To Be a Good Psychiatrist, I Need Your Help
I am going to be a psychiatrist. Through hard work and deliberate practice, I fully intend on being one of the good ones. Four years of medical school are over. I’ve earned my MD and I am currently immersed in five years of psychiatric residency training. I could spend a lifetime reading the innumerable textbooks, guidelines, and research articles on mental illness and I will certainly spend countless hours doing so. Even so, if my goal is to provide relief and healing for my patients, then surely my most important resource are the very people whom I am hoping to treat.
The World Health Organization tells us that one in four people will suffer from mental illness during their lifetime. When fully licensed, I will certainly have my work cut out for me! Everyone either personally experiences a mental illness or knows someone who does. This means that everybody I meet, be it professionally or socially, has the potential to provide new perspectives to add to my ever-growing repertoire. The prospect can be daunting!
My limited experience makes it clear that individuals do not experience mental illness in the same way. Through my studies, I learn what science tells us about typical presentations of each disease and the average treatment response. The clear problem is that almost none of my patients fit the exact ‘typical’ picture and each response to treatment is hardly ‘average’. The way I experience anxiety is sure to be completely different from the way you do, and depression has numerous disguises. It is almost laughable to me that I will soon be considered an ‘expert’ on mental illness. Most of the time I feel like a guy on a lifeboat in the middle of the ocean, and I’m throwing lifesavers to people I happen to come across. Sure, I am trying to help in any way that I can, but I am still essentially lost at sea with no land in sight.
Don’t get me wrong, my scientific knowledge of mental illness and its treatment is essential to my work. However, it is not even the biggest part of the equation when it comes to helping my patients. That is where you come in.
If we ever meet in a clinical setting where I am your psychiatrist. I will learn far more from you than you will from me. I’ll bring my psychiatric expertise, but you will bring expertise on yourself, your own experience. Both sets of knowledge are crucial. The more you can teach me about you, the better my chance of being effective. Only together will we come up with a treatment plan that has any real chance of success. I apologize in advance if our first encounter feels like an interrogation. I am working on it. I am.
With every patient I see, I develop as a doctor. I make mistakes, and when I do, I try to learn from them: to interact more effectively, listen more deeply, inquire more sensitively, and better respond to pain in its many forms. On hearing many patients’ stories of depression, for example, each unique experience sculpts my amorphous textbook understanding of the ‘average’ depression.
Unfortunately, these interactions are stunted by clinical reality. Confiding in a stranger is never easy, especially when the subject matter is so personal, painful, and too often stigmatized. Now, place that encounter in a busy emergency department where treatment areas are wedged together and separated only by a flimsy curtain… You can imagine my struggle to conjure up anything remotely resembling a therapeutic connection. Too often, I feel that I am not adequately understanding my patients. There many factors that contribute to this, but at times it seems that patients simply don’t trust my intentions or motivations enough to earn their honesty. Why should they? They don’t know me, and despite every effort, I don’t know truly them.
Turning to online forums and blogs, I am excited by the wealth of personal stories about mental illness. I have found great value in reading thoughtful posts and discussions that shine a light on aspects of mental health that can be difficult to illuminate in a clinical setting. To be the best doctor I can be, I must broaden my understanding of mental health and mental illness, integrating my clinical knowledge with real lived experiences. Whether it is in a doctor-patient encounter, everyday discussion, or through engaging with online forums, your insights and perspectives will help me towards that goal.
Thank you.
