ANOTHER WAY OF LIFE-

DEAR DOCTOR COLLEAGUES,

William Osler described medicine as not a profession or a calling but a way of life. Psychiatry is a way of life for us. Psychiatry has come a long way now. Yet there is a lot of distance to be covered. The most crucial journey is into the hearts and minds of medical colleagues and that is still a work in progress. Among all the reactions I get from people, the most baffling are those from doctors.  They reflect not only ignorance, but also prejudice, superstition and sometimes contempt. Here are the commonest:

WHY DID YOU TAKE UP PSYCHIATRY? (usualy accompanied by a wink and chuckle)

Somehow there is a myth that folks who did not do well academically took up Psychiatry, because of lack of options. Or worse, that people with ‘inner conflicts’, ‘perverse desire to pry ’or otherwise maladjusted in life are drawn towards Psychiatry. Most Psychiatrists of today have an outstanding academic record and have chosen to train in the subject on account of their passion for patient care. They are well rounded personalities being gifted writers, artists, musicians, social workers, researchers- in addition to being full-time clinicians. People take up Psychiatry because they are sensitive and want to make a difference to the quality of life of their patients; not just cure them or treat test reports.

PSYCHIATRISTS KNOW NOTHING AND DO NOTHING

This is a famous adage told to undergraduate classes. The fallacy of this statement reveals itself to doctors when they or their loved ones have to suffer from emotional issues or psychological disorders. Eventually whatever is the specialty chosen by a doctor- at least 15-20 pc of the work turns out to be psychological intervention and that is the time most people realise the value of what psychiatrists know and can do. Unfortunately having learnt that Psychiatry is useful and lucrative, some people will start practising psychiatry after a perfunctory course in Counseling (usually long distance or part-time).

YOU GET THEM ADDICTED TO DRUGS/ MAKE SURE YOU DONT MEDICATE MY PATIENT

This is an incredible statement considering that the knowledge about chronic nature and biological basis of Psychiatric disorders is in the public domain and even laypersons know about it. I cannot understand the difference between putting a patient on an anti hypertensive drug and an anti depressant drug- both are chronic medical problems requiring lifelong medication. Next is the insistence to treat ‘my patient’ with only therapy.  It is like insisting that normal delivery should be done even if there is severe cephalic pelvic disproportion or that patient should be treated with physiotherapy even if there is a fracture. I think you all need to back off and respect Psychiatrists as experts of their domain. They will deliver the results- subject to the prognosis as in all specialties.

SPEND SOME TIME, HE/ SHE NEEDS TO TALK

These are the doctors who confuse Psychiatry as a sort of ‘escort service’ embedded in the medical profession.  Just for the record, Psychiatrists are qualified medical professionals who diagnose and treat mental illnesses. Psychiatrists (and for that matter psychologists or counsellors) will not be able to ‘spend time’ to ‘talk’ to someone who is merely lonely and bored.  In case you come across persons who are not mentally ill and require no treatment; definitely don’t refer them to Psychiatrists. They can look up the net for more productive diversions and hobbies.

TELL THE PSYCHIATRIST TO STOP THE MEDICATION, THEN YOU TAKE TREATMENT FROM ME

Some doctors have either Psychiatry or my treatment approach which makes life very difficult for the patient. Some doctors feel that it is natural for a patient with a serious illness like infertility, cancer or heart disease to be depressed, and in the scheme of things it is sufficient to treat the ‘serious illness’ ONLY. Actually psychiatric treatments including medications are perfectly compatible with all kinds of treatments including infertility treatment, pregnancy and cancers and that too, in all age groups. And they add much to the quality of life of the patient (and bottom-line of hospital by reducing ALOS).  Psychiatric treatments are safe, cost effective, efficacious and increasingly accepted by patients. So, what's your problem, doctor?

IN LEAVING

The essential service in medicine is to save life and alleviate suffering. There are many ways to do that. In Psychiatry, it is done calmly and through the agency of the patient himself. It requires a different kind of judgement and courage to believe that the patient will transcend his predicament and to motivate him to do so. We Psychiatrists understand this and respect each other for it. Among Psychiatrists you will rarely see competition or bad blood- all of us know that the task before us is monumental and all hands are required to accomplish it.  That is why, rarely will a Psychiatrist discourage anyone from taking up medicine or Psychiatry.  It is another way of life.

Careless whispers

I am sitting across someone who is extremely depressed, suicidal and in a very miserable and dangerous situation. Things were not always like this......about 6 months ago this person was a well adjusted happy person going about life smoothly- inspite of the many challenges.
That he was on one anti depressant pill was not common knowledge. He went to fill his prescription at a new chemist- the chemist advised him not to take pills. He told him that Psychiatrists do this 'business' purposely to enrich themselves. One must take as less of these medications as possible and meditation is a better remedy for mental illness. This unnecessary intrusion caused stopping medications resulting in a severe relapse. Now I will have to probably give a course of ECTs to save the patient's life. And how he is suffering!

Then yesterday I have a call from a distressed mother. Her 9 year old has obsessive compulsive disorder. He spends several hours a day doing meaningless rituals. When the mother gets in the way, even by mistake she is severely assaulted by slaps and verbal abuse. Their family has not slept properly for 3 years because the rituals continue well past midnight. After trying homeopathy for 6 months she has come to a Psychiatrist who gave her pills and put the child on therapy. But her family physician, who is a homeopath has said that she is an impatient mother- his opinion- 'medications are harmful and being given in high doses so that the childs brain gets damaged and he gets addicted to it for life. What kind of mother gives such medicine to her child?' I am really upset at this shooting from the hip of a person who has no idea about how qualified I am versus him in this field. And about how indifferent he is to the childs and familys suffering. OCD needs higher doses (definitely higher than homeopathy, where the medicine is only a memory not actually present). I have put in decades of painstaking effort to acquire the expertise to treat this kid. And if this kid is not treated now he will have to drop out of life and his family will be devastated. Taking a pill is a small price to pay to be able to live a reasonable life.

Then the third call is from a Physician who practises in the neighbourhood. She is enquiring about phobia, suspects that one of her hypertensive patients aged 36 years may be having it. At the end of the discussion, though she says she will try her her best to convince him that he does not have phobia, so that he stops worrying about it....because she doesnt want her patient to be put on any life-long medication! She could have knocked me down with a feather! He is already on antihypertensives which are far more expensive and dangerous than anti depressants. And by convincing, will the phobia go away?

Really people should stop advising on mental health unless they have reliable information. Please consider that the Psychiatrist is a qualified responsible person. We will not only treat the patient, but also take responsibility and manage if anything unexpected like side effects occur. For God's sake, if someone is looking better after Psychiatric treatment do not make them stop it. And please get proper information about the Psychiatrist and medication before carelessly insinuating malafide intention.