According to a recent USA Today article, a U.S. physician-recruiting firm received a 47% increase in the number of requests for psychiatrists between April 2009 and March 2010. This was a 121% increase from 2006-2007.
Psychiatrists were the third-most-requested physicians, trailing only family practice and general internal medicine.
How can this trend be explained?
By both supply and demand.
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There is a natural conflict of interest that occurs when a psychiatrist who is providing treatment to a patient agrees to perform an evaluation or render an opinion about something of a legal nature regarding the same patient.
In treating patients in the community, I’ve turned down requests from attorneys on several occasions when they wanted me to provide expert opinions about my own patients. I simply did not feel comfortable doing so as I believed that it was going to interfere with my treatment relationship with them.
This viewpoint is endorsed by the American Academy of Psychiatry and the Law in their Ethics Guidelines for the Practice of Forensic Psychiatry (PDF).
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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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Aggression.
It’s an ugly term. And drug companies don’t want to be associated with it.
I recently attended a lecture on the pharmacologic treatment of aggression that got me thinking about this issue.
There are many different ways to treat aggressive behavior. Psychotropic medication is only one strategy, but in prisons and state mental hospitals, it can be a crucial one for many patients. And, although there is no “magic pill” for aggression, there are some medications that work quite well for reducing it.
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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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A few months ago I performed an inpatient consultation on a non-incarcerated patient. His psychiatric care was being managed by a neurologist in another community.
I was shocked and disappointed when his family informed me that the neurologist told them that if the patient sought a medical opinion elsewhere, the neurologist would no longer treat the patient.
Even on a bad day I cannot fathom exuding such arrogance and insecurity! Hopefully this doctor’s attitude about second opinions is the exception and not the rule among physicians. However, this situation sparked my curiosity about second opinions.
Throughout my career, I’ve often encouraged my patients to obtain second opinions, either when
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Current Psychiatry (Vol. 8, No. 11/November 2009) recently published an editorial, “Health care debate: Do psychiatrists support the public option?“.
I thought the title was a little misleading, though, because the figures that ended up being presented were from a survey of 5000 readers asking, “If you could reform the nation’s health care system, you would favor a single government-run system to cover every American?”
The results:
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Suicide is an absolutely horrible phenomenon. It destroys families and forever leaves survivors on an elusive search for why it happened. Suicide is often viewed as a very selfish act, yet I believe that in many cases those who do it truly cannot endure the emotional pain any longer and believe that they are out of options. When I was a young adult, an extended family member committed suicide. During my career I have lost a small number of patients to suicide as well. These were all very tragic experiences.
In the United States, mental health professionals have a legal responsibility to take action when our patients appear to be at risk for harming themselves. It is not possible for us to accurately predict when a person is going to commit suicide, but we are expected to assess for and document suicide risk factors. If necessary, we may have to call police or take other action to have patients involuntarily admitted to an inpatient psychiatric unit.
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