Greetings all,
I bet as fellow psychiatrists you are
asked this all the time, or maybe not. I always start my session with new
patients targeting this to attempt to and debunk any stigma and myths they
invariably have about us. The stock standard answer from the new patient is
that 'you prescribe drugs, psychologists don't'.
What a shame that after over a
hundred years, post collaborations between Freud and Jung who later parted ways
as the genesis of psychiatry and psychology was forming, we still have to
explain to patients who we are and what we do. In stark contrast, if a patient
presented with a broken leg to an emergency department, they would demand to
see a doctor, not an allied health professional fully qualified to assist with
rehabilitation. Yet for some reason psychiatry is not recognised as a medical
specialty amongst lay people in 2014, and we still need to 'sell' ourselves to
those who are referred to us. For those of you reading this and disagree, I
suggest you begin your sessions the same way and see what they reveal. Reality
ain't pretty.
There are so many reasons why psychiatry
and psychology are two different disciplines that share similarities and should
complement each other. Go read a standard text and work it out. In clinical
practice, although I incorporate my own mix of pharmacological and
psychotherapeutic approaches, I have a niche of psychologists whom I refer to
constantly to request their guidance, and deliver their expertise for patients
we share. In private practice it is a lovely nurturing model that the public
hospital system with all its rhetoric and useless catch phrases never
accomplish when they refer to the use of a multidisciplinary team. Where would
I have ever learnt about schema focused therapy in my training, yet how many
patients have I referred to psychologists for this expert type of therapy that
have resumed their lives, better than before with a collaborative approach
between psychiatrist, psychologist and GP? Any patient, for which there are so
many, with childhood trauma, benefit so beautifully with this approach and I
have learnt so much from my psychology colleagues.
But here is the disparity. Last week, I
met a psychologist who was keen to work 'collaboratively' with me. After about
10 minutes he was keen to impart his ideas that in about 20 years, psychiatry
would be a dying profession, and by then psychologists would be able to
prescribe medications. In his eyes, psychiatry was the path of last resort for
patients with mental illness, as psychologists were much more expertise when it
came to understanding the mind and brain. He had little time for doctors in
general and psychiatrists in particular who prescribed medications
indiscriminately, and didn't seem to appreciate what psychiatrists could offer.
Yet he wanted to work with me and share patients. If I could refer them to him.
Gee, thanks, but I chose politely to decline the offer. However, I was left
thinking, was his view reality based on his interactions with our specialty or
was it skewed? It's easy to argue the latter when defensive. We ain't surgeons,
we don't fix almost AMI's and death amongst our patients is taken on as
personal failure. Our work is not glamorous, but was he frustrated about our
resistance to work together collaboratively, or was he trying to claim our turf
bestowed with our medical registration and specialty training?
And then the second disparity. A new
patient referred to me and in the throes of engagement with our fortnightly
sessions. Towards the end of the second session she felt compelled to talk
about her conflict. Not about her life, her family, her chronic illness or her
existence. No, her conflict was she didn't see me as a psychiatrist. She asked
me to label what was wrong with her and I replied by saying that labels were
not always useful, getting to know people was much more helpful. I reassured
her that I was still getting to know her and for her to feel comfortable with
me. But her feedback was compelling; she stated I acted more like a
psychologist as I was more down to earth and easy to talk to. How did she form
that opinion? Where did that come from? In her early 20's and without any
formal psychiatric history, this was her opinion.
What is psychiatry getting wrong? Why do
we have to constantly defend what we do? Are we going to be obsolete? I welcome
you unabashed, candid views...
As always,
Helen
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