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.”



36 thoughts on “Teaching Influence

  1. I love this 🙂 It’s great you had a change of heart and accepted it graciously. And of course there’s a lot to learn from “bad” attendings…like how to not be a doctor and how to not treat patients (aka: other people). I hope to be as good as you someday in the not so far away future!

  2. There is quite a few mental illness issues represented in my extended family, so this is a topic near and dear to my heart. I love it when I “meet” Dr’s and nurses that still have that most important ingredient alive and well in their tool bag… and those qualities would be empathy compassion.. You have it,.

  3. I genuinely love the mental health center where I am at. They offer a great variety of counseling services to meet the different recovery levels of their clients. My only complaint is that when we meet the psychiatrist, he literally says: “Hello. Is there anything I can help you with? Okay. See you next month.” Bam. Sixty seconds.

    He may recognize my face; however, I doubt he knows my name. There are simply way too many clients in his caseload to give each of us ten minutes or so each month.

    Keep up the good work. Perhaps one day I’ll meet a psychiatrist like you.

    • Hi LaVancia, thanks so much for your comment! Yes, unfortunately psychiatrists are very much overloaded and sometimes minimal connection is the only way to survive and maintain themselves. and therapists are overwhelmed as well! I’m very much overloaded at the clinic i work and told myself once I notice the quality of my work decrease, I’d need to make a change in job, but that would leave so many patients in need without care…sooo hard! But I’m glad u enjoy your workplace…I’m sure you’re doing great work helping your clients in recovery 🙂

      • Thanks…only one thing…are you confusing me to be a therapist? No, I do get a lot of people saying I should be a counselor, but no. It this point in time I am a consumer, client, peer, and writer who’s a little bit OCD. 🙂 Anyways, thanks for responding. LaVancia

        • oh yes, forgive me for making that assumption. i just read your profile on your blog — you’ve definitely experienced a lot and i’m sure have a lot of empathy given your own personal experience so its no wonder that others say you should be a counselor! following your blog now 🙂

          • Thanks so much for following me. I have had one hell of a journey, but I’m not complaining. If the Great Spirit didn’t think I could handle it, I don’t imagine He would have put me on this path. Hugs, LaVancia

  4. First the fashion. Let me say I am disillusioned to see you on the beach wearing a sweater! What kind of SoCal scene is this? You might think you were on the shores of Lake Michigan. 😉

    Now the Freud. I really like this post because you’ve focused on the personal element of your profession. Erik Erikson would be impressed. 🙂 Of course, having read your blog for a while I’m not in the least surprised. And that is a great compliment for you from your patients.

    PS: good for you for expressing some (pent-up?) anger at Mr. Psychiatrist who let you down rather than being a good mentor.

    PPS: You’re glad you turned out to be a “decent” psychiatrist. Faint praise, indeed.
    I only know you from your blog and I’m quite sure you’re much more than merely decent.

    • first, let me say that the sweater is mesh, which is very so-cal 😉
      and since you’ve read a lot of Erikson’s work, that is a very high compliment to think that erikson himself would be impressed!

  5. I did not see the patients’ reaction to you clearly at first. What they’re saying is, I think, more than a compliment. They are acknowledging your giftedness. As mental patients, they have learned that they are often shunned. You, in contrast, have accepted them, recognized them, and gotten to know them. That in itself is healing.

    • thanks Tom, i feel that being in therapy myself has made me realize what it’s like to be in the patient’s chair…all i could ask for is to be understood and accepted, so i try to provide the same to my patients.

  6. This is true of all medical specialties but especially psychiatry. I have a huge respect for your field. In fact it was the only field I considered going into after my autoimmune disease attacked my heart and left me with a pacemaker and sans neurosurgical career. As I have mentioned before i have a strong family history of depression and have suffered for years. Emotional pain is just as difficult as physical – I have been through both. I will never forget 2 great psychiatrists who took the time to listen and talk to me. They saved my life. Your job is truly important and don’t ever forget that!

    • that’s a strong and telling statement to say that emotional pain was just as difficult as physical…it only solidifies that mental health should be made a priority just as much as the physical, or even more. that’s great to hear u worked with psychiatrists who made u feel understood. And, by the way…you would’ve made an excellent psychiatrist! (i know you’re doing amazing things w/ your career right now tho 😉

  7. Awesome post as usual! 🙂

    I have a gifted psychiatrist who was going to be a psychotherapist, but then he switched over to being an M.D. He has so much empathy, when we meet I do feel like i’m with a therapist in some ways (positive ones!) but he also definitely knows the nuts and bolts of psychiatry.

    I would never have appreciated him the way that I do if I didn’t have 98% bad experiences with other pdocs. I don’t wish *that* journey on anyone!

    p.s .I love the Malibu pic – if you ever get the chance, try hiking up to Skull Rock in Temescal Canyon in the Palisades. There’s a totally gorgeous ocean view from the rock, & you’ll get a great workout.

    • hi dyane, thanks for the tip on the hiking trail…i’m always on the lookout for good ones! as for your psychiatrist, it’s often difficult to find a psychiatrist who is strong in both psychotherapy and medications, so it’s great that you have one.

  8. I am very fond of my psychiatrist.

    Not only does he do consult liaison with inpatients from teenagers to the elderly, he takes an interest with elderly patients with dementia and their complex physical and mental healthcare needs. Further more, he is training at 55 in palliative medicine.

    Each if his patients get at least 15.minutes with him, more if they require. At least 15 minutes, even if I as his patient have nothing to report as I’m stable on my current dosages. He’ll sincerely and genuinely ask me “How are you doing?” even if I try to brush things off with “I’m fine” and ask after important areas of my life such as work and my family.

    As I am in my 20s with a (mild) history if parentification, neglect and abuse, he advises me, self discloses appropriately about his own parentification and abuse history, encourages and reminds me that I can “break the cycle”.

    He makes do with short lunches, I’ve no idea how he manages it, really.

    He probably knows that I look at him as some sort of paternal father figure of sorts.

    We disagree on a lot of personal beliefs but he has never judged me for being LGBTQ despite his ignorance on how sexual orientation is not a choice.

    (We live in a nation where gay sex is a crime)

    Good, experienced psychiatrists with empathy are worth their weight in gold!

    • Hello, thank you so much for sharing your own personal experience with mental health. 15mins appointment goes by so quickly, but i believe it’s possible to establish a connection between doctor and patient if the doc is skilled, empathetic, and self-aware themselves…which is what you experience w/ your own psychiatrist. and how wonderful that he is able to put his own viewpoints aside…having a nonjudgmental clinician is essential for having a trusting therapeutic relationship! i’m curious which nation you’re from, if you don’t mind me asking? (feel free to decline to respond). i really appreciate your comment 🙂

      • There’s a dire shortage of psychiatrists despite strong stigma on mental illness – about 100k people to 1 psychiatrist. Hence usually even in tertiary psychiatric care, appointments can be 3minutes – which is really “assembly line psychiatry”. For a patient to get 15 mins in secondary outpatient care is seriously considered exceptionally fortunate! 🙂

  9. wow…you are the 1st psychiatrist i have seen in instagram…
    anyway i just want to say hye..
    i am 2nd year student in counselling from malaysia…

    • Hi Tarmizi…nice to meet you! I’ve seen a few psychiatrists on instagram, but yes there aren’t very many of us on social media. Wonderful to hear you will be doing work in the mental health field in Malaysia!

      • hehehe…this semester i need to do research about sexual orientation and sexual fantasy…quiet hard for me…

  10. Such an amazing story of experience that has shaped the way how you practice today. Keep it up, your changing lives!

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