tag:blogger.com,1999:blog-7772182113499451603.post8579299399841168959..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Clinical Care - The Hype Versus the RealityGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-7772182113499451603.post-64241249037399641432014-06-25T18:11:49.574-05:002014-06-25T18:11:49.574-05:00That is exactly the problem with the 360 review. ...That is exactly the problem with the 360 review. To make it even worse in some places it is completely anonymous so there is no accountability at all. The retaliation can consist of overt lying and fiction. I am aware of situations where it was a complete free-for-all and people who had performed their jobs flawlessly for decades were slandered. I guess they assume that you will "manage" the comments to prevent this.<br /><br />George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-70424072553210735652014-06-25T18:05:22.718-05:002014-06-25T18:05:22.718-05:00In the business world, a 360 evaluation means thos...In the business world, a 360 evaluation means those lower evaluate their managers and managers at the same level evaluate each other. I am not sure what it means MOC.<br /><br />Also, in the three different businesses I have been in, the 360 review was either not implemented or dropped before I got there. They found that it was largely misused for retaliation, in addition to the fact that management didn't like being rated by their employees. With rare exceptions, everyone "manages-up". This leaves little time for managing your direct reports and it shows.RBnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-71540808335636755702014-06-25T10:06:56.979-05:002014-06-25T10:06:56.979-05:00Here's the problem with patient satisfaction s...Here's the problem with patient satisfaction surveys in forensic psychiatry...patient satisfaction has nothing to do with whether or not you did a good job! You would think the poobahs in forensic psychiatry would realize that. What will happen is that doctors will cherry pick those cases in which the patient had an outcome they liked. This is absolutely a waste of time. Getting a satisfaction report from a judge or a lawyer would make more sense.<br /><br />But in the other specialities, that option is probably the easiest. But still a waste of time. You can always find five people who like what you did, and that's even easier if you're handing out Adderall and Vicodin like candy.<br /><br />If they keep trimming it down to a test and documentation of CME, I have no problem with that. This other stuff is just a shakedown.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-12037909361951754642014-06-25T09:38:05.217-05:002014-06-25T09:38:05.217-05:00The 360 degree is one of six options, but yes it i...The 360 degree is one of six options, but yes it is stupid as can be.<br /><br />I'm still not going to do it for forensics in two years, but it seems like they're backing off a little.<br /><br />This is like Common Core, they're just beta testing it out on everyone and hoping it works. When did this become acceptable?James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-3262613876492810942014-06-25T06:45:06.610-05:002014-06-25T06:45:06.610-05:00I got the ABPN quarterly update and at first read ...I got the ABPN quarterly update and at first read through was not too impressed - apart from the political implications of being told that we need a completely arbitrary process. I guess I was annoyed by the "360 degree" evaluation. I consider it to be a business tactic designed to give the employer leverage over most reasonable employees. Why would that be relevant to recertification?George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-76188859950923168372014-06-25T01:09:02.192-05:002014-06-25T01:09:02.192-05:00Hey on a positive note I got an email from ABPN st...Hey on a positive note I got an email from ABPN stating they were dialing back on some of the MOC insanity..did you get this too?James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-88508201579250218542014-06-24T10:56:59.126-05:002014-06-24T10:56:59.126-05:00The continuum model only goes so far. The current...The continuum model only goes so far. The current addiction diagnosis using either DSM or ASAM criteria is selecting a population based on severity (90+ percentile) so the continuum would run in that zone. Even in the people meeting that diagnosis at points in their life, most people remit spontaneously without treatment but on the other had, we know that among the people who do not, there is a very high morbidity and mortality. Addiction treatment applying ASAM criteria is multifaceted and highly individualized.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-82510553516491126722014-06-24T10:26:01.299-05:002014-06-24T10:26:01.299-05:00When an individual can respond to a patient's ...When an individual can respond to a patient's problem on a continuum, it is possible to construct an approach to that patient's problem.<br />When it becomes necessary to shove patients into boxes, some patients don't fit into any particular box. Those patients are then ignored, under the myth that "undefinable" is "untreatable" (especially if the definition is made by algorithm.) Not everything codes in ICD-10, or ICD-11 which is coming soon. <br />The approach is utterly backwards. If ICD-10 categories are "real," then a patient is something that fits into a pigeonhole under some sort of bijective mapping of a patient to a "defined real thing," i.e. a disease entity.<br />That's way too much precision for the real world. The patient is real; the diagnosis is something that's a cluster of approximations with a name.Anonymousnoreply@blogger.com