What do patients expect of me?

Walter (mon cher!) recently asked: “what do patients expect of you?” I thought I would reply in an entry.

The culture has changed. It used to be the psychiatrist was seen as a cliché analyst with whom you share your dreams and inner-most thoughts. He tells you what it all means and through this insight you feel better. Nowadays (at least in the States) the psychiatrist is the ‘guy who prescribe the meds” while others deal with your personal problems. Based on this ersatz job description, most folks who come to see me nowadays are looking for me to prescribe them something.

In my office are two pottery jars. One is labeled “Eye of Newt”; the other “Fairy Dust”. Patients fear I will give them something sinister that will turn them into zombies or werewolves while simultaneously hoping for magic pills to take away all their ills.

First-timers are often not at ease if downright skittish. They often look around for ‘the couch” and are relieved and disappointed to find none. Rather, I am sitting upright and writing on a pad but typing on a keyboard. I do a lot of explaining what we are doing; they seem assured I am ‘always looking for the most conservative methods’ to treat what ails them.

Many patients still look to me for help with their personal problems. I have a handful of patients who regularly check in with me to get grounded and hear sage advice. Their meds are stable; they are coming in for a talk. Some of them want advice/support but most of them just want me to listen.

Alas, I have many patients who should be in counseling but won’t go. The usual explanations are they don’t have time or money to do so. They often come in for 15 minute ‘med checks’ and spend it venting their woes and then want me to do something about it – with medication. I butt heads with these folks the most. They often spend a lot of energy/time – and money in this way.   At best I can get them somewhat better.

I learned in school not everyone wants to grow. The majority of people just want some symptoms alleviated and just enough to function. However there are still few, the lucky few, who are interested in learning about themselves; they want to be on The Journey.  I do what I can for them. Most of the time they need to do that elsewhere with someone who has sufficient time (and coverage) for it. I was trained in Jungian Psychology – great for Self growth but not good for panic attacks and general anxiety etc.

And then there are the folks who want pills – pills to sleep; pills to calm; pills to focus and give them energy. I have to be careful with these folks as they can be black holes of need which no amount of medication appeases. “Give me more (fill in the blanks)” These folks needs education – and limits.  People often think psychiatrists push pills when in reality they spend a lot of time trying to get people to do/try non-pharmaceuticals rather.

I like my job for I never know who and what matters  will next come through the door.  Mostly I go on The Journey with my patients,  sometimes as Guide but more often as Companion.  I may not be able to always heal but I nearly always influence. That in itself is nothing to sneeze at – and better than Fairy Dust or Eye of Newt.

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