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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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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I recently published a post asking for readers to submit questions to me that they might have (primarily about my profession). I’ve paraphrased when necessary:
1. “Why do people who truly do have mental issues despise taking their medicine-often times going off of it and landing themselves back into the hospital due their condition? They say they don’t need the medicine-but obviously they do. And those who fake an illness love their medicines and will fight, steal and lie to have these medications.”
A: Most people do not actually want to have a mental illness. For various reasons they resist it and can be in some degree of denial. One aspect of some mental illnesses is also a lack of insight (or varying insight depending on how sick they are). People who fake illnesses for secondary gain (entitlements, attention, etc.) have a large incentive to stay in the illness role to obtain what they seek. The better they play the part, the less likely their cover will be blown.
2. “Do you have any risk management tips? What are some practical things correctional medical and mental health providers can do to minimize lawsuits by inmates?”
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I’m getting tired of hearing myself talk. You’re probably getting tired of it, too. So, it’s your turn!
Seriously, I really want to hear from you.
Ask me whatever you want about my profession, and I’ll do my best to answer (as long as the questions aren’t too personal or about my employers!).
You may leave your question(s) as comments to this post, or you may e-mail them to me (click on Contact at the top of the page to quickly send me a message).
I look forward to your questions and appreciate the time you take writing them. Please help me make this interesting! Thanks.
Photo by crystaljingsr
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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This blog was born 6 months ago today.
I want to thank all of the readers who visit this blog and especially those who comment on posts. You make all the work worth it! Also, thanks to the other bloggers who have been gracious enough to include Lockup Doc on their blogrolls.
My goal was pretty simple–to write for a broad audience about interesting topics related to correctional and general psychiatry. I wanted to get people thinking about ideas and situations that others weren’t writing about. I also wanted to see how I enjoyed writing regularly.
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For quite a while I’ve been wanting to update the look of the blog. I didn’t like the black banner at the top of the theme. I personally don’t think that it looked bad; it’s just that it was a bit boring, and I was concerned that it might look a little too “dark” for a blog that has anything to do with prison. One reader I know told me she thought it looked like “bars.” I didn’t want the blog to look like a prison!
I’ve had mixed feelings about the name, “Lockup Doc.” I’ve generally liked it, but I’ve always feared that those new to the blog might be scared off by that name or make negative assumptions about it. Hopefully if you’ve been reading this blog for a while, you realize that this blog is not a scary place and that I mean no harm. I try my best to point out and focus on the positives in life situations that are less than ideal. My hope is that the new blog theme looks a little brighter and cheerier to reflect the spirit of my intentions.
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T
he provision of quality health care in any setting is the product of a concerted effort. Correctional settings are no different in this regard. Although practicing psychiatry in a prison or jail setting is challenging in many ways, a well-orchestrated team not only makes it easier but also better.
Detecting mental illness or psychological distress in inmates can be challenging, and the more observers that are involved in their care, the less likely that something significant will be missed. And, determining whether a given intervention is effective is likely to be much clearer and more accurate.
Unfortunately, patients in forensic and correctional settings also exhibit malingering at a much higher rate than do non-forensic mental health patients. Therefore, if a psychiatrist or other mental health professional attempts to do his or her job in isolation, it will be much more challenging to determine whether a given patient may be exaggerating or feigning symptoms. Even if they are, they still may be suffering from psychological distress that could benefit from having several disciplines involved in their care.
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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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