This post was inspired by Dinah, a psychiatrist over at Shrink Rap. She recently described how a psychiatrist friend of hers has been going through some phase-of-life changes. Recently he has regretted some of the advice that he previously had given to patients who were going through the same life changes he’s now going through himself. He realizes that he was not nearly so qualified to give the advice he gave because he looks at the situation differently through the new lenses of his own experiences.
Reading the post got me thinking more about psychiatrists and advice. When should and shouldn’t psychiatrists give advice to patients? I’d love to hear your opinions about this, but first I want to lay some groundwork and give you my own opinion.
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Today I posted a piece on the Positive Medical Blog about how my views of forgiveness have evolved over the years, mostly as a result of hearing the life stories of many patients.
Since it’s a topic that would be entirely appropriate for this blog as well, I wanted to share it with you. Please click here to read the article.
PATIENT:
adjective: bearing pains or trials calmly or without complaint
noun: an individual awaiting or under medical care and treatment
from Merriam-Webster Online
Photo by frances 1972
But, like it or not, the world is filled with situations where we commonly have to do so. Sometimes the waits are excusable and even predictable, and other times they are not. At most doctors’ offices, one can expect to wait to varying degrees beyond their scheduled appointment time. It’s predictable. But is it excusable?
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Great doctors listen to their patients. They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard.
Of course no doctor is likely to be able to do all of these things all of the time, but some come closer to this ideal more consistently than others.
But great doctors additionally have a “sixth sense.” They can “read between the lines.”
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“Everyone wants to tell you what to do and what’s good for you. They don’t want you to find your own answers, they want you to believe theirs. I want you to stop gathering information from the outside and start gathering it from the inside.”
from the Way of the Peaceful Warrior by Dan Millman
Photo by h. koppdelaney
Progress.
Inevitably it means change and supposedly inventing better ways of doing things. And as a society we’ve done just that. But there have been side effects.
Since we’re more “human-doings” than “human-beings,” we’ve focused on utilizing our advances to cram more work into our day instead of using our new-found efficiency to create more time to spend with our families and friends and to pursue volunteer and recreational activities.
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Psychiatrists treating patients who can’t talk: Sounds fishy, doesn’t it?
Well, I do it 2-3 days per week, and as strange as it may sound, it makes perfect sense.
Let me explain.
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Saying or hearing “no” in any circumstances involves setting a limit with others or having them set a limit with you. It invariably involves some degree of confrontation. Although learning to say no can be liberating, most people would prefer not to be put in situations where setting limits is necessary.
One of my least favorite but necessary tasks as a physician is saying no to patients.
In the ideal world, doctors wouldn’t have to deny patient requests. Patients would read information only from reliable web sites. Direct-to-consumer marketing of pharmaceuticals would not exist. Patients with addiction histories wouldn’t ask for potentially habit-forming pain and anxiety medications. Doctors would always listen carefully to patients. Doctors would arrive at carefully thought-out formulations of their patients’ problems and then would explain all reasonable treatment options thoroughly. Ultimately patients would then make informed, logical decisions about their health care. Everyone would be happy!
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I’ve previously written about the many challenges of practicing medicine in correctional settings. But if there are so many cons (pun intended), why should anyone consider such a career?
Well, there are many benefits to it as well. If you are a psychiatrist or primary care physician and are either looking for a change or just starting your career, you may want to consider correctional medicine.
Although I’ve done correctional work for quite a few years, my experience has been limited to one geographical area of the country. I contacted correctional healthcare recruiter, Vikkie Schill, from MHM Services, Inc., to help me to convey accurate information about this topic. I want to take this opportunity to thank her for her input. I have no relationship either with Ms. Schill or with MHM Services, Inc.
Here are my top 5 reasons to consider a career in correctional medicine:
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Like it or not, life is full of them: difficult, demanding, hostile, rude, irritable, aggressive, arrogant, and “manipulative” people. Fortunately most do not have all of those traits! But, in our journey called “life,” we all must interact with people who push our buttons, challenge our patience, and even make us have hateful thoughts that we may shamefully hide from others.
Some of these unpleasant people we may choose to avoid. But, there are many others we cannot: patients, coworkers, and close family members. And, if you provide health care in any setting, but especially in a prison or jail, you already know how the more challenging patients can turn a good day bad, cause your hair to turn gray, and make you seriously consider changing your work setting.
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There are many enjoyable aspects to practicing psychiatry. Humor, unfortunately, is not usually one of them. If psychiatrists are not careful, the seriousness of what we do can deplete our emotional energy, and our work can become depressing. Also, psychiatric patients are people, too. Even when they are in a melancholic state, they can still have a sliver of humor left. And, properly-timed humor can be therapeutic, right? So, is it appropriate for psychiatrists and other mental health professionals to joke with our patients? If so, when?
A psychiatric resident wrote a NY Times article about this topic. Interestingly he mentions that when he was an intern on the internal medicine service, he regularly joked with his patients. But, when he started working on the psychiatric service, the humor stopped. He not only felt uncomfortable with the idea of joking with his new patients, but he squirmed when they attempted to joke with him. Ultimately he found a way to joke with a delusional woman in a manner that allowed him to establish enough rapport with her so that she readily gave him her history.
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