetine - had no obvious benefit, with a number of patients getting worse. Finally, Eli Lilly tested it on mild depressives. Five recruits tried it; all five cheered up. By 1999, it was providing Eli Lilly with more than 25 per cent of its $10bn revenue."
Seasoned Psychiatrists(with a conscious) are frustrated with the currently horrid cure rates
Most of the comments here at least touch on the ineffectiveness of current treatments. As does the blog post. To which I respond with two words:
BIG DATA
I don't think individual doctors, as well intentioned as they might be, can really make a difference in the big picture. But doing some serious data mining might help. Throw everything into the mix:
people's age, gender, genetic background
their previous and current environment
previous treatment successes and failures
their self-reported moods
1000x etc etc etc
What can analyzing that data tell us? What works better than SSRIs?
Medicine is in the stone ages compared to e.g. VLSI design. Chips have literally billions of transistors on them, and they work reliably at multi-GHz frequencies for many years. That's both science and engineering at its finest.
But psychiatry? It's a little bit of book knowledge, a little bit of intuition, a little bit of apprenticeship, and a lot of frustration.
The guy seems quite ambivalent. You'd think he would still be a starry eyed idealist, but he's not ... after only two years of residency.
The thing is, "What works better than SSRIs?" is already known. The post's author had an idea, and the analysis of ~50,000 reviews (not very big data) confirms it by a large margin. SSRIs are not prescribed because they work best, but because they are considered best compromise of many factors including efficacy and safety.
Fascinating reading that, especially that doctors and patients see things completely differently, especially relating to the older class of antidepressents.
There was a post, a few days ago, about biological lab studies. The post had something to do with errors in biological studies, and how some researchers will redue lab results, until they get the results they want?
I can't recall the post, but in the comment section someone suggested, 'How about a Database that would include all studies/results; irrelevant of the outcome. Just how all good science results should be presented?' Could you imagine a database that researchers could go to, and find honest results for their particular area of interest? Honest data--free for all to see. Open Source?
Right now we have some data bases, but they are not easily accessed, and even though most some have a peer review process; we need a better system?
Will we ever get a better system? I don't know? Yes, studies are expensive, but why do I feel if money wasn't the number One concern; we would be so much farther along?
Growing up I viewed medical researchers with holy reverence!
Now--I picture a bunch of MBA's basically telling the employees(highly educated) what they want, or what drug/procedure/devise will make the company the most money?
I've taken so many expensive drugs that were basically pushed through the system. I had no idea about "cherry picking" the best studies, excluding early placebo responders, manipulating the data--to the point of fraud, outright double blind, placebo controlled fraud; of course hidden and presented in a way most professionals didn't even realize they were being basically lied too.
I don't know the best way to cure, or research disease, but hiding behind "well it's all we have"; I find infuriating!
So yes, I am too jaded to offer solutions. I probally threw the baby out with the bath water.(I am open to honest--agenda free advice though?). Big Data--yes! Government paid research--yes. Honest privately funded research--yes, but honest!
Big Pharma essentially lying to doctors, and patients--No.
When I was younger, I walked away from a profession that was based on placebo, and really bad science. I walked because of two reasons--one personal, and the other was I just couldn't be a hypocrite! In retrospect, it probally was not the best career move, and I don't recommend doing what I did, but integrity, and morals are all I really cared about at the time. I will die a poor loser, but I can honestly say, I never took advantage of the poor, or uninformed.
That said, I briefly read your post, and while I admire your optimism, and trust in the system; Psychiatry is currently trying to pull itself out of a deep hole of bad science, bad studies, faulty theories, etc.
I'm too tired to list my gripes with the Art of Psychiatry, please don't just set up shop somewhere and make a comfortable income.
Yes, set up shop. Yes, make a comfortable living. But, please there's a reason some doctors are prescribing offlabel, and taking more risks than what your being taught. The tried and true methods are not working, or working so closely to placebo it's beyond ironic.
Seasoned Psychiatrists(with a conscious) are frustrated with the currently horrid cure rates, with the "tried and trued" traditional medications. They are tired of finding all those theories are not holding up. They are just tired.
Right now you are seeing the really ill. When you get out and set up shop. Most of you time will be seeing a patient every 15-30 minutes. Your patients will be a lot like you(come from a good homes, but they had a breakdown usually in their twenties, or thirties. So many will be high achievers, but stopped dead by a breakdown.). You will find so many medications just don't seem to work. SSRI's just might be the biggest scam perpetuated on the medical profession in part by Eli Lilly? Right now, you must have realized Placebo will be the best tool in your arsenal?
What I am trying to say is when you get out, and set up shop, most of your patients will come to you at the worst time of their lives. They will put a lot of confidence in your judgement. Many will be paying out of pocket.
I'm not going to give a soon to be doctor much advice, but question the studies. Don't just chalk up the non-responsive to statistics. I'm not saying you should take heroic risks in trying to get the patient functioning again, but be honest. I don't see anything wrong with--Patient, "The medication, and therapy didn't work as I expected, but you will get better with time!". Be honest about the results of your profession, especially when any chance of placebo cure is long gone. In other words, don't make the patients life worse because you picked a particularly ineffective speciality. Oh, yes you will probally find yourself surrounded with other Psychiatrists, and they will encourage you to keep your head up high, and keep that income up; Don't abuse that magical transference on the poorer patients. (I think you get my drift?)
I'll get hammered for this post, but as a former patient these are just my honest thoughts. Take care of your own health, and realize in the end--we are all in this mess toghther?