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Dive into a collection of past posts and rediscover timeless content.

Workforce & Economics

“I Charge $400 an Hour” Is Not My Hourly Rate

Aug 26, 2026

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9 min read

“I Charge $400 an Hour” Is Not My Hourly Rate

The arithmetic is right. The conclusion is not.

The Psychiatric Record
The Psychiatric Record

Policy & Regulation

“The REMS Is Gone” Is Not “The Monitoring Is Gone”

Aug 25, 2026

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10 min read

“The REMS Is Gone” Is Not “The Monitoring Is Gone”

A federal program ended. A label recommendation didn't. What disappeared between those two sentences was the system that noticed when the blood draws stopped.

The Psychiatric Record
The Psychiatric Record

Clinical Evidence

Lamotrigine Is Not a Diagnosis

Aug 24, 2026

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10 min read

Lamotrigine Is Not a Diagnosis

An Editor's Note on Mood Reactivity, ADHD Explanations, and Why I Keep Reaching for an Off-Label Drug

The Psychiatric Record
The Psychiatric Record

Clinical Evidence

“The PHQ-9 Came Down” Is Not a Response

Aug 23, 2026

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10 min read

“The PHQ-9 Came Down” Is Not a Response

A falling score is a signal, not a response or a remission.

The Psychiatric Record
The Psychiatric Record

Policy & Regulation

“The Non-Compete Is Banned” Is Not Your Contract

Aug 22, 2026

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16 min read

“The Non-Compete Is Banned” Is Not Your Contract

Neither “banned” nor “back” is the status of a clause. A clause has a governing law. A headline is not it.

The Psychiatric Record
The Psychiatric Record

Practice Operations

“Referral Placed” Is Not a Closed Loop

Aug 21, 2026

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10 min read

“Referral Placed” Is Not a Closed Loop

A placed referral is an open handoff until the result is in the chart and the patient knows.

The Psychiatric Record
The Psychiatric Record

Technology & AI

“I Used the Model” Is Not a Clinical Act

Aug 20, 2026

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8 min read

“I Used the Model” Is Not a Clinical Act

Using an LLM on notes, differentials, patient-facing text, or decision support is a draft step. It is not a documented clinical act, a cited source, or a supervised decision.

The Psychiatric Record
The Psychiatric Record

Technology & AI

“I Use ChatGPT Between Patients” Is Not a Workload Plan

Aug 19, 2026

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9 min read

“I Use ChatGPT Between Patients” Is Not a Workload Plan

Informal LLM use between visits is hidden labor, not a workload plan. A chat tab is not a clock, a draft, or a job with an owner.

The Psychiatric Record
The Psychiatric Record

Workforce & Economics

“There’s a Psychiatrist Shortage” Is Not a Compensation Model

Aug 18, 2026

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11 min read

“There’s a Psychiatrist Shortage” Is Not a Compensation Model

Demand for psychiatric care may be extraordinary. That does not tell a psychiatrist who captures the economic value, how much work is hidden outside the schedule, or whether a particular job is sustainable.

The Psychiatric Record
The Psychiatric Record
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The Psychiatric Record

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