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  #21

Hi all,

Hope you are doing very well.

Thank you usdreams for those criteriaes...I also tried to make a list but finally I decided to rank programs based on their friendly atmosphere and city...I will try to do an additional psychoanalysis and psychotherapy course after doing my residency...

I believe becoming a good psychiatrist mostly depends on you not the residency program.

Xenopus, I agree that there is a big business in psychiatry field but nobody can deny and ignore the positive effects of psychiatric medications in improving people's lives. I know some people with bipolar disorder who got much much better by taking medications and they now live like a normal person ( though who knows what are really normal and abnormal? ) but on the other hand you could see overdiagnosis of psychiatric disorders such as bipolar disorders and ADD, etc.
Psychiatry is a newborn science, it is not a pseudoscience. We cannot cure diabetes or HTN, we just control them. We also control psychiatric disorders and of course psychiatric medications could help a lot, but pharmaceutical companies and many psychiatrists take advantage of it and abuse this newborn science and they should be stopped!

Psychiatry is an exciting field. Some psychiatrists are alive DSM 100!!! I mean they are very creative and have their own methods in managing patients and could help many people to live a better life and it could be the most rewarding experience in somebody's life smiling face




  #22

Hi All,

The time is here for all of of us to play our dice. Its been an incredible journey whatever the result!!!!!!. Best of Luck.

usdreams.


  #23

hallucination wrote:
Hi all,
Xenopus, I agree that there is a big business in psychiatry field but nobody can deny and ignore the positive effects of psychiatric medications in improving people's lives. I know some people with bipolar disorder who got much much better by taking medications and they now live like a normal person ( though who knows what are really normal and abnormal? ) but on the other hand you could see overdiagnosis of psychiatric disorders such as bipolar disorders and ADD, etc.
Psychiatry is a newborn science, it is not a pseudoscience. We cannot cure diabetes or HTN, we just control them. We also control psychiatric disorders and of course psychiatric medications could help a lot, but pharmaceutical companies and many psychiatrists take advantage of it and abuse this newborn science and they should be stopped!

Psychiatry is an exciting field. Some psychiatrists are alive DSM 100!!! I mean they are very creative and have their own methods in managing patients and could help many people to live a better life and it could be the most rewarding experience in somebody's life smiling face


Certainly we're going to solve this problem here and now. For the sake of simplicity and because you're going to see many more things with your own eyes in the next years, probably I'd be more interested in hearing from you again 20 years from now. For the time being I just give you the benefit of the doubt.

Believing that out of the blue a significant portion of the U.S. population just became mentally sick and is in dire need of drugs...is insane. We can explain the obesity epidemic, and even treat with drugs...but we know who to blame: sedentary lifestyle & high calorie-high fat intake. There's widespread agreement on that, nobody denies it. Even non-industrialized societies are getting into the same trend (thanks to globalization).

But what is the cause of the mental disease epidemic?

I leave you with this question, knowing beforehand that properly answering it it's going to take more than a couple of posts. Actually it could take a lifetime.
Sincerely I wish you good luck with your studies...and please let us hear from you as you get more evidence along the way. smiling face


  #24

hallucination, sorry if I sounded too haughty. I guess what I wanted to say is that the social component is largely ignored from most of the mainstrain psychiatry. So please forget my words. Keep us posted on your progress, I know this talk will get better and not exactly on my side.


On Feb 22, 2011 - 2:12 PM, hallucination responded:

It's OK smiling face I need to learn a lot about this field...

I agree that social factors have been ignored somehow in this field..I think that some psychiatric disorders such as personality disorders should be removed from DSM IV ( I think we wouldn't have them in DSM V)... but, the other point is many of psychiatric disorders have always been there named mood swings, concentration problem, etc. They have been increased like many other disorders...heart attack, cancers, etc.

We need to acknowledge that there are some psychiatric disorders and we also should accept that there are some biological, genetic, social factors causing or aggravating them. In my opinion psychiatrists MUST take responsibility and consider all aspects of psychiatric disorders during management and treatment of them. We should not ignore social factors which triggering or aggravating psychiatric symptoms and at the same time we should pay attention to possible genetic and biological reasons.

I know a lady back home who had been considered for many years as a person with mood swings, hurting her family and herself...all were miserable for years and then she was diagnosed with Bipolar disorder, has been taking her medications for 4 years and now she lives and functions more normally...the whole family's life has been changed....A friend of mine never was a good exam taker, though I considered her a smart and knowledgeable doctor...she always told me she had difficulty concentrating at exams...she saw a psychiatrist, was diagnosed with ADD and put on Adderall ...
she had failed her step 1 twice and then she got 99 in her 3rd attempt after taking Adderall for a while... she told me she was very alert and concentrated this time, never experienced it before in her exams...
We know, what, is called social phobia has some symptoms could be controlled very well by Propranolol...why should we resist that some other symptoms could be relieved by SSRI?

Isn't it great if we could help some people function better in society? we should put ourselves in their situations to feel their pain...But I do agree with you that pharmaceutical companies along with many psychiatrists have been trying to abuse this field and for sure they only think about their business.

Other point is that most of the psychologists cannot stand psychiatrists smiling face This is a fact...they do not know medicine, they do not know biology...and they cannot understand that they are different from psychiatrists...

As you see in that documentary they try to shout the rarest side effects of psychiatric medications...the fact is you could see some of those side effects for any medication used for even simple disease like common cold..You also can see some psychiatric symptoms as an adverse effect of some medications like Anti- Malaria medications...so, for sure there are some biological factors that their imbalance for any reason could cause psychiatric symptoms...of course psychotherapy could be the mainstay of treatment for some psychiatric disorders and today we even know the neuroscience of psychotherapy and we know that if medications could have a general effects on synapses in the brain and cause some side effects, psychotherapy could make gene expression and similar but focal ( in spite of medications)changes in brain synapses without those side effects...but psychotherapy is not always possible or helpful... it takes lots of time...it is expensive and many people want to get a rapid response...so let's hope someday soon we could have psychiatric medications which could have less side effects...though we also need to fix this problem in other fields...
I think we should always consider pros and cons of different kinds of therapies including medications, psychotherapy, family therapy, etc and we should also notice that unfortunately it is not always possible to control or eliminate many contributing factors like social factors...it requests cooperation of government and many organizations with psychiatrists...we know no matter what is the main reason for a suicidal ideation, suicide usually happens after a sudden impulse...the main suicide tool is firearm...why should firearm's access be so easy? it is not fair to blame psychiatrists if a patient commits suicide after starting to take a mood stabilizer, because almost always psychiatrists announce their patient or her/his family of possibility of raising suicidal thoughts in first few days/weeks of starting a new medication...the patient could even commit suicide without taking any medication...we could even have sudden death as a side effect of many other medications.

I think the main goal is raising people's quality of life and it is not just psychiatrists' responsibility to educate people to look upon psychiatric disorders as any other disorders, though psychiatrists could play a big role.

Long story short , biological psychiatry is a new field, and of course it will take time to get stabilized, and it is every psychiatrist's responsibility to be very careful in managing people with psychiatric symptoms. They should not over diagnose patients..in deed some psychiatrists are responsible for worsening of stigma in society...


Thank you smiling face I would try my best to know psychiatric disorders...of course if I match smiling face


  #25

hi Xenopus,

I think this is interesting discussion about future psychiatry. You have helped us to think about our Chosen branch and it is shame that you are not in it. I saw some of your links which are interesting and heard elsewhere psychologists and psychotherapist and social psychiatrist's views.

These are my personal opinion and of Course I am new to the field. I have few argument for and against main stream psychiatry practice of today.

For,

I am sure many agree that there is a mental disorder whether it is in a developed or developing country.

Psychiatrists are trying to explain systematically what constitute a mental disorder and how to arrive at a specific diagnosis using DSM and ICD.

Psychiatrists have tried explaining the causes and all agree that there is not only biological causes but also psychological and social component. Hence the management is not only medication but also psychological and social support.

And I see genuine concern from medical community and there attempt to help patients with mental disorders.

The arguments in the links provided appear one sided, and the videos had interviews only with people who are affected but not from those who are benefitting or benefitted.

Against

I agree that some of the mental disorders like anorexia nervosa are less prevalent in developing countries. I have seen more and more parents and schools are pushing to get children labelled with ADHD, ADD and CD and treat with medications. I am sure many benefit but a lot more get unnecessary labels and treatment which is sad or put it bluntly abused. The other negative is personality disorder which I don't think is diagnosed and treated with medication at a rate, in developing world, as they are here.

We will come to your million dollar question" mental disorder epidemic" in this part of the world and as the world is becoming smaller place we have a imminent responsibility to ask ourselves who, what, when, where, why, how? now . Because tomorrow it is going to become a global concern.

I agree that there is real danger of over diagnosis and treatment. However I think it is wrong to blame only psychiatrists as portrayed in the paper. I am sure the pharmaceutical industry and politics played huge role in shaping the management of mental disorders, rightly and wrongly. There are other explanations like industrialization, isolation and stress probably responsible for increased prevalence.

Hence the solution:

You are right when you suggested to choose the program which offers right training. We have a enormous burden as future psychiatrists to correctly identify a mental disorder, and try to find the cause and help patients with new and innovative management. We have the responsibility to do research and ask ourselves if there is robust evidence before prescribing medication or any therapy for that matter. We need to offer psycho-social support in almost all cases to help patients and family the maximum, lessen disability and to prevent recurrence.

At the same time I urge all the psychologists, psychotherapist and social psychiatrists to come with a model to help us identify the mental disorder correctly, explain the causes and management rather than wasting time getting the license to prescribe medication and blaming psychiatrist for genuinely trying to help people. The claim that psychiatrists are trying to find genetic link only to suppress alternative explanations and treatment appears baseless. For example psychologists have devised CBT and are successfully helping neurotic disorders. And most of the psychiatrist and psychologists agree that the management for depression is both medications and CBT except for severe cases like psychosis . In such instances even psychologist do not attempt to treat them and rightly seek medical advice.

The psychiatry is lagging behind other fields of medicine in finding many unanswered questions and hence the controversies would only hinder the progress. If our aim is same why not work together.


On Feb 22, 2011 - 2:13 PM, hallucination responded:
good points smiling face


Edited by usdreams on Feb 22, 2011 - 4:29 PM. : grammer

  #26

Thanks hallucination and usdreams for providing such balanced and well supported views on psychiatry. I celebrate both of you taking a stand on this important & huge issue and I remain confident none of you will lose sight of it as you delve yourselves into the intracacies of the system. Because I celebrate physicians being able to see the big picture, I just recently opened a thread in the Lounge on a physician whom I admire deeply (Dr. Margaret Flowers, a pediatrician) for advocating the 'single payer' healthcare system (aka Medicare for all). As you can see from the interview with Bill Moyers, she says in the last 5 seconds...[that she is working on this fulltime because] "It's too important". This sentence strongly resonates as I watch the video already several times.

I agree with your views that on an INDIVIDUAL scale all physicians, psychiatrists and even psychologists are trying to help even if some iatrogenia gets done. However, what I found most troubling is that psychiatrists and all physicians for the matter, buy into the lies of the system...ignoring society as the major culprit, and focusing too much on the individual. It's society that is sick not the individual. There might be a few rare screw-lose individuals but to extend that view to an epidemic scale is a grave error. I'd recommend again Dr. Bezruchka's lecture. But why is so difficult to have alternative views? We are are busy as hell working on extremely competititve professions and rarely do we have time to examine the big picture. Also the lack of leadership troubles me and that's why usdreams sentence is particularly accurate:

"
usdreams wrote:
...I am sure the pharmaceutical industry and politics played huge role in shaping the management of mental disorder. There are other explanations like industrialization, isolation and stress."
.

Yes. these are big culprits but the most educated members of our society... the M.D.'s, the Ph.D. are buying into many lies, that 'the individual is sick, that the individual is successfully treated', on the thesis of the chemical imbalance of the brain, sometimes just to get a grant, to get a paper published, to file a patent, to get whatever coveted reward is offered by the big players. And this way physicians are becoming sheep (as I’ve referred to in other threads). Now that we're talking about it I can't help bringing the example of the physicists of Operation Paperclip... always keeping their job, just switching employer, not questioning anything, and just doing their job. And when they changed their minds, the damage is done...it's too late (Here J Robert Oppenheimer talks about the reaction to the atomic bomb by the members of his team http://www.youtube.com/watch?v=n8H7Jibx-c0).

I would hate to extend myself too much, but big lies are being perpertrated on the people of the world. Let me bring an everyday example: boingboing.net/2008/01/09/t.../tsa-searches-detains.html Like these, there are thousands of lies but we're so busy, no time for looking critically into this. Hey...I haven't finished my Kaplan Notes for the day...I've got tons to read. Sorry.. I have to go. I'll catch up with you guys later.



On Feb 23, 2011 - 2:35 PM, hallucination responded:
I understand what you are talking about...That's exactly the reason I told you sometimes I'm thinking about doing gardening or something like that...of course, no big money but at least I wouldn't be a sheep smiling face


  #27

One of the comments in the news:



Takuan:



"As an American once explained to me: "you know how they keep people tied to their shitty jobs here ? Health insurance. If you get fired or quit on principle, who knows when you will be covered again. And getting seriously sick without insurance means homelessness. That's how they keep people in line."

Would universal health care as they have in Canada and the UK help Americans find their courage again?"





disapprovalSo sad and true, people here stick with jobs they hate just because of the insurance....Isn't that like being a prisoner?!



  #28

doctor4usmle wrote:
One of the comments in the news:
Takuan:
"As an American once explained to me: "you know how they keep people tied to their shitty jobs here ? Health insurance. If you get fired or quit on principle, who knows when you will be covered again. And getting seriously sick without insurance means homelessness. That's how they keep people in line."
Would universal health care as they have in Canada and the UK help Americans find their courage again?"
disapprovalSo sad and true, people here stick with jobs they hate just because of the insurance....Isn't that like being a prisoner?!


Awesome testimony...pure truth. Thanks for bringing it up doctor4usmle. I notice that you're socially conscious. smiling facesmiling facesmiling face


  #29

Oh I WAS socially conscious, until I got into "immigrant survival mode" and mind only my own business...usmle.....job.....no days off...full time..part time....holiday shift...no time to take exam....pay your bills...usmle again......so i am rolling in this vicious circle and hope it ends some day....rolling eyes







xenopus wrote:


Awesome testimony...pure truth. Thanks for bringing it up doctor4usmle. I notice that you're socially conscious. smiling facesmiling facesmiling face



  #30

doctor4usmle wrote:
Oh I WAS socially conscious, until I got into "immigrant survival mode" and mind only my own business...usmle.....job.....no days off...full time..part time....holiday shift...no time to take exam....pay your bills...usmle again......so i am rolling in this vicious circle and hope it ends some day....rolling eyes


It won't.


On Feb 23, 2011 - 2:37 PM, hallucination responded:
I agree...it won't smiling face


  #31

yeah...i was thinking the same...so better get used to this...it's called "life"sticking out tonguegrin



xenopus wrote:


It won't.



On Feb 23, 2011 - 2:40 PM, hallucination responded:
I don't like to get used to it...Do I have to? sad


  #32

Hi Genius (Xenopus,I am giving you new name as you deserve)

God, I thought your discussions were challenging me my chosen specialty, psychiatry but you are far more sinister. Now I have started to think about life!.

Xenopus, I am getting the impression that you are not happy with the whole system and the society, how it is structured and the direction we all are heading. And our psychiatric practice and thinking is only one of the things you want to tackle. Am I right?

I will limit my discussion about the heath care and quality of life.

I have seen the NHS system in UK, yes there are obvious advantage in that the health care is free for all but don’t forget everyone are not happy. People don’t have much choice, waiting time is long and the rich country like Britain is struggling to fund the health care. People are not happy to fund treatment for drug and alcohol services, smoking cessation programs and few other life style dependent problems. Few suggested France model is better as there is universal health coverage and people have more choice and majority of health care is provided by public hospitals.

I think it is like “grass is greener syndrome”. Every system has inherent deficits and I am not sure it would that easy to change the whole health care system and as you’ve seen people didn’t support the Universal health care policy and the result “ the shellacking” as spoken by President Barack Obama.

Second is corruption I am sure the guys who are benefitting the most are not letting it go easily.

Third to change society we need to find why the society is breaking and can we stem the cancer out that is spreading and consuming everybody. To me it appears almost an impossible task; hey it does not mean we should stop! Realistically we need to go back to mother of all “the Politics” for a definitive and robust answer. The bottom up approach is time consuming and god knows whether we would live to see that day.

I know that in life there are three kinds of people, first are those who worry about the society and blame others. And second are those who want to do something about it but stuck for various reasons and there are these third type who do it and change the world for the betterment of the society. Most of us don’t want to be the first kind.

We are as disturbed as you are. Xenopus, Please stop torturing us! (Just kidding).


Conclusion, As long as there is privatisation of hospitals there is this grave risk of treating patients individually. And it may not matter in other field of medicine as it does in psychiatry hence we need to consider the whole family and society.

I will end my conversation here and assure you that

As a doctor, bound by the Hippocratic oath “ I will prescribe regimens for the good of my patients according to my ability and my judgement and never do harm to anyone”.







Edited by usdreams on Feb 23, 2011 - 10:29 PM. : grammer

  #33

usdreams wrote:
Hi Genius (I am giving you new name as you deserve)
you're kidding, that's a good start.

usdreams wrote:
God, I thought you guys are shaking only my application to psychiatry residency but you are dangerous.

That was the point (just kidding). The point being was to create awareness. Become aware first, then act, not the other way around. Please don't quit your application. Like I said to hallucination: get into the belly of the beast and make it blast into a million pieces. You can do more inside than outside. That's why if I happen to have some influence on you is now, later you'll have an influence on me because you'll be closer to the real thing. But once you implode the beast, the trickiest part is with what do you replace it with? Open question, hard to answer.

usdreams wrote:
Xenopus, I am getting the impression that you are not happy with the whole system and the society, how it is structured and the direction we all are heading. And our psychiatric practice and thinking is only one of the things you want to tackle. Am I right?


Partially right. But certainly not happy at all, in fact, sometimes I do get depressed, no thanks, no SSRIs. But being here, preparing for my Steps was a long fight with many demons. Now let me go back to society. Humankind is inherently structured to collapse. In fact, all living organisms are destined to collapse especially if they deplete their resources (and we're doing just that, sustained economic growth as the paramount model of development in a finite planet with limited resources). But since collapse is unavoidable from an animal point of view, I just thought because we're the smartest species we'd somehow counteract it. But pulling this trick is supernatural. Nature has a more simple way: letting a population die off, that's more natural. And so collapse it's everywhere, its slow enough for people not to see it, however fast enough for 100% of American citizens to be contaminated with dioxin, an industrial waste now rated as the most dangerous organic pollutant among the POPs
(persistent organic pollutants). Regarding collapse I see it, I see it everywhere and everyday, even in the forum: physicians from all over the world trained by their countries oftentimes with taxpayer paid subsidies for the benefit of Uncle Sam and struggling like we are to achieve a dream forbidden in our countries even if these already paid for it (http://www.nejm.org/doi/full/10.1056/NEJMsa050004 and http://www.nejm.org/doi/full/10.1056/NEJMe058188). At the end, I don't know the outcome.

Now, I don't tackle just psychiatry, I tackle everything according to my possibilities, being these few and limited, that's what you can expect from me. But there are courageous people out there... whose snipets I do bring from time to time. And knowing that here in the forum there are many good people too, it comforts me to invest time on this exchange: to talk to them if they happen to read this thread.

usdreams wrote:
I will limit my discussion about the heath care and quality of life. I have seen the NHS system in UK, yes there are obvious advantage in that the health care is free for all but don’t forget everyone are not happy. People don’t have much choice, waiting time is long and the rich country like Britain is struggling to fund the health care. People are not happy to fund treatment for drug and alcohol services, smoking cessation programs and few other life style dependent problems. Few suggested France model is better as there is universal health coverage and people have more choice and majority of health care is provided by public hospitals.

I think it is like “grass is greener syndrome”. Every system has inherent deficits and I am not sure it would that easy to change the whole health care system and as you’ve seen people didn’t support the Universal health care policy and the result “ the shellacking” as spoken by President Barack Obama.


We were educated and we can reason in our minds that 10 divided by 5 is 2 (10/5=2; something like a cake of 10 pieces divided into 5 people 2 pieces for each one). Even if mathematically correct, we accept social inequality as the rule. Although in practice is an unachievable goal, at least we could get closer to it, like an asymptote getting close to the X axis without touching it. In contrast, everyday we live in a more polarized society...one that we rarely question it, and one that we do little about.

One of the lies we believe is that we need a new system, that we just need 'the right system'. And experts do bring us new models, new updates, they twitch here and there, and so we keep hoping someday they find the right one. But not true. Single payer or any arrangement of fair distribution is like the equal division we learned in school (not the unequal division we deeply believe for political affairs). It's mathematically sound, logically correct and we can get close enough to it if we participate. Let me repeat it: If we participate, it has be grassroots, from the bottom up. That's the key to democracy. But if we remain as spectators hoping for experts to find us 'the right system', we're are doomed. Just to round it off, any system even the most fair won't stand sustained and relentless growth. That's why the Canadian single payer healthcare system (and possibly the British one as you mention) is starting to fail. Nothing will stand an unstoppable need for resources, no system regardless of its proper design will stand the cancer of relentless growth. So the problem is not the system, it's sustained growth. Now it doesn't mean that we should contend ourselves with an even worse system of unequal distribution. We should still look for the best one, so far single payer is the way to go.

Universal healthcare will get to America. Mandatory, universal mandate. According to Obama's bill, you have to buy health insurance. It's like you have to buy a Toyota. Of course Toyota will make tons of money. So universal healthcare will come, is coming to the benefit of whoever sells insurance. Please notice is not doctors who'll benefit, these being a step below in the food chain they'll get whatever trickles down. Patients will get even less. But single payer is another story. In fact, there's the story of a guy who was a fervient advocate of single payer healthcare and one day he died in a car accident and went to Heaven. When he first saw God, he asked him "God, do you think America will ever get single payer?". And God carefully thought for a moment and said "Yes, America will get single payer...but not in my lifetime".

I planned to write more about the healthcare system but this topic is huge. It can not be tackled unless we cover some basic ground first; so I'd suggest to address it one piece at a time, especially because it fits perfectly with your next sentence "Second is corruption I am sure the guys who are benefitting the most are not letting it go easily.". Let's take a look at this key piece (from insider whistleblower Wendell Potter). Please enjoy.
http://www.pbs.org/moyers/journal/07102009/watch2.html

Last, you provide 3 examples of people: the ones that complain, the ones that try to do something but can't, and the ones who actually do something. The question is how are you going to do something if first you don't become aware? Reading between the lines I captured that you possibly rate me as the first kind of people, a complainer. Well, let me tell you: my political statement, with links, references and support is not a complaint. It's a statement, a political one. It might sound like a complaint because that's how most people have been trained to perceive them, but its real intention is to make people aware. First become aware, then act. usdreams I know that you didn't mean to offend me but I'd like to clarify. Actually the real problem are people who don't complain. These are the inertia, the burden of the system...the ones that need to be pulled by the ones who are doing something. Possibly this is why Martin Luther King Jr said to 'love your enemy', he meant to love even those politically wrong, who oppose you or remain disengaged. So in that regard complainers are one step ahead. And if the price of democracy is a bunch of complainers, so be it.

I wellcome your thoughtful remarks. Doing this, even if neither myself or anybody gets it right, it's a good exercise on democracy.




On Feb 24, 2011 - 9:07 AM, hallucination responded:

But once you implode the beast, the trickiest part is with what do you replace it with? Open question, hard to answer.

Exactly! I am from Iran...back home our people have been protesting government since last year to redeem their human rights...being killed...they know what they don't want but they don't know what's the next step even if they could implode this government...they just struggling to gain democracy...it's saddening...unfortunately history repeats itself...

The question is how are you going to do something if first you don't become aware?

Totally agree.

it's a good exercise on democracy.

I'm not sure if democracy is the best system...because the majority doesn't always know what is the best...after educating people and after raising awareness, democracy could be a good system...

I don't want to offend anybody, but as a spiritual nonreligious person who just believe in God, I consider religious as the root of most of the problems in the world...just think about it with an open mind and without any prejudice...Again, I don't like to offend anybody, it's just my opinion.

“Those who say religion has nothing to do with politics do not know what religion is.” Gandhi


Thanks guys...have to study for step3



Edited by xenopus on Feb 23, 2011 - 11:46 PM

  #34

Sorry Xenopus, I should have separated your notes from mine smiling face


  #35

hey xeno my friend....thx for all ur time and the links for us.....

after watching the video with the volunteers in Virginia i did a search and found so many......this is a real shock, cause is one thing to know that something exists and is so different to see it with ur own eyes! i will post the link in the lounge section, about uninsured in america; i will also look for a link for sicko,maybe.... just maybe there is somebody who didn't see the movie yet.


@ hallucination: I agree with u, religion is the root of most of the problems in the world. Actually religion and politicians are responsible for this mess here on earth.... I admire this doctor, he worked in emergency medicine, but somehow he managed to go straight to the root of all the problems: things cannot change and we cannot fight this financial crisis if we are not aware or we constantly suppress the truth....we cannot function as long as we know that there are resources out there but we cannot use them, cause we are not allowed to........ I really admire him cause he is not afraid of being ridiculed!!! Humans are still primitive creatures and very violent. Is sad but is the truth. Humanity is facing this financial crisis because is full of 'sheep', as xeno says.......they dont talk about it, is more important to keep the job than to save ppl who die of starvation.

www.youtube.com/watch?v=c9i...re=player_embedded#at=2830

ok,back to study!!!
all the best guys


  #36

Hi Xenopus,

I am not sure how to start and end, as the discussion has gone out of psychiatric practice. I want to clarify that you are not the complaint type at all .You are a fighter, more precisely close to the third type. My attempt is sincere and I am learning and contributing that is all.

Thanks for the links. I always want to limit the discussion how to provide best care possible and not to venture out. I want to tread carefully here and don’t want to upset anyone.

The journals rightly depict the picture about Brain drain of doctors, nurses or other professionals. Brain drain is becoming more of ethical question than political and economical [keeping India as a major provider). Why would the developed world imbibe professional even when they know that it is going to affect the services in third world? In Britain they used this tricky argument when there was crisis with too many doctors and change the law. And at times of need they would allow many doctors and keep quite on this ethical question. Who would buy it? If you say we are educated people and need to know that our country need us (ethical question). Then I would argue the permanent and effective solution is with the Indian government who has to do more to train, and retain doctors by providing right opportunities. If you target the individual doctor by bottom up approach you already lost the game. So I was suggesting the top down is the best approach in such scenarios.

I am not saying bottom up approach is weak but in contrast it could result in revolution like that n Egypt recently. The circumstances were dire the regime was affecting everyday life of millions of people. Now here we are talking about the health care “reform” not health care “revolution”. So if you are talking about revolution we need to reach people and educate them. As an individual doctor you are right we need to understand what is the best system and then fight for it. I support you in developing awareness in forums, hospitals, and when it is time we all should “go to the mattresses”. At the same time identifying and supporting the politicians who are supporting our agenda is vey important. We have no socialist party who supports “revolution” so the next best is democratic who believe in “reform” so I am not sure we have a choice.

Hey Hallucination Thanks for bringing Gandhi and only few can live like Gandhi.

“It’s the action, not the fruit of the action, that’s important. You have to do the right thing. It may not be in your power, may not be in your time, that there’ll be any fruit. But that doesn’t mean you stop doing the right thing. You may never know what results come from your action. But if you do nothing, there will be no result”.
~ Mahatma Gandhi

“Always aim at complete harmony of thought and word and deed. Always aim at purifying your thoughts and everything will be well”.
~ Mahatma Gandhi

Usdreams


  #37



If you target the individual doctor by bottom up approach you already lost the game. So I was suggesting the top down is the best approach in such scenarios.

As an individual doctor you are right we need to understand what is the best system and then fight for it. I support you in developing awareness in forums, hospitals, and when it is time we all should “go to the mattresses”.




Good points usdreams smiling face








  #38

@hallucination, I agree with your points, gaining democracy in one thing, maintaining it is another. Education is a MUST to enjoy the fruits of democracy, otherwise it might degenerate into dictatorship. The quote from Gandhi and your assessment of religion is also very accurate, I couldn't have put it better myself. But there's one exception although is contained also in the wise quote from Gandhi you brought here. It turns out that you can use religion to build a political movement to your advantage. This rather underutilized exception was the one that allowed the Libertarian Universalist Association to publish back in 1971 the "Pentagon Papers" (the equivalent of today's Wikileaks release) and seek protection under the freedom of religion amendmedt. Similarly some people use religion to refuse State ordered compulsory vaccination argumenting a religious right. So it's like using bullshit to counteract another bullshit.

So the moral of the story is: never underestimate the power of bullshit.
--
I'm glad having participated in this thread...it brings me peace to know that in the field of psychiatry we have at least two inquisitive and truth-seeking minds (hallucination and usdreams)... so I can rest now.

@anunnaki, thanks for the link, I'll be watching it. Thanks also for posting the Sicko documentary. I agree these issues of healthcare systems deserve a closer look.


  #39

Usdreams,
You’re right our discussion has spilled into other topics because the imbalances are systemic. So no wonder we’ve touched a lot of bases already. I know your words are kind and sincere, I just wanted to reiterate that is alright to raise awareness even if it might sound as a complaint.

This topic about brain drain of doctors I still don’t know how to feel about. I’m one of them and I know is a fact of life that will continue to create imbalances and that’s why my quasi-desertation about ‘sustained economic growth’ and collapse (especially also triggered by your words about the direction to which we’re heading, in my view we're heading to collapse). I’m still trying to understand what the ultimate reason is why the U.S. spends so significant amount of resources in training IMGs…it might not be just because the domestic production of doctors is insufficient… with some frequency we see cases here in the forum of U.S. citizens struggling to find a residency spot. In one of my trips to the library several years ago I found an old policy document probably from the 1970’s where it depicted the need to recruit more foreign students (not just doctor-wanna-be's) to spread the American culture and way of life and compared it with the number of applicants accepted in Soviet Union schools. This policy paper further made recommendations of allocating funding and setting up the legal environment under which that could be attained. Unfortunately I don’t recall any specific clue about how to recover this document. At the time I didn't have the political awareness I have today but it made a lot of sense since these two superpowers had (have) imperialistic aspirations. Bottomline I can’t rule out now the political question. Is it an economic issue?…for sure. Ethical for sure too as you discussed so clearly. Now if other reasons are used to sell it or countersell it, well I don’t know, advertising is so creative.

I support reform or social change even if it doesn’t bring us to the desired goal precisely for reasons that are more brilliantly and beautifully articulated by the Gandhi quotes you brought. Worth repeating:

“It’s the action, not the fruit of the action, that’s important. You have to do the right thing. It may not be in your power, may not be in your time, that there’ll be any fruit. But that doesn’t mean you stop doing the right thing. You may never know what results come from your action. But if you do nothing, there will be no result”.
~ Mahatma Gandhi

“Always aim at complete harmony of thought and word and deed. Always aim at purifying your thoughts and everything will be well”.
~ Mahatma Gandhi

Thanks a lot.


  #40

Hi Xenopus,

Thank you. I am not sure I have an answer. The immigration is complex issue. The Brain drain could be seen from individual and government perspective.

At individual level one should ask themselves what are your dreams and aspirations, what is the most important thing in your life, are you happy with what you are doing, are you sure what you doing is right. It is very personal and if you think taking all this hassle (USMLE) is worth it so be it. This is depicted well in the bollywood movie Namesake.

Why should US government pay for IMG doctors training? I heard it from all developed world they have this ideology of training doctors in order to help their countries in providing the best care possible and this is what they diplomatically say to the Indian government in justifying the import. How many doctors really believe that and you could do a survey on this forum asking doctors why are they coming to USA? My guess is that majority says they want to get the best training but not to go back. And if they do I wouldn’t believe they do to improve the health of our nation. Even if the reasons are like that shown in Bollywood movie Swadesh I would still be happy. I think it is time that all developed nations should come clean why they are so much dependent on the foreign professionals.

I don’t believe in these controversies as long as there is simple explanation. Why do you think US and other developed countries are outsourcing software jobs and other businesses to India and china. Why are they importing all the ready-made household items from china? It is simple economics! I believe when there is need to bring the trained doctors or professional from other countries and is economical, they allow migration of skilled people, period, end of story.

However I heard more problems from engineering field in USA and UK where university lobbyists are filling university seats with foreign students especially from India and china and locals were very worried about jobs as the students are staying in the country too long and competing after graduation.

Solution:

At Government level, as I said if they are worried about doctors leaving then they should do something about it. I haven’t seen Indian Government taking robust initiative at all. Next we will discuss about US, and other developed countries, here the institutions, state Boards, and immigration department should liaise to check how many posts are unfilled by locals each year and allow equal number of doctors to train in US. I thought US is well regulated compared to UK as I can see from match there is great disparity between AMG’s and IMG’s getting into placements. And if the local doctors are not getting the job they should take it to the representative of the house. In UK the institutions by law couldn’t prefer locals over IMG’s hence it was a big issue for locals however recently they changed the law.


Do not worry, I heard the immigration department are already looking into how many work permit visa they could issue. In Britain they are looking into changing visa for foreign students so that they are made to leave as soon as they finish their training. Here I heard that they are looking closely the need for exemption of H1B cap for teaching hospitals and university affiliated hospitals and I also heard they are going to issue only J1 visa only for IMG’s very soon. (please don't spread bull as I can't confirm for sure)

In Australia they introduced point-based system immigration of professionals hence it is also better regulated.

At the end of the day we are economically productive young people who work hard and contribute to the economy even while training. I guess the institution would have the advantage of subsidies and funding from central reserve if they get status as training institutes. So I wouldn’t worry about the cost they spend on us because most of the IMG who get training settle here so it is a loss to the home country more than the burden to USA. I think the burden for these developed countries is from “illegal immigrants” and those who depend on the benefits and resources. Don’t get me wrong; I have enormous sympathy towards “illegal immigrants” as they are not as fortunate like us with money, education, family and political stability for being “legal”.

At the end of the day I follow this simple principle, everyone has liberty and right to move around and explore and so enjoy while you can, learn when you could and help others on the way.

If all these didn’t help I will hum John Lennon song before going to bed.

Imagine there ‘s no countries
It isn't hard to do
Nothing to kill or die for
And no religion too
Imagine all the people
Living life in peace

You may say that I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as one


Usdreams



Edited by usdreams on Feb 25, 2011 - 4:16 PM




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