Hello faithful blog readers,
I am not going to apologize for this lengthy absence because I have been having a wonderful and, in my opinion, well deserved vacation before starting medical school. However, I hope to write more in the upcoming months because I have a feeling that medical school will provide lots of fodder, both in terms of my own mental health management and exposure to mental health professionals and patients in the system.
I spent the last week in the 1,100 person town of Heppner, OR, working with the local family physician. As most family physicians do, she assured me that there is plenty of psychiatric exposure in family medicine, and she was correct. I often wondered what aches and pains might be cured by speaking with a therapist or addressing brain chemistry, and which ailments truly needed pharmaceuticals and which needed lifestyle and outlook changes.
Just outside of Heppner is an eight bed step down facility for mentally ill patients on involuntary holds. This was a beautiful place: clean, well run by loving staff, and providing lots of activities and resources for the patients. It was also, particularly for me, a sad place. The psychologist was extremely dedicated and knowledgeable. When discussing the support staff, she listed dedicated social workers, a psychiatrist out of a town several hours away, and the "peers": people with mental illnesses who work as "peers" to inspire and coach those on a hold. She told me about "peer conferences" and "peer advocates" who work with clients to inspire and counsel them. How interesting that a "peer," someone with a mental illness, is given their own designation; it seems implicit in this setup that the vast majority of other professionals (doctors, psychologists, et cetera), are not in fact "peers" with their mentally ill patients and could not provide the same type of empathy. It seems implicit that health care professionals are not "peers" with their patients when it comes to mental health, that we are intrinsically different. Whether or not this is the case, stigmas around mental health certainly perpetuate the stereotype. A doctor could much more easily say that they have a family member with diabetes, or they themselves have taken a certain antibiotic (indeed, I have observed doctors do both), but it would be something else entirely for a doctor to confide that she, too, is bipolar, or that she has tried an antidepressant.
Should health care professionals confess when they can empathize with their mentally ill patients (I don't know why I linked that article just there but it's a great article)? Should they be allowed and empowered to disclose their own experiences with mental illness (within their own boundaries?) Wouldn't this truly encourage their patients and improve their relationship, rather than further divide the mentally ill and their providers by designating "peers" who serve no other purpose BUT to empathize? I certainly hope that I someday have the courage to share my own diagnosis with my patients, but I know that I will not do so as a medical student, or a resident, or even anything but a very well respected psychiatrist, because my peers and perhaps my patients might view me differently. All other things being equal, would a bipolar patient want a bipolar doctor? All things being equal, would anyone want a bipolar doctor? I entered this profession because all things are NOT equal, because my experiences as a bipolar person will make me a better doctor and in particular a better psychiatrist, but it frustrates me to know that I will be in hiding in my new profession for most if not all of my professional life.
I am your peer, I want to say, and isn't that the most profound thing one human can say to another? How frustrating that as a doctor, I will be unable to say that to the patients that I empathize most with. But I will say it here. I am your peer. I am your peer. I am your peer.
I am not going to apologize for this lengthy absence because I have been having a wonderful and, in my opinion, well deserved vacation before starting medical school. However, I hope to write more in the upcoming months because I have a feeling that medical school will provide lots of fodder, both in terms of my own mental health management and exposure to mental health professionals and patients in the system.
I spent the last week in the 1,100 person town of Heppner, OR, working with the local family physician. As most family physicians do, she assured me that there is plenty of psychiatric exposure in family medicine, and she was correct. I often wondered what aches and pains might be cured by speaking with a therapist or addressing brain chemistry, and which ailments truly needed pharmaceuticals and which needed lifestyle and outlook changes.
Just outside of Heppner is an eight bed step down facility for mentally ill patients on involuntary holds. This was a beautiful place: clean, well run by loving staff, and providing lots of activities and resources for the patients. It was also, particularly for me, a sad place. The psychologist was extremely dedicated and knowledgeable. When discussing the support staff, she listed dedicated social workers, a psychiatrist out of a town several hours away, and the "peers": people with mental illnesses who work as "peers" to inspire and coach those on a hold. She told me about "peer conferences" and "peer advocates" who work with clients to inspire and counsel them. How interesting that a "peer," someone with a mental illness, is given their own designation; it seems implicit in this setup that the vast majority of other professionals (doctors, psychologists, et cetera), are not in fact "peers" with their mentally ill patients and could not provide the same type of empathy. It seems implicit that health care professionals are not "peers" with their patients when it comes to mental health, that we are intrinsically different. Whether or not this is the case, stigmas around mental health certainly perpetuate the stereotype. A doctor could much more easily say that they have a family member with diabetes, or they themselves have taken a certain antibiotic (indeed, I have observed doctors do both), but it would be something else entirely for a doctor to confide that she, too, is bipolar, or that she has tried an antidepressant.
Should health care professionals confess when they can empathize with their mentally ill patients (I don't know why I linked that article just there but it's a great article)? Should they be allowed and empowered to disclose their own experiences with mental illness (within their own boundaries?) Wouldn't this truly encourage their patients and improve their relationship, rather than further divide the mentally ill and their providers by designating "peers" who serve no other purpose BUT to empathize? I certainly hope that I someday have the courage to share my own diagnosis with my patients, but I know that I will not do so as a medical student, or a resident, or even anything but a very well respected psychiatrist, because my peers and perhaps my patients might view me differently. All other things being equal, would a bipolar patient want a bipolar doctor? All things being equal, would anyone want a bipolar doctor? I entered this profession because all things are NOT equal, because my experiences as a bipolar person will make me a better doctor and in particular a better psychiatrist, but it frustrates me to know that I will be in hiding in my new profession for most if not all of my professional life.
I am your peer, I want to say, and isn't that the most profound thing one human can say to another? How frustrating that as a doctor, I will be unable to say that to the patients that I empathize most with. But I will say it here. I am your peer. I am your peer. I am your peer.
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