One unique feature of psychiatrist is: we consider ourselves both as a physician and a mental health provider.
We are physicians because we went through medical school and residency training, we studied anatomy, physiology, pathology, pathophysiology, pharmacology and all the clinical knowledge including internal medicine, surgery, OB/GYN, and so on. We then went through several years of residency training, multiple strict board exams and certification exams as all the other physicians do to be licensed and board certified.
We are mental health providers because we work closely with clinical psychologists, licensed professional counselors and licensed clinical social workers. Together with these other mental health providers, we help people in need of mental health services.
A good psychiatrist should be both a good physician and a good mental health provider.
I did not become a psychiatrist right after medical school. I worked as an internist and endocrinologist for 7 years in Peking Union Medical College Hospital, one of the top teaching hospitals in China. It is well known that quite a lot of psychiatric symptoms including depression, anxiety, mania, and psychosis can be caused or exacerbated by medical conditions in particular, endocrinology/metabolic diseases including thyroid disease, diabetes, and adrenal gland diseases.
After I finished my psychiatry residency in Memphis, TN and became a psychiatrist, I worked for 2 years providing psychiatry consultation liaison services in a general hospital in New Jersey on the medicine floor, and I found my prior experience in internal medicine extremely helpful. I had been consulted for management of depression, and I found the patient actually has severe hypothyroidism, which has symptoms that mimics depression. I was also consulted regarding a patient with severe anxiety, but eventually it turned out that the patient had pheochromocytoma, an adrenal gland tumor that can secret massive amount of adrenaline and cause uncontrolled anxiety and panic attacks.
In the field of consultation liaison psychiatry, one important rule is: prioritize treatment for medical conditions, in addition to treatment for psychiatric symptoms. This is really not hard to understand: For instance, when a patient is having sepsis, severe infection, high fever and confusion, infection needs to be controlled first. As a matter of fact, when infection is controlled, a lot of times the confusion also goes away. When a patient has untreated severe hyperthyroidism or pheochromocytoma, it would be impossible to improve anxiety with only anxiolytic medications.
As a psychiatrist, I find I am quite skilled when treating patients with coexisting medical conditions. I am also quite proud of my dialogue with peers during our internal biweekly clinical meetings when we are discussing clinical cases that involves medical conditions.
“Cure sometimes, treat often, comfort always.” – Hippocrates
This famous quote had been seen in medical literature quite often, especially in family medicine, palliative care and oncology fields. However, I believe it is also very suitable, if not more suitable, for the mental health field. In my humble opinion, one of the best things we can do as a mental health provider is to listen and comfort.
I firmly believe that every human being is unique. Everybody has his or her own unique life stories. To be suffering from mental health symptoms that are in need of psychotherapy and/or psychotropic medications, the individual must have some life stories that he or she really wants to talk about. What is lacking is not life stories, but a person who cares and is ready to listen nonjudgmental.
Just the fact of being listened to and being understood is in itself THERAPEUTIC. As a mental health provider, I am trained to listen with empathy. I will tell the truth. I do not necessarily always agree with my patients’ opinion, but I give my full attention to listen and understand where their emotions and thoughts come from, and why they are acting the way they are now. This type of listening and understanding forms the basis of psychotherapy and psychiatric medication management.