Psych Patients Desire Authenticity

Two women and two men wearing blue face masks with Mona Lisa painting on wall

I Want To Learn More About You

It’s not so much the content of what you say but your approach and delivery. Anyone can walk in with pride and command a patient to do this or that, but the chances that the patient will listen to you or open up are not that high. An honest approach followed by consistent listening and the development of rapport and a strong therapeutic alliance will take the patient much farther into his or her treatment.

This is because like anyone in life, psychiatric patients desire authenticity. Patients are very good at sniffing doctors who are authentic from those who just go to work to make a living. The former are the ones who tend to be of the most help, regardless of the medical school or residency which they have attended. Patients want a doctor who can connect with them and put them before the doctor’s pride and image.

It’s very difficult for psychiatric patients to deal with their mental illness, especially when they are involuntarily locked into a psychiatric unit for up to 60 days at a time. Not only are they battling their internal demons, but their environment which is a closed unit with windows, some computers and a television displaying negative news from around the world. The last thing that they need is a doctor who is not authentic in their ways.

On the other hand, many physicians are struggling themselves with balancing work and their personal lives. Especially in the field of psychiatry, it’s not easy to listen and talk all day about other people’s problems and then go home and take care of yourself and your family. There is currently a high burnout rate among physicians around the world; the stress and pressure of the job is very demanding and adds up over time.

Many physicians don’t actually intend to mistreat a patient with disrespect; they are just so stressed out themselves that their encounter with the patient may come off as non-empathetic. But this is the difference between great physicians and mediocre ones; the former know how to keep their stress levels in check and maintain their professionalism at all times.

Overall, the field of psychiatry is not an easy one. Many believe that it’s not difficult to just sit around all day and talk, but talking everyday for 8-12 hours does become very tiring, especially if your life is not balanced. Whether patient or physician, everyone has a different struggle that they experience, but at the end of the day, we should all aim for authenticity and respect and nothing less.

Are you Ready? (This is Defeating Stigma Mindfully)

Saying Goodbye To Patients

Terminating Treatment

Saying goodbye to psychiatric patients is a unique process that is much different than with other patients. Psychiatry is based on emotions, thoughts and behaviors while still maintaining professional patient boundaries. During your time with a psychiatric patient, you will come to develop a bond or attachment with them; each patient has a unique story. Knowing how to say goodbye is very important for both the psychiatrist and the patient.

Perhaps the most important factor is telling the patient ahead of time that you will be terminating treatment with them. Sometimes it’s the other way around: the patient terminates treatment with the psychiatrist. Either way, it’s always best if both parties are made aware at least one month in advance.

Disclosing last minute goodbyes can be especially detrimental to a patient’s well-being. Patients often become very attached to their psychiatrists; perhaps the only people who seem to understand them. When that is suddenly taken away from them, they often mentally decompensate and revert back to their previous self-destructive thoughts and behaviors.

There are several reasons why a psychiatrist may terminate treatment:

  • They are in residency training and are moving on to a new rotation
  • They are in the process of obtaining a position at another hospital
  • The patient has been referred to another psychiatrist
  • They are retiring

On the other hand, there are several reasons why a patient may terminate treatment:

  • They are seeking another psychiatrist
  • They are moving to a new location
  • They no longer require or desire treatment
  • They no longer feel comfortable with the psychiatrist

Whatever the reason, letting the other party know about their departure one month ahead of time, is the right way to go about the process. One month is plenty of time to allow the thought of termination to sink in for both parties. It provides enough time for emotions to be processed and arrangements to be made.

It’s never easy to terminate treatment with a psychiatric patient. Many easily decompensate even after they’ve been informed a month prior. Psychiatrists have to be able to reconnect with their patients and explain that what is most important is for them to remain focused on their treatment, regardless of who their new psychiatrist will be.

Whether personal or professional, all relationships eventually come to an end; it’s just part of life. The factor that separates early termination of relationships from late termination is time. The big picture always comes down to time; how and why are just the details. So rather than getting stuck on the details, always look at the big picture.

It’s not the end of the world if a physician-patient relationship comes to an end. The important thing is that the patient and psychiatrist recover smoothly, and continue to focus on improving themselves mentally, physically and spiritually.

Are you Ready? (This is Defeating Stigma Mindfully)

Persistence With Psychiatric Patients

Do Not Give Up On Treatment

Psychiatric patients oftentimes need reassurance that a certain treatment will be beneficial. The sound of a tricyclic antidepressant causing cardiac problems or electroconvulsive therapy inducing seizures can be understandably scary and concerning. Do not ever push a certain therapy onto a patient unless it’s an emergency.

Emergencies include suicidal ideation, past suicide attempts or current severe depression. Even substance abuse may be considered an emergency if the patient has a history of depression and overdoses, and is currently using. No matter what the situation is, always be kind with psychiatric patients; you are the potential healer of their suffering.

Persistence is important with psychiatric patients because many times, their judgment is too impaired to make rational decisions. For instance, many severely depressed patients in state hospitals are non-responsive to multiple antidepressants; their only hope is ECT.

But many patients refuse ECT out of the fear of feeling the electroconvulsive shocks being delivered via electrodes placed on the temporal regions of the head. The chances of feeling the shocks are slim to none, considering that anesthesia with Brevital, an anesthetic barbiturate, is given at a dose which induces sleep within 10 seconds, for a duration of 5-7 minutes.

The actual convulsions, on average, do not last longer than 180 seconds. The point is that psychiatric patients need persistent explanations and reassurance that a certain therapy has the potential of being beneficial. Giving up on a certain therapy because a patient consistently says “no” is giving up on your patient!

Do not settle for mediocracy. Psychiatric patients need persistent, healing human beings who do not give up on them. An excellent psychiatrist attempts to put him or herself in that patient’s shoes, in order to try to understand their perspective and where they are coming from.

Be that excellent psychiatrist. Be that caring healer. Be that loving human being!


Are you Ready? (This is Defeating Stigma Mindfully)

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