{"id":54105,"date":"2015-02-05T16:19:11","date_gmt":"2015-02-05T21:19:11","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=54105"},"modified":"2015-02-05T16:24:28","modified_gmt":"2015-02-05T21:24:28","slug":"do-what-george-says","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/02\/05\/do-what-george-says\/","title":{"rendered":"do what george says…"},"content":{"rendered":"\n
I just read George Dawson’s excellent advice to psychiatry residents on Real Psychiatry [Advice To Residents<\/a> and Advice To Residents – continued<\/a>]. As a former residency director, I can say that, as usual, he’s right on the mark. There are some things I might add or come at from a different angle, but just editorial comments. His posts are full of pearls<\/em>. Some thoughts:<\/div>\n

The Suicidal [or Homicidal]<\/font><\/strong> Patient<\/font><\/strong>: These patients are, indeed, the ones where we need to do things right. And the thing I saw over and over was that lethal patients frightened the resident and the interview turned into an is-he-going-to-do-it-?<\/font><\/em> or a what-do-I-need-to-do-now-?<\/font><\/em> agenda driven interview. People who become suicidal have plenty of things rattling around in their minds. In Man Against Himself<\/a>, Karl Meninger said a suicidal person wants to kill [rage], wants to die [a communication], and wants to be dead [relief]. So they have lots of things they need to say and they don’t need some nervous interviewer who is focused on not making mistakes. They need someone who will deeply understand their suicidality from the inside. If you get there, you’ll know what to do. If you don’t, that tells you something too. There’s plenty of time at the end to deal with the agendas they obviously raise.<\/p>\n

Crisis Intervention<\/font><\/strong>: This was the  outgrowth of World War II that inspired the Community Mental Health Movement – how to manage patients who are in crisis states filled with emotion and unable to think clearly or make rational decisions. All they can think of is feeling un-panic<\/em>. It’s an essential skill with simple principles. Go to the library and look it up. Those dusty books from the fifties and sixties are full of wisdom. It’s a skill to never leave home without. It’s part of preventive psychiatry, because the goal is to head off the huge mistakes they make and bad patterns they learn acting in the crisis mode.<\/p>\n

Neuroscience<\/font><\/strong>: I completely agree with George when he says…<\/div>\n
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    There are many excellent psychiatrist-researchers in this area already and I encourage reading their research and some of their popular works as a starting point.  There are any number of Luddites out there who seem to think that psychiatry needs to remain stagnated in the 1950s to provide any value.   I don’t think there is a shred of evidence to support that contention or that neuroscience will never be of value to psychiatrists…<\/font><\/em><\/div>\n<\/ul>\n<\/div>\n
    …[plus, who wants to be a Luddite?] But I’d add that his admonishment to not get stuck in the past has an important corollary, Don’t get stuck in the future either<\/em><\/font>. A lot of the recent psychiatric focus has been on our neuroscience future, but our patients are sick in the very-much-right-now. There was a massive backlash against psychoanalysis, existential psychiatry, the biopsychosocial perspective, group therapy and group dynamics, cultural and social psychiatry, etc. after the coming of the DSM-III in 1980. So my advice would be to learn all the neuroscience you can, and everything else too. Don’t let your teachers’ that have lived through this last 35 polarizing years transfer their dogmas and attitudes along with their knowledge. And seek out mentors from all sides of the realm – brain, mind, society, culture, etc. You’ll have plenty of time for skepticism down the road.<\/div>\n

    Identity<\/font><\/strong>: I’ve never been smarter or more competent than the day I finished my Internal Medicine Residency. I hadn’t been brought down to size by the whips and scorns of medical life, made my mistakes, been dwarfed by the afflictions that beset mankind. But my identity as a doctor was as solid as a rock. When I finished my psychiatry residency I felt anything but smart and competent. And that’s not vastly changed even now in retirement. I realized that I only feel like a psychiatrist when I’m being one<\/font><\/strong><\/em>. Otherwise, I’m just a guy with a bunch of diplomas and a ton of facts. And I noticed that was how my senior residents felt as they approached graduation – wary. I think it’s still true for them, even with their heads filled with neuroscience and evidence-based medicine, because you never know what’s going to walk in that door and our classification systems are hardly maps that lead straight to gold. I suggested that the residents start with a part time job doing something they already knew how to do – clinic, mental health center, etc. And let their practice grow slowly as they get in touch with how much they really had learned and how competent they really had become. We talk about how hard it is without biomarkers to guide our work. Internal markers are equally hard to find too, and hard to hold on to once located.<\/p>\n

    But those are just some other perspectives to George’s advice. I did medicine multiple ways along the road. And as much as I talk about problems in psychiatry in this blog, that doesn’t detract from the fact that I can’t imagine having followed any different path. Psychiatry is about the people that come to see us, not the books and conferences along the way. I wouldn’t have missed having my career in psychiatry for anything I can think of.<\/div>\n","protected":false},"excerpt":{"rendered":"

    I just read George Dawson’s excellent advice to psychiatry residents on Real Psychiatry [Advice To Residents and Advice To Residents – continued]. As a former residency director, I can say that, as usual, he’s right on the mark. There are some things I might add or come at from a different angle, but just editorial […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-54105","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/54105","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=54105"}],"version-history":[{"count":5,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/54105\/revisions"}],"predecessor-version":[{"id":54110,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/54105\/revisions\/54110"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=54105"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=54105"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=54105"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}