Dear Doctor: Nidhi Goel
The adult and geriatric psychiatrist with a passion for mindfulness
Dr. Nidhi Goel practices as both an adult and geriatric psychiatrist, and has worked in several diverse environments — from the inpatient unit an acute care and state hospital to private practice in New York’s Chelsea neighborhood. No stranger to a challenge, she founded and led a geriatrics department as her first job in New York, and she enjoys training and teaching, working regularly with residents and fellows. Dr. Goel has a patient and thoughtful approach to care, and encourages her patients to practice mindfulness to cope with the stresses of aging and change. Read on for more on her approach to care and how texting can serve as an important tool.
“I grew up in India and went to medical school there. I started my neurosurgery residency in a busy trauma center, where there was quite a high mortality rate, and after some time, I realized that wasn’t for me. I switched over to preventative medicine and did my thesis on mental health in prisoners, where I visited prisons for two years and met all types of people, from pickpockets to murderers. It was fascinating!
I then moved to the United States and did a residency in psychiatry followed by a fellowship in geriatric psychiatry. I was inspired to do so by my husband’s grandmother, who had hypochondriasis. I would take care of her and help her with her medication, and as her health and memory declined, she continued to remember me even in her late stage of dementia. There was something very special and moving about this, and it cemented my interest in geriatrics.
From the Inpatient Unit to Private Practice
In my first job, I actually founded and headed up the geriatrics department at a hospital. I was the only one doing electroconvulsive therapy (ECT), and I taught it to others. In addition to managing all of our patients, I also managed our staff. It’s important in an inpatient unit especially to make sure staff feel supported, since they often have to deal with cases that are mentally and emotionally tough. I also taught a class of 36 residents, as well as geriatric fellows. In training, the residents and I saw patients together, then I give them the chance to come up with their own diagnoses. We also covered finer skills, like body language and how to approach a patient.
Life brings on changes, and after I had my twins in 2016, I decided to move into outpatient, which is a bit more forgiving in terms of time commitment and commute. Practically, I have experience with everything from high-functioning patients in my private practice to acutely and chronically ill patients in the hospital setting. When patients reach out to me, I applaud them for taking that first step that can be so hard for a lot of people. I then ask a lot of questions, come up with my formulations, and share my thoughts. I try to be as honest as I can. I’m not into fad psychiatry.
Geriatrics
There are some key differences in the treatment of geriatric patients compared to adult patients. As our body gets older, there is some functional decline and we find more and more issues. Medications that a younger person may be able to assimilate, an older person cannot.
My motto with my geriatric patients is “start low, go slow.” These patients often have many different doctors who are all prescribing different medications. For this reason, I have patients bring in everything they are taking and help them manage their medications. I take a comprehensive approach and examine everything. For example, could their blood pressure medication causing depression? One of the benefits of private practice is that I can take my time with patients. I don’t rush. Everyone receives a minimum of 30 minutes for an appointment.
While there are many new apps that promise to help an older patient population manage their medications, I still think most of them are in a very nascent state. The most common thing I suggest for my patients is to get into a regular routine, like sending a “good morning” text to friends and family. This serve a dual purpose; it encourages regular communication and also helps loved ones know a person is doing well. There are also some interesting new developments in robotics and sensors that can help notify others if a person hasn’t gotten out of bed or has fallen, which I think are valuable for older adults who are living on their own.
Mindfulness
Mindfulness is for everyone. We all have days where we feel a little off and I’m sure most of us would welcome the tools to feel better. The practice is able being in the zone and recognizing your own reactions; check in with what is going on before reacting.
You can’t fix any problem until you know what it is that is bothering you, so always begin by checking in with yourself. Then, you can figure out what you need and how you can most effectively use mindfulness, even if it’s a quick walk around the block. Most people can benefit even from taking a pause to breathe. It is scientifically proven that the center in the brain that controls anxiety is so close to the breathing center, and it just takes a few minutes and it doesn’t cost anything!
The degree to which mindfulness is embraced by my geriatric patients really depends on the individual. Most of them have a very set way of life, and it can be hard to embrace change. Many of my patients have spent most of their life focused on creating wealth and saving and it can be hard to let go of that “go, go, go” hard-working mindset and start to enjoy life and relax! Many of my patients are also at the age where they are coping with loss more frequently, and mindfulness plays a role in helping them work through that.
Lightning Round
I love what I do because….everyone needs help and I like being able to play a part in making people feel better!
My life mantra… “I make plans and God laughs!” I’ve learned that not everything is under my control and that we have to do our best to cope with that.
I’m inspired by…watching the way that young children perceive the world and how they develop personalities.
Favorites
NYC neighborhood: I love Morningside Heights and Harlem for the great restaurants and the suburban feel within a big city. I also love to visit the Bronx Botanical Gardens.
Winter activity : Walking around the city bundled in boots, coat, and scarf.
Relax ritual: Sleeping!
You can read more about Dr. Goel here.
Know a great female doctor in NYC? We’d love to meet her, introduce us here!
