Forensic pediatric neuropsychiatrists, tell us about your day to day life and what you think of your specialty!

Well, as my flair states, I'm usually a pathologist but I do moonlight twice (sometimes thrice) a week in a FPNP job. It's not an easy residency by any stretch, since the entire continental US requires only one such specialist, you pretty much have to wait for that guy to retire/die before you can get a job. That wasn't such an issue for me since I used to be a patient of my predecessor before his unfortunate passing (more on this later), so I had my connections.

Because there's only one FPNP for the entire country I spend a lot of my time in my private plane, flying state to state and visiting the numerous unfortunate children incarcarated in the various maximum security juvenile detention centres. Once I check in my baton (I moonlight as a police officer), handcuffs (dominatrix), and calculator (accountant) at the reception, I'm ready to roll.

I tend to see the kids in an one-to-one setting in the interrogation wing, by which I mean watched over by four burly security guards. Now remember these kids are the worst of the worst the society has to offer - sociopaths, murders, grand theft auto (video game addicts), arsonists, bed wetters - but who the district judge has deemed rehabitable via an intensive (two sessions) FPNP program. It is hard work! Imagining trying to take a smoking history from a slobbering five-year-old boy, incarcerated for peddling cocaine at the local daycare, all the while waving a rattle and singing the Pokemon theme song to keep him focused. Because the subjects are so young, it is very easy to become attached and empathetic. That is the mark of a poor FPNP specialist. These children are born from the demon's loins and their affable persona is an attempt to deceive. Thus, even though rapport is important to elicit easy (but useless) history such as foreign travel and psychotic symptoms, I always remember to ask closed, intimate questions, mainly about how they feel about their parents and fellow inmates. From my personal experience with my predecessor, I know to keep at least six feet from the child at all points during the interview (more on this later).

After a brief history, I normally skip the physical examination since I have been banned from touching children in eight states (two are pending). Due to the spartan resources available in most correctional facilities further investigations are difficult to perform, but I can normally obtain an excrement sample from the child with relative ease, by scraping it off the walls post interview. The routine bloods, EEG and MRI are skipped.

Treatment of these children is often difficult due to insurance hurdles, and the only treatment available in prisons is electroconvulsive therapy, as adminstered via electric chair at a quarter of the voltage. I ensure all my patients receive this treatment, and I am led to believe it is very effective since by the time I return for my followup visit, most children have been discharged (or released, depending on how you look at it) on a good behaviour bond.

/r/medicine Thread