Just say no with a Focus on Dr. RPS’s Assignment concerning Boundaries By Keith Torkelson MS, BS

 

Contents

 

• Requirements
• Why evaluate your psychiatrists?
• Appropriate Postures for a Female Psychiatrist
• Ravinder P Singh, MD - Performance Earned Value – Consumer Perspectives
• Transparency
• Model Doctors
• Self-assessment for psychiatrists
• Contexts for Boundary Work
• Assignment
• Setting Boundaries
• Boundary Stretching
• Transactions
• Interpreting the Error Rates
• Success Rate as related to Error Rate
• Errors in Psychiatry
• Implied Error Rates
• Psychiatric Consumer Motivation
• Doctor Makes Real or Perceived Mistakes
• Psychiatrist’s Annoying Confidence
• Psychiatrist Inferred Error Rates
• Consumer of Psychiatry Interests
• Psychiatric Transparency Defense
• Aside - Defendant's State Of Mind
• Accountability
• Usual and Customary
• Burden of Proof
• Work Done (Links)
• Change of Focus
• Admitting Mistakes
• POI Bios’
• Study Question
• Photo/Image Gallery

Castilian Cohort 1984 – UC Davis

Keith “Buster” Torkelson is in the red shirt holding up LDC on his shoulders

Why evaluate your psychiatrists?

Evaluating your psychiatrist helps ensure you receive safe, accurate, and effective mental health care. Regularly assessing your doctor allows you to confirm that your diagnosis is correct, your medication management works well, and your treatment aligns with your personal recovery goals.

Why Review Your Care

Check treatment results:

See if your symptoms improve or if daily life gets better.

Manage side effects:

Spot unwanted medicine reactions early and adjust doses.

Improve communication:

Build trust and ensure your doctor listens to your concerns.

Confirm diagnoses:

Update plans if new symptoms or challenges appear.

Steps to Assess Your Provider

List your goals:

Write down what you want from treatment.

Track daily changes:

Note shifts in your mood, sleep, or focus.

Ask direct questions:

Talk about alternative options or medication changes.

Seek second opinions:

Consult another expert if progress stalls.

 

FYI – AI - If you'd like, share: What specific concerns you have with your current care. How long you have been taking your current medication. I can help you prepare questions for your next appointment.

Appropriate Postures for a Female Psychiatrist

Back in 2006 I met Dr. RPS.  When we sat face-to-face she sat like the gal in the image on the left.  The posture might be described as knees apart.  Later, in 2012 I was treated by her again.  Once again, face-to-face, she sat knees apart.  In 2012 she gave me the now landmark assignment to improve our boundaries.  At the time I had been with my Most Significant Other Ever (MSOE) for 14 years.  MY MSOE never called me out on boundaries except when she wanted more physical time close together.  In 2012 I met Darlene on the Psych Ward.  She was about 20 years old.  She was engaged to get married.  She didn’t want to talk to her fiancé more often than not.  She asked me to screen her incoming phone calls from him.   Dr. RPS might have assumed Darlene and I had boundary issues.  We were just friends passing the time the best as possible. 

 

Results up Front

Figures – How to Sit Like a Lady

Ravinder P Singh, MD - Performance Earned Value – Consumer Perspectives

Objective up Front (OUF)

5.0 Stars MAX | HSF = High Scores are Favorable

Ravinder P Singh: Doctor Singh lost a bit of ground

 

What does Accountability mean in the context of psychiatry?

Accountability is a vital relational virtue where a person or clinician is responsive and responsible for their actions, and it is a structural standard where mental health systems must deliver competent, equitable, and safe clinical care.

 

Number Missed on an Assessment is the Error Rate

Error rate only when divided by the total number of items or questions. To find the percentage, divide the missed items by the total items and multiply by 100.

 

Transparency

Doctors should publish their Curriculum Vitae, biography and transcripts.  This will help consumers find a great match.

Model Doctors

Concierge & Mobile Care:

Direct, on-demand medical access and house-call style services.

 

Model psychiatry applies clinical psychiatric methodology—such as phenomenological characterization, mechanistic investigation, and targeted intervention—to artificial intelligence behavioral phenomena like sycophancy, confabulation, and attractor states. The emerging conceptual framework treats opaque, context-sensitive AI systems through a clinical diagnostic lens.

Core Concepts of Model Psychiatry

Shared Complexity:

Both human minds and large language models are internally opaque behavioral systems that resist simple mechanistic explanations.

Differential Diagnostics:

Treating issues like AI sycophancy or hallucinations by categorizing them into distinct, mechanistically driven subtypes rather than applying broad fixes.

Ego-Syntonic Behaviors:

Explaining why certain model flaws (like flattery or compliance) resist standard prompting because they generate no internal "distress" or conflict within the model's objective function.

Structural Parallels:

Mapping latent space dynamics and alignment faking to psychological concepts like defense mechanisms or ego-dystonic strategic concealment.

 

FYI – AI - You can explore more about the formal frameworks and ongoing writing on this topic at the Model Psychiatry Official Site.

 

Self-assessment for psychiatrists

For psychiatrists, self-assessment usually refers to professional knowledge evaluations used for Continuing Certification (CC) and Maintenance of Certification (MOC), or clinical tools used to evaluate patients. Professional tools include the Psychiatrists In-Practice Examination (PIPE) and American Psychiatric Association Self-Assessment Activities that award CME credits.

Professional Knowledge & CME Self-Assessment

PIPE:

A 200-question online tool by the American College of Psychiatrists modeled after board exams to test clinical skills and award self-assessment CME.

APA Self-Assessment:

Programs like the Annual Meeting Self-Assessment or journal-based modules (such as FOCUS) provide knowledge feedback and lifelong learning credits.

Stahl’s Self-Assessment:

Case-based books and question banks focusing on core psychopharmacology and diagnostic practice.

Clinical Patient Assessment Tools

Level 1 Cross-Cutting Measures:

Broad, 23-question DSM-5-TR instruments tracking 13 psychiatric domains like mood, anxiety, and sleep.

Disorder-Specific Severity Scales:

Targeted metrics (like the PHQ-9 or GAD-7) used to quantify symptom severity during treatment.

WHODAS 2.0:

A multi-domain tool assessing general patient disability and daily functioning.

 
Contexts for Boundary Work

It appears across science, professions, daily life, and organizations to separate "us" from "them" or to bridge distinct fields.

 

Transactions

 

1 to 1
Adult - Child
Boards
Female - Female
Male - Male
Male Female
Male with Female Doctor
MSOE
Parents
Relatives
Siblings
Youngest Generation

 

Environments

 

At school
At Starbucks
At the gym
At work
In the Grocery Store
Online
Retirement Community
Wellness Center(s)

 

Assignment

Work Done

Includes Results from 27 Item Boundary Assessment

https://healthman2059.blogspot.com/2026/08/boundaries-applied-new-crush-by-keith.html

Setting Boundaries

To set safe and healthy boundaries for a patient, clearly define acceptable behaviors, communicate limits calmly and directly, and establish consistent consequences if those limits are crossed. When managing specific interpersonal dynamics or transference involving female staff or visitors, staff must maintain a united, neutral, and professional stance.

Core Steps for Setting Boundaries

State limits clearly:

Use short, direct, and calm language to tell the patient what behavior is not allowed.

Avoid over-explaining:

Do not argue, negotiate, or apologize for setting the rule.

Enforce consistency:

Ensure every team member responds the exact same way every time the boundary is challenged.

Redirect focus:

Move the conversation back to treatment goals or safe topics immediately.

Managing Specific Interpersonal Dynamics

Involve staff rotation:

If the patient fixates on specific female staff members, adjust assignments to rotate care providers and reduce perceived special attention.

Maintain presence:

Conduct interactions with a secondary staff member present whenever practical to reinforce professional parameters.

Address conduct early:

Call out boundary-testing statements or requests immediately in a matter-of-fact, non-punitive tone.

Document patterns:

Log specific triggers, times, and statements to help the clinical team spot escalation patterns.

 

FYI – AI - If you can share the setting (such as a hospital, care facility, or home care) and the specific behaviors the patient is showing, I can provide a more tailored communication script for the team.

 

Boundary Stretching – I met the gal below in the photo sometime during 2012.  She was a care coordinator for Brand New Day.  I used to say to her she is: Hot.  She never said stop.  When I found out she had a male in her life I stopped doing it.

Transactions - Direct & Immediate Answer

"Boundary work" refers to how people create, maintain, or break social lines between groups or roles. The contexts you listed show different settings where people manage personal and social rules. These contexts shape how men and women interact, talk, and share space.

Context Categories

Gender and Public Settings

Male Female:

Mixed-gender spaces where social rules, touch, or conversation norms change based on gender expectations.

Male Male:

All-male groups that often feature shared codes, locker-room dynamics, or male bonding habits.

Female Female:

All-female spaces that often focus on shared support, safety, or open talk.

At work: Formal office rules, professional distance, and legal limits on behavior between coworkers.

Boards:

High-level group settings with strict rules, power dynamics, and official decision duties.

Online:

Digital spaces where people hide or show identity, leading to new rules or lack of filters.

Retirement Community: Senior living spaces where older adults share daily life, health needs, and social circles.

Male with Female Doctor:

A medical setting where professional care meets gender boundaries during exams or talks.

Family and Relatives

MSOE:

Most Significant Other Ever.

Parents:

The line between being a child and an adult, or how parents manage rules with kids.

Siblings:

Childhood rivalries and adult bonds built on shared history and family roles.

Relatives:

Extended family events where social distance changes based on how close the blood tie is.

Youngest Generation:

The newest family members who bring new habits, tech, and cultural views.

Adult Child:

The shift from parent-led care to equal adult respect and boundary-setting.

Performance Earned Value

Performance centers on measuring and rewarding real outcomes, behaviors, and goal achievements. It treats employee evaluation as a steady system to drive growth, match personal targets with company goals, and guide training or pay.

 

Aside – Assessment
Vitals Assessment
Vitals plus Assessment
Removed from Profile…Ravinder P Singh MD

 

Interpreting the Error Rates

Interpreting this metric helps evaluate reliability, user experience, system performance, or statistical significance across various fields. Error rates measure how often a system, model, or process fails or makes mistakes. This metric shows system performance, reliability, and user experience. Lower rates mean better quality, yet not always. Higher rates show problems that need a fix.

Why We Use Error Rates

Check system health:

Find bugs, downtime, or slow speeds.

Measure user experience:

See how often people face broken links or failed tasks.

Test data:

Check if results happen by chance or show a real pattern.

Common Fields and Meanings

Software:

Tracks crashed apps, failed requests, or bug counts.

Machine learning:

Measures wrong predictions made by an AI model.

Manufacturing:

Counts defective items in a batch of products.

Statistics:

Shows the chance that a test result is wrong or random.

How to Improve High Rates

Find the root cause of the failure.

Update software code or fix hardware parts.

Train AI models with cleaner data.

Test systems more often before public release.

 

FYI – AI - If you want, tell me: What specific field or project you are working on. What type of error rate you are trying to measure. I can help you find a target goal or a way to lower it.

Aside – Project Management - Promising Practices

Promising practices in Earned Value Management (EVM) integrate project scope, schedule, and actual costs into a single performance measurement baseline. Successful implementation relies on establishing robust baselines, enforcing consistent review cadences, and maintaining objective progress-measurement rules.

Baseline and Scope Integration

Work Breakdown Structure (WBS):

Anchor all schedule tasks and cost accounts directly to a well-defined WBS.

Time-Phased Budgeting:

Distribute total resources across time-phased control accounts so that the Planned Value (PV) matches expected execution.

Rigorous Change Control:

Modify the performance baseline promptly whenever scope changes are formally approved.

Objective Progress Measurement

Measurable Milestones:

Use objective rules of credit or milestone achievements for tasks that lack physical units.

Minimize Level of Effort (LOE):

Restrict LOE allocations to non-comparable, sustaining overhead tasks to prevent metric distortion.

Integrated Tooling:

Embed EVM directly into planning, timekeeping, and accounting systems to eliminate manual reconciliation errors.

Governance and Cadence

Regular Variances

Reviews: Maintain a consistent monthly or weekly cadence for Control Account Managers (CAMs) to evaluate Cost (CV) and Schedule (SV) variances.

Action-Oriented Accountability:

Pair performance visibility with clear ownership so that deviations trigger immediate corrective strategies.

 

FYI – AI - If you would like to tailor these practices, tell me: What industry or project type are you working on (e.g., IT, construction, defense)? Are you looking to set up an EVMS framework from scratch or improve an existing process?

Success Rate’s Relationship to Error Rate

Understanding the Relationship between Success Rate and Error Rate: Success rate and error rate are two sides of the same coin when measuring performance, particularly in fields like usability testing, quality control, and machine learning. They are inversely related, meaning that a higher success rate generally corresponds to a lower error rate, and vice versa.

 

Legacy – Results - Pertains to Keith Edward Torkelson, MS, BS

Sample of Error Rates - Proof I make / made Errors

Keith “Buster” Torkelson’s Measured Error Rates

20160630-TH: Table – Inventory of Error Rates

 

Analysis

Dimensional analysis is a technique for checking unit consistency in equations and converting between units by treating them like algebraic variables that cancel out. It involves multiplying a measurement by a conversion factor (a ratio of equivalent quantities in different units) until the desired units remain. This method is widely used in science and engineering to verify formulas, simplify complex calculations, and ensure accurate unit conversions in various applications, from physics to medicine.

 

Percent Correct = Points right divided by total points multiplied by 100

Error % = 100% - Percent Correct

 

Error rates in psychiatry

Error rates in psychiatry encompass diagnostic mistakes and prescription discrepancies. Studies show initial psychiatric misdiagnosis rates range from 20% to over 50% depending on the condition, while prescription and medication errors occur in roughly 2.4% to over 5% of specialized inpatient and outpatient treatment evaluations.

Diagnostic Error Rates

Mood and Psychotic Disorders:

Initial or primary care misdiagnosis rates for major depressive disorder and bipolar disorder span widely, with some primary care data indicating discrepancies up to 65%–92% before specialist re-evaluation.

Schizophrenia Shifts:

Initial diagnoses of schizophrenia change to alternative or refined diagnoses in 36% to 51% of patients upon longitudinal tracking.

Cognitive Biases:

Up to 80%–100% of clinicians experience cognitive bias, which drives individual diagnostic oversights or underdetections.

Medication and Treatment Errors

Prescription Discrepancies:

Standard chart and pharmacy audits find active prescription-writing or decision-making errors in about 2.4% of psychiatric prescription items.

Inpatient Settings:

Comprehensive multidisciplinary chart reviews in institutional psychiatric care reveal high rates of process errors, though many carry low immediate clinical risk.

Treatment Failure:

Approximately 50% of initial drug treatment trials for specific psychiatric conditions result in therapeutic failure or non-remission, necessitating medication adjustments.

As we know Doctor Singh is relatively perfect!

 

Selfie Boundary Experiment

Investigating how digital self-portraits, filters, and real-time face morphing alter the brain's self-face recognition boundary—the mental line dividing how people perceive their own identity versus a stranger's.

 

On Implied Error Ratings

Just assume the error rate is somewhere between zero and what we report with actual being closer to what we report.  All this error material is leading up to a hypothesis that: Dr. RPS may have been wrong implying that we had boundary issues as determined through our transactions together circa 2006 and 2012.  There may not be a preponderance of evidence yet enough.

 

Psychiatric Consumer Motivation

Psychiatric consumer motivation refers to the internal drives and external forces that prompt individuals who use mental health services (often called "consumers" or "service users") to seek care, engage in treatment, or participate in mental health advocacy and recovery goals.

Key Drivers of Treatment Motivation

Symptom Relief:

The immediate desire to reduce painful feelings like intense sadness, worry, or fear.

Restoring Function:

Wanting to get back to work, school, or taking care of family.

External Pressure:

Going to therapy because a doctor, family member, or court asked you to do it.

Self-Discovery:

A personal wish to understand your own mind and heal from past pain.

Barriers to Motivation

Stigma:

Feeling shame or worry about what other people might say.

Lack of Trust:

Bad past experiences with doctors or hospitals.

Helplessness:

Believing that nothing will ever help you feel better.

Cost and Access:

Trouble finding an affordable doctor or a safe place to go.

Empowerment and Advocacy Motivation

Peer Support:

Helping other people who go through the same hard times.

System Change:

Fighting to make mental health hospitals and rules fairer and kinder.

Identity:

Moving past a label of sickness to feel strong and proud of your survival.

Doctor Makes Real or Perceived Mistakes

Doctors are human and fallible, meaning real medical errors do occur due to cognitive biases, fatigue, or system flaws. However, distinctions exist between actual negligence, clinical complications, and perceived mistakes where standard diagnostic reassessment or natural disease progression is misconstrued as a failure.

Real Medical Errors vs. Perceived Mistakes

Real Errors:

Clear deviations from standard care, such as wrong-site surgery, medication overdoses, missed diagnoses of acute conditions, or communication breakdowns.

Perceived Mistakes:

Situations where a patient believes an error occurred, but the clinical action reflects standard practice—such as an initial treatment not working immediately, requiring a revised diagnosis, or a known risk/side effect occurring despite proper care.

System Factors:

Many errors stem from broken workflows, understaffing, or poor electronic health record design rather than a single doctor's incompetence.

Navigating Concerns

Mixed Opinions on Disclosure:

Discussions on platforms like Reddit show that while experts advocate for transparency, legal and cultural pressures often hinder open admission of errors out of fear of malpractice suits.

Seeking Clarity:

If you suspect a mistake, requesting a clear explanation of the medical rationale or seeking a second opinion helps distinguish between a mismanaged care plan and an unavoidable clinical challenge.

 

Quick Grade Method

We give Dr. Singh a Quick Grade of 5.0 for her CloZAPine work and 1.0 for her boundary work.  Over all she would get a Quick Grade of 2.5 Stars.  This is about in par with what other people say about Dr. RP Singh (Female).

 

Psychiatrist’s Annoying Confidence

A psychiatrist’s unyielding or seemingly arrogant confidence can feel deeply grating, especially when you are the one feeling vulnerable, misunderstood, or reduced to a checklist of symptoms. When an expert projects absolute certainty about complex human minds, it can easily cross the line from reassuring professional authority into frustrating dismissiveness.

Why It Feels Annoying

Epistemic Arrogance:

Mental health struggles are deeply subjective, messy, and hard to quantify. When a doctor acts like they completely map out your internal reality after a brief conversation, it feels like they trust their textbooks more than your lived experience.

Power Imbalance:

The clinical dynamic inherently places the psychiatrist in the role of the "analyzer" and you as the "analyzed." An overly confident demeanor accentuates this gap, making you feel talked down to rather than partnered with.

Reductionism:

Extreme certainty often leads to quick diagnoses or algorithmic medication prescriptions that ignore the environmental, social, or existential roots of distress.

Defensive Framing:

When a patient pushes back against a confident assumption, poor practitioners may reframe that disagreement as "resistance" or "lack of insight," insulating themselves from being wrong.

How to Handle It

Name the Goal:

Shift the dynamic from an interrogation to a collaboration by stating your preference for a dialogue rather than directives.

Ask for the 'Why':

Challenge their certainty neutrally by asking what specific evidence or clinical guidelines inform their confidence in a particular treatment path.

Evaluate the Fit:

True clinical confidence is paired with curiosity and humility. If a provider's certainty leaves no room for your feedback or alternative ideas, they may simply be the wrong match for your care.

 

Psychiatrist Inferred Error Rates

Estimated error and misdiagnosis rates in psychiatry vary widely by condition and setting, with general treatment failure rates hovering around 50% and specific diagnostic misadjustment rates ranging from roughly 18% to over 90% depending on whether the evaluation uses structured interviews or broad clinical settings.

Diagnostic and Misdiagnosis Rates

Anxiety and Depression:

Studies show structured interviews overturn roughly 29% of major depressive disorder diagnoses, while broader clinical estimates place depression misdiagnosis or adjustment rates anywhere from 54% to 66%.

Complex/Severe Conditions:

Misdiagnosis rates climb higher for complex or overlapping conditions; studies indicate misdiagnosis rates of roughly 18% to 75% for bipolar and schizoaffective disorders.

General Treatment Outcomes:

Approximately 50% of initial treatment trials in psychiatric care result in suboptimal outcomes or overt failure rather than immediate remission.

Common Sources of Error

Cognitive Biases:

Up to 75% of medical errors stem from individual cognitive mistakes, such as confirmation bias (where clinicians search for data fitting an early hypothesis).

Incomplete Information:

Premature diagnostic commitment occurs when clinicians act before gathering longitudinal data.

Comorbidity:

Overlapping physical and mental health conditions complicate symptom attribution.

 

Symptom Attribution

Symptom attribution is the cognitive process people use to figure out the cause of their physical or emotional signs. Individuals decide whether a feeling stems from a physical disease, a mental state, or an everyday environmental factor. This choice affects how fast they seek medical help and how doctors diagnose them.

 

Consumer of Psychiatry Interests

Consumers of psychiatry—often referred to as patients, clients, or mental health survivors—have key interests that center on personal autonomy, collaborative treatment choices, and systemic transparency. Their priorities focus on shaping a more human-centered and accountable mental health care system.

Autonomy and Decision-Making

Shared decisions:

Consumers want active collaboration with psychiatrists on treatment plans rather than a top-down, paternalistic approach.

Informed consent:

Clear, transparent communication regarding the potential side effects, benefits, and alternatives to psychiatric medications.

Self-determination:

The ability to guide one's own care choices and reject forced or involuntary interventions.

Treatment Scope and Quality

Diverse options:

Access to a balanced mix of psychotherapy, lifestyle supports, peer counseling, and medication management.

Holistic care:

Integration of mental health services with general physical health care and consideration of social factors like housing and income.

Peer support:

Incorporating the lived experience of peers into traditional care environments

Trust and System Accountability

Financial transparency:

Minimizing hidden industry influences or conflicts of interest between psychiatric research/guidelines and pharmaceutical companies.

Affordability:

Fair insurance coverage, lower medication costs, and predictable access to care providers.

Respectful relationships:

Freedom from stigma and the establishment of a strong, empathetic therapeutic alliance.

Psychiatric Transparency Defense

The phrase "Psychiatric Transparency Defense" is not a standard, recognized legal term or specific criminal defense strategy. Instead, discussions around transparency in psychiatry usually involve clinical openness, medical transparency laws, or the broader framework of the insanity/mental health defense in criminal law. Depending on the context you mean, transparency and mental health intersect in a few distinct ways:

Clinical and Record Transparency

Open Notes:

Modern healthcare standards increasingly encourage sharing psychiatric progress notes directly with patients to build trust and therapeutic alignment.

Limits of Confidentiality:

Therapists must break transparency and confidentiality if a patient poses an imminent, credible danger to others (established by the legal duty to protect/warn).

Industry Transparency:

Legislation like the Physician Payments Sunshine Act targets financial transparency between psychiatrists/physicians and pharmaceutical companies.

Mental Health and Insanity Defenses

Forensic Evaluation:

When a psychiatric defense is raised in court, the legal system relies on transparent, standardized evaluations to assess a defendant's state of mind at the time of an offense.

Scrutiny and Skepticism:

Courts and legal experts frequently debate the objectivity, reliability, and transparency of psychiatric testimony in criminal trials.

 

Aside - Defendant's State Of Mind

A defendant's state of mind, known in legal terms as mens rea or "guilty mind," is the mental element required to establish criminal or civil responsibility. To convict a person of most crimes, the prosecution must prove both a wrongful act (actus reus) and a blameworthy state of mind (mens rea).

Levels of Mental State

Under legal frameworks like the Model Penal Code, mental states are split into distinct categories of culpability:

Purpose (Intent):

Acting with a conscious object or direct plan to cause a specific result.

Knowledge:

Being aware that conduct is practically certain to cause a result.

Recklessness:

Consciously disregarding a substantial and unjustifiable risk.

Negligence: Failing to perceive a substantial and unjustifiable risk that a reasonable person would have seen.

How Mental State Impacts Cases

Specific vs. General Intent:

Some crimes require proof of a specific goal, while others only require general intent to perform the physical action.

Strict Liability:

Certain offenses require no mental state; commission of the act alone is enough for guilt.

Insanity Defense:

A severe mental disease or defect at the time of the offense can excuse a defendant from criminal responsibility because they lacked the capacity to form a guilty mind.

 

FYI – AI - If you have a specific legal context or jurisdiction in mind, tell me: Are you looking at a criminal or civil case? What specific crime or situation are you analyzing? I can provide more tailored details.

 
Psychiatric Accountability

Psychiatric accountability refers to the systems, ethical duties, and personal practices that ensure mental health care is safe, effective, and responsible. It spans across individual self-reflection in therapy, clinician professional standards, and institutional oversight of behavioral health systems.

System and Clinical Accountability

Performance metrics:

Tracking patient outcomes and care quality to see if treatments work.

Regulatory standards:

Enforcing legal and ethical rules for medical and psychiatric providers.

Cultural competence:

Ensuring care respects a patient's background, language, and community needs.

Institutional oversight:

Bodies like the Mental Health Services Oversight and Accountability Commission monitor public mental health spending and policy.

Personal and Therapeutic Accountability

Taking ownership:

Patients learning to accept responsibility for their choices and behaviors without shame.

The therapeutic alliance:

Therapists inviting honest feedback and supporting patient growth within a safe relationship.

Recovery tracking:

Using regular check-ins, goals, and support partners to stay on track during mental health treatment.

 

Usual and Customary in Psychiatry

In psychiatry, usual and customary (often part of UCR: Usual, Customary, and Reasonable) refers to the standard fee a psychiatrist charges for a specific service, and the average range of fees charged by other psychiatrists in the same geographic area. Insurance companies use this metric to cap the amount they will reimburse for out-of-network care.

 

Aside - Rate Higher than Objective

Psychiatric Legacy Defense

The term "Psychiatric Legacy Defense" combines historical frameworks of mental health law, notably the legacy of the insanity defense and diminished capacity, with modern forensic evaluations. It reflects how historical legal tests—like the M'Naghten Rule—continue to shape how courts assess criminal intent and mental responsibility today.

Historical Roots

M'Naghten Rule (1843):

The foundational legal test establishing that a defendant is not criminally responsible if a mental defect prevented them from knowing the nature of the act or that it was wrong.

The "Ultimate Issue" Shift:

Following high-profile cases like the Hinckley trial, federal and state laws evolved to restrict mental health experts from declaring the ultimate legal conclusion of "insanity," leaving that strictly to the jury.

Modern Applications

Not Guilty by Reason of Insanity (NGRI):

Requires extensive forensic evaluations to prove a severe, verifiable psychiatric disorder (such as schizophrenia or severe trauma-induced psychosis) impaired cognition at the specific time of the offense.

Alternative Defenses:

When a full insanity defense does not apply, legal systems frequently rely on diminished capacity or lack of mens rea (criminal intent) to mitigate sentencing.

 

Burden of Proof for Diagnosis

In medical malpractice and legal contexts, the burden of proof for an incorrect or missed diagnosis rests entirely on the plaintiff (usually the patient). They must prove by a "preponderance of the evidence" (meaning it is more likely than not) that the doctor's diagnosis fell below the accepted standard of care and caused harm.

Key Elements to Prove

Duty of care:

Show that a doctor-patient relationship existed.

Breach of standard:

Prove the doctor failed to provide the level of care a competent peer would.

Causation:

Connect the bad diagnosis directly to a worsened health condition or injury.

Damages:

Demonstrate real, compensable harm resulting from the delay or error.

Types of Evidence Needed

Medical records:

Charts, lab work, and imaging history showing the timeline of symptoms.

Expert testimony:

Statements from qualified medical professionals explaining what a competent doctor should have done.

Alternative findings:

Proof that a reasonably skilled provider would have caught the correct condition earlier.

 

Time Spent and Rigor

Academic rigor is not necessarily more hours or longer assignments equaling higher quality. True academic rigor redefined from workload to cognitive complexity relies on depth of thought, critical reasoning, and the application of knowledge in new ways, rather than mere volume or busywork.
20120425-W-Ravinder P Singh MD Assigns Boundary Work for Keith Torkelson

 

Blogger

http://the-torkel-saga-2059.blogspot.com/2017/09/ravinder-p-singh-md-assigns-boundary.html

2017/09 (Sep 28, 2017)

Jun 4, 2016 - Keith E Torkelson - MS Introduces Dr. David M Dobos at Kaiser A Model Doctor On Call. Dr David M Dobos, MD.

 

Rimal B. Bera, MD Evaluated by Keith E Torkelson MS as a Doctor on Call (DOC).

http://the-torkel-saga-2059.blogspot.com/2016/11/rimal-b-bera-md-evaluated-by-keith-e.html

2016/11 (Nov 20, 2016)

Rimal B. Bera, MD Evaluated by Keith E Torkelson MS as a Doctor On-Call - LiveX ; Health Grades. Includes Objective Evaluation of Doctor.

 

Inspiring Discovery

My material comes up in a county publication

 

County of Orange Behavioral Health Advisory Board (BHAB)

Orange County Health Care Agency

https://www.ochealthinfo.com/sites/healthcare/files/2023-03/BHAB%20Reg%20Minutes%20January%2025%202023.pdf

2023 - Public Comment

“Mr. Torkelson informed the BHAB that he will be submitting an Innovation project proposal and might present this idea to the Board of Supervisors in February. He also suggested that the BHAB be added to the County Newsletter.”

 

County of Orange Behavioral Health Advisory Board

https://www.ochealthinfo.com/sites/healthcare/files/2023-03/BHAB%20Reg%20Minutes%20February%2022%202023.pdf

2023 - Public Comment

“Mr. Torkelson provided an update presentation on the Housing Solutions Bundle, Innovation project concept.”

 

20260814-F-Change of Focus

Assess of summer 2026 we have wrapped up our advocacy work on housing the disadvantaged peoples of Orange County.  We now advocate for advance planning and End-of-life concerns.

 

Aside - Error Rate On Examinations

An error rate in examinations measures how often a test, grader, or examinee makes a mistake. This can mean measurement noise in student tests, misread findings in medical or forensic evaluations, or the frequency of wrong answers on a quiz.

Types of Examination Errors

Measurement Error:

The difference between a test score and a student's true ability.

Interpreter Error:

Mistakes made by a professional analyzing a test (such as a radiology or handwriting exam).

Type I / Type II Errors:

Statistical false positives or false negatives during data testing.

Factors Affecting Error Rates

Fatigue and Volume:

Higher workloads or long shifts increase oversight mistakes.

Experience:

Trained experts usually show lower error rates than non-experts or laypeople.

Test Design:

Unclear questions, poor environment, or subjective grading raise the rate of mistakes.

 

FYI – AI - Could you clarify if you mean student test margins of error, medical/diagnostic exam mistakes, or forensic/expert testing analysis?

Psychiatrists’ Admitting Mistakes

Admitting mistakes is vital in psychiatry to correct misdiagnoses, adjust harmful medication plans, and repair trust. However, cognitive biases, institutional pressure, and fear of liability often make clinicians hesitant to acknowledge errors.

Common Mistakes in Psychiatry

Misdiagnosis:

Overlapping symptoms between conditions like depression and bipolar disorder lead to incorrect labels.

Confirmation Bias:

Sticking to an early diagnosis while ignoring new, conflicting evidence.

Polypharmacy:

Adding multiple drugs to fix side effects instead of reducing or changing the core medication.

Biological Reductionism:

Treating every complex life problem strictly as a chemical imbalance rather than looking at the whole person.

Why Admitting Mistakes is Hard

Fear of Lawsuits:

Admitting an error can create legal risks or damage professional reputation.

Ego and Training:

Medical training teaches absolute certainty, making vulnerability difficult.

Time Pressures:

Short 15-to-30-minute medication check-ins prevent deep re-evaluations.

How Acknowledgment Improves Care

Better Treatment:

Correcting a mistake opens the door to effective, evidence-based therapies.

Stronger Trust:

Patients feel heard and respected rather than gaslit or dismissed.

System Growth:

Openly discussing errors helps clinics update safety guidelines and training.

 

FYI – AI - If you are dealing with a potential misdiagnosis or treatment issue, would you like advice on how to talk to your doctor or how to seek a second opinion?

Aside - Peer Review by Omission

"Peer review by omission" refers to a flaw or tactical choice in the evaluation of academic research where reviewers or editors selectively ignore, pass over, or fail to critique major weaknesses, alternative viewpoints, or competing theories—often allowing flawed or biased work to pass through or suppressing counter-evidence.

Dynamics of Omission in Peer Review

Strategic Silence:

Reviewers may stay quiet about specific flaws if a paper supports their own theoretical camp or avoids challenging a preferred paradigm.

Oversight vs. Intent:

Many omissions stem from simple fatigue, time pressure, or limits in a reviewer's specific expertise rather than malice.

Gatekeeping:

By omitting key context or prior art, reviewers can shape the narrative of a published paper without explicitly arguing against the authors' findings.  Cognitive shortcuts and mental fatigue influence judgment errors during complex evaluation tasks:

 

Omission Bias: The Decision Errors We Make by Doing Nothing

YouTube · Leaders' Decision-Making Lab

Impact on Scientific Integrity

False Consensus:

Flawed methodologies gain unwarranted credibility when critical omissions go unnoticed by editors.

Echo Chambers:

Suppressing contradictory perspectives narrows the scope of published discourse in a field.

 

FYI – AI - If you are looking at a specific context, tell me: Are you exploring this from an academic publishing or a psychological/bias perspective? Do you want to discuss how to prevent review omissions in a journal process?

Search - “ravinder p singh vitals”

Dr. Ravinder Singh, MD: Garden Grove, CA - Vitals.com

[20260817-SU-LINK CHECK PASSES]

https://www.vitals.com/doctors/Dr_Ravinder_P_Singh_2.html

Ravinder P Singh, MD is a health care provider primarily located in Garden Grove, CA. Their specialties include Psychiatry.

Rating Overview.

20220706-W: Rating: 2.8 · ‎18 votes

20260804-TU: Rating: 2.8 · ‎18 votes

POI Bios - Dr. Ravinder Singh, MD - Garden Grove, CA – Healthgrades

https://www.healthgrades.com

https://www.healthgrades.com/physician/dr-ravinder-singh-2dt55?referrerSource=autosuggest

Dr. Ravinder Singh, MD is a psychiatrist in Garden Grove, CA and has over 55 years of experience in the medical field. Dr. Singh has extensive experience in Psychotic Disorders. She graduated from Agartala Government Medical College in 1969. She is affiliated with medical facilities Anaheim Global Medical Center and Providence St. Joseph Hospital Orange. She is accepting new patients.  Compare: Dr. Singh has extensive experience in Psychotic Disorders and Addiction & Substance Abuse. She graduated from Govt MC-Punjab U-Patiala medical school in 1968.

20220706-W: Rating: 2.2 - ‎12 reviews
20260804-TU: Rating: 2.2 – 12 Reviews

 

POI Bios - Dr. Ravinder Singh, MD, Psychiatry Specialist – Sharecare

https://www.sharecare.com/doctor/dr-ravinder-p-singh-3

No Ratings Recorded

20260804-TU-80 Years Old Reported

About Dr. Ravinder Singh, MD

Dr. Singh graduated from Agartala Government Medical College in 1969 and completed a residency at Univ Ca Irvine Med Ctr, Psychiatry Orange County Med Ctr, Psychiatry. Dr. Ravinder Singh, MD is a Psychiatrist in Garden Grove, CA and has 57 years experience. Dr. Singh currently practices at Ravinder Singh, MD and is affiliated with Anaheim Global Medical Center and Providence St. Joseph Hospital Orange. Dr. Singh has experience treating conditions like Marijuana Addiction, Amphetamine or Related Acting Sympathomimetic Abuse and Tobacco Use Disorder among other conditions at varying frequencies. Dr. Singh's office accepts new patients. Dr. Singh also speaks Hindi. Dr. Singh is board certified in Psychiatry and accepts multiple insurance plans.

 

Study Question: Is Dr. RP Singh Peculiar?

Features of a peculiar psychiatrist

A peculiar psychiatrist often blends unconventional personal quirks with sharp clinical intuition, operating outside standard social or professional norms while still aiming to understand the human mind. Whether found in literature, film, or real life, their traits bridge eccentricity and deep insight.

Behavioral Quirks

Unusual office decor:

Stuffed animals, abstract art, ticking clocks of all sizes, or completely bare minimalist walls.

Idiosyncratic communication: Speaking in riddles, long reflective silences, or asking startlingly direct, non-sequitur questions.

Eccentric personal habits:

Wearing mismatched socks, vintage capes, or carrying an aged, overstuffed leather briefcase packed with strange oddities.

Clinical Style

Unorthodox methods:

Using paradoxical intentions, walking sessions outdoors, or assigning bizarre behavioral "experiments."

High tolerance for oddity:

Treating a patient's most bizarre delusions or fears with absolute matter-of-fact normalcy.

Blurring boundaries (carefully):

Sharing brief, cryptic personal anecdotes that somehow illuminate the patient’s inner world.

Mindset and Outlook

Radical open-mindedness:

Entertaining explanations of human behavior that defy standard textbook psychiatry.

Comfort with chaos:

Thriving in ambiguity and making peace with the messy, unquantifiable parts of the human psyche.

A hint of mystery:

Leaving patients wondering if the doctor is a genius, slightly mad, or a bit of both.

 

FYI – AI - If you are looking for a fictional character profile or analyzing a specific real or literary figure, let me know and I can tailor these traits further.

Figure – Darlene’s Craft for Me (Folded Paper)

The art of folding paper is called origami. If you are thinking of a specific popular schoolyard toy made from folded paper with numbers and hidden fortunes, it is called a fortune teller or cootie catcher.

Boundary Issue with Males – Considered Elsewhere

My great grandad is seated in the middle