My approach to treatment in Psychiatry is called “eclectic”. I do not pigeonhole or rubberstamp patients so that they appear once monthly for a 5-minute prescription refill and then disappear until the next month.
Instead, when I evaluate my patients I do as complete a review of their health as possible. A diagnosis is determined and a treatment approach is planned.
One time I was speaking on the practice of Psychiatry at an educational conference. A psychiatric resident in the audience asked, “Why does it take you so long to figure out what is wrong with the patient? I can usually make the diagnosis within the first few minutes.” My answer was, “The psychiatric diagnosis is the last diagnosis made.” It is necessary to rule out other illnesses that simulate psychiatric disorders. Aleksandr Solzhenitsyn noted, “Truth eludes us if we do not concentrate with total attention on its pursuit. And even while it eludes us, the illusion still lingers of knowing it and leads to many misunderstandings.”
These are some general instructions on listening I try to follow:
- “So when you are listening to somebody, completely, attentively, then you are listening not only to the words, but also to the feeling of what is being conveyed, to the whole of it, no part of it.” – Jiddu Krishnamurti
- “To be listened to is, generally speaking, a nearly unique experience for most people. It is enormously stimulating. It is small wonder that people who have been demanding all their lives to be heard so often fall speechless when confronted with one who gravely agrees to lend an ear.” – Robert C. Murphy
- “I like to listen. I have learned a great deal from listening carefully. Most people never listen.” – Ernest Hemingway
- “It is the province of knowledge to speak. And it is the privilege of wisdom to listen.” – Oliver Wendell Holmes
Aleksandr Solzhenitsyn wrote in The Cancer Ward, “Sometimes it’s easier to find a wife than to find a doctor nowadays who is prepared to give you as much time as you need and understands you.” My first training supervisor advised me, “If you listen to the patient, he will tell you what is wrong.”
My new patients may be referred on to sleep specialists, endocrinologists, or neurologists for further evaluation of medical diagnoses. I promise my patients that I will leave no stone unturned to try to find the cause(s) of their concerns.
Followup visits include a review of original symptoms, a review of the effectiveness of treatment, and supportive therapy.Supportive therapy is the discussion, education, and decision-making of and about what has happened because of the illness. Together, the patient and I try to remedy the damage, mistakes, and hurt that the illness may have caused to the patient, to the family, and to the community. The purpose is to gain a way forward to a better quality of life.
God bless my family, and bless me in this endeavor.