Look, I have no delusions that I’m a psychiatrist. (Get it?  Delusions?)  My specialty encompasses many things, but my general involvement with psychiatry is trying to assess depression, anxiety, psychosis and suicidal ideations; or the risk for future suicidal or homocidal events. 

I do practice medicine well. As an emergency physician, I know sick.  It’s what I was trained to do, and what I have practice for nearly two decades.

So I find it very unsettling to have this conversation, prior to a psychiatric hospital accepting a patient:

‘We can’t accept him, he has an elevated white blood count.  It’s 13,000.’

‘He fell down, it means nothing.  He has no focus of infection.’

‘He might be medically unstable, or have an infection. You need to make sure he’s stable.’

‘I examined him, he’s stable.’

‘He has a white count.’

‘I know, but it means nothing.  I’m looking at him.’

‘You need to do more blood work, maybe a chest x-ray.’

‘What do you think he has?’

‘I don’t know.  I’m a psychiatrist.  You need to evaluate him more.’

‘But I have; you need to take him.’

‘No, he’s unstable.  He has a white count.’

You see, people who don’t know what they’re talking about stonewall, tell me to do things they don’t understand themselves, thereby delaying care and making things more difficult and more expensive.

So please, Mr. and Mrs. Psychiatrist:  I’m confident you understand mental illness.  Don’t pretend to understand white counts, liver function tests, x-rays or EKGs.  Leave that to me.

Edwin

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