Teaching Influence

{Malibu, CA}

Current thought: I’m glad I turned out to be a decent psychiatrist.

I remember being an eager medical student during an internal medicine rotation and asking a consulting psychiatrist the reason he diagnosed two of my elderly patients with schizophrenia.  I anxiously awaited his response (Note: I highlight the word elderly because diagnosing schizophrenia at such a late onset in life is rare) and he gave me the most nonchalant, dismissive response: “because they’re having hallucinations.”  He got up and walked away before I could ask him any more questions.  Well, Mr. Psychiatrist, if I knew what I know now, I would’ve told you back then that you were a horrible doctor because you did not even talk to my patient nor put any thought into your diagnosis, nor care that giving a frail 70-year old woman excessive doses of antipsychotic medication might actually make her worse (excessive doses of antipsychotics may increase risk of confusion, oversedation, and pneumonia in the elderly population).

The accumulation of my experiences working with various attending physicians (aka supervising physicians) have shaped the way that I practice psychiatry today.  One of the first lectures I attended during my psychiatry residency was about the emphasis of humanism in mental health, which was a concept that was markedly different than what I observed during internship (I had made the decision to switch to a different residency program after internship).  I remember feeling ashamed during the lecture because I recalled how I used to write orders for “B-52’s” (the nickname for a cocktail of medications given by injection for acute agitation; a chemical restraint) so frequently and unhesitatingly during internship.  Needless to say, that lecture set the tone and confirmed that I made the right decision to change training programs.  My whole perspective and approach to psychiatry changed by working with the most caring and compassionate psychiatrists, therapists, and nurses.  I obviously recall interacting with a few terrible psychiatrists, which actually turned out to be a useful learning experience: I learned how NOT to practice psychiatry.  So, if you are interested in pursuing a career in the mental health field, I hope that you train with amazing supervisors, remain open-minded (psychiatry is not so clear cut as reading the DSM 5, our diagnostic manual), maintain empathy, and remember that each individual/client/patient has a story.

The greatest compliment that I’ve received from several of my patients is also a sad reality about the spectrum of practitioners in my field: “You’re not like any psychiatrist I’ve met before.  You actually try to get to know me.”