u/Super-Ad7996

The hospital system where I've worked in a different role is probably going to make me an offer for a full-time inpatient PMHNP position. I like hospital work because I find it easy - tons of on-site support, kind of repetitive; you just show up and do the work and clock out and go home; no note writing at 11pm. Plus the stability and the benefits. It's a locked adult unit.

But I also got to like the 1099 format, too - you get to do more nuanced and elegant work, you build a relationship, and you get to see people get better and stay better. Plus, one of my 1099s offers group clinical supervision weekly and case consultation on demand. And, I get to see kids and adolescents in this role, which I like. However, it feels less stable - patients can cancel, stop seeing you, they can close the practice, etc.

If someone here has done both, which one do you prefer and why?

I got an acceptable quote through Zivian, but I would rather build a relationship with a person and let them keep all the $ instead of Zivian taking a fat share.

Anyone know a psychiatrist licensed in VA who's willing to provide the collaborating physician service?

Does anyone know anyone interested?

If you consider yourself PDA-affirming, what resources do you think are helpful to help support families that want to approach things from that perspective? (Please also include which country you are from. TIL that the UK is the only country that formalized PDA as a psychiatric diagnosis).

The threat to our profession is real, and the more AI is used for note taking/editing or scribing the more we train it to do anything - from therapeutic communication, to matching symptoms to workup to diagnosis, to treatment.

If you're new to your profession and are hired in someone else's company, chances are that you will have to use AI for such purposes.

Other than going into specialties that are hands-on, what ways do we have to protect our profession from being taken over by AI to a very large extent?

Have you seen one of the two consistently have a better response in your practice, in patients for whom either option is an option?

I occasionally get patients with a history of substance abuse (a few years ago), with current prescriptions for benzos and Z drugs. How do you mitigate that risk? Do you always try everything else first? Do you just document the conversation or risk benefits and consider that sufficient?

This is a sequel to a question I asked previously about a pt with high BMI and a few risk factors for sleep apnea who presents with a primary complaint of insomnia. Has tried doxepin, trazodone, Vistaril, melatonin, and doxylamine and wants something else, but has been resistant to getting a sleep study (I'm not the first one to recommend it, of course). Finally, pt agreed to an in-home sleep study via a wearable. How valuable would you consider those results? The device is FDA approved... does that mean that citing the results of that report carries enough weight to guide medication selection or next step?

If you provide this or know someone who does, please comment on what's the best way to connect.

I am OK with us having a contract that you are not liable for my decisions and only provide consultations on "hypothetical" patients.

Client I saw a few weeks ago for an intake appointment had a SA with hospitalization recently. I got them an early appointment and Headway allowed me to schedule that, as well as to have the visit online.

However, the client's payment method on file declined and Headway automatically blocks me from confirming that visit and documenting on it. Not to mention, I am not able to schedule a follow up.

Has this happened to anyone? How would you handle it? The documentation and the follow up care?

Patient scores low on depression scale. Their attempts are reportedly related to boredom, and they think it's better to try to die than to be bored.

Keep them in the hospital until they are med paneled, discharge them on a LAI, but then what? Technically, at the time of discharge, they remain high risk based on the CSSR-S due to the recent attempts and to statements that that's just how they are and nobody can prevent them from dying if they want to.

Do you feel at all hesitant about stimulants as an option for this crowd? What is your experience trying to get Qelbree covered by insurance as first line for someone with those risk factors?

This is more of an ethical issue, I suppose.

Severely overweight patient, lives alone, diabetes, GERD, you name it. Says Trazodone & melatonin don't help, and the only thing that helped them "once" was Ambien (nothing recent in CRISPR). Refuses a sleep study and strongly rejects the possibility of OSA.

Would you even go the DORA route or just refer to a sleep specialist?

New patient denied use of pain medications, pain issues, and use of any other substances besides occasional marijuana, but reported previous SA with percocet (a few years ago); denies any ideation at the moment. I was setting her up on iScribe as a new patient after the appointment and found two new opioid prescriptions (percocet and one for oxycodone) on her profile, issued two weeks and then five days before our appointment date, as well as suboxone and clonidine scripts from two years ago.

What is the most effective way to bring this up with her, with still some chance of preserving the therapeutic relationship?