I ask this question because I sense patients are looking for something when I talk to them the first time. Perhaps they were unsatisfied by prior treatment efforts, are looking for better explanation of their diagnosis, or didn’t gel with their previous provider? I always ask what the person is looking for this time with their doctor.
My own experience, having talked to hundreds of prospective patients, is that they are feeling disconnected with healthcare providers or even the whole system itself. Common themes I get are that the visits were too short, too superficial, the doctor didn’t make eye contact, the prescription doses were not changed or that the medication was ineffective, but they carried on with it anyway. They are looking for something different.
This is where I think a doctor can make a difference. My own approach is very straightforward, earnest, and passionate. I tell patients that there IS hope, that we CAN do better, and that, we WILL get through their distress, but only if we work together. I establish that this is the beginning of a journey where I will be there, alongside a therapist, during ups and downs and that they can get hold of me directly so that they know I have their back throughout the process.
This is what is referred to as the treatment alliance: a meeting of the minds between doctor and patient. It’s a professional relationship that is a crucial part of recovery because it occurs from regular, open discussions between patient and physician, trust, faith, hope, and ultimately confidence and empowerment in the patient. This may sound “cheesy” but it matters to me as a physician. I know from what my patients have told me, that it certainly matters to them.
Of all the disorders I treat, I see anxiety as the most common symptom. This is one of the most treatable symptoms and that I have seen incredible recovery from this debilitating disorder. I try to instill realistic expectations that anxiety can’t just be excised (like taking out a wart or tumor surgically) and that they cannot expect to be rescued from it by medication alone. Instead, I ask them to learn about the natural patterns of their disorder so they feel empowered to better handle fluctuations or relapse of symptoms.
I also educate patients that this requires practice and persistence on their part, which is the other crucial element of recovery. Along the way, I impart what I have learned from my own clinical experience. Then I couple this with relevant psychological approaches and models. That way they can begin to appreciate how all of these interventions dovetail together in facilitating their own, lasting recovery.
Perhaps that’s where my approach differs from the message that our system unwittingly imparts to patients: that something else–not them–is required to eliminate symptoms and suffering. This message has left many patients beholden to “as needed” pills such as benzodiazepines which are too commonly prescribed, leaving them hobbling from crisis to crisis, not improved, and none the wiser about their anxiety/mood disorder. Sadly, they were not encouraged to develop skills and tools that might have stopped things getting worse.
It can take time to reorient one’s expectations. That part can be hard for anyone, especially when anxiety is so discomforting and persistent. This is where my personal passion for teaching my patients about what medication does comes in, and how it can really make a difference.
As a psychiatrist, I have seen countless positive outcomes with the right medication, dosed correctly. Does it cure? Not exactly, but it does make the bumps much less frequent and bumpy. When we couple that with the patient’s learning and practicing lifestyle changes and new coping skills, I see a substantial reduction in symptoms, and what really heartens me in my work: a corresponding new sense of confidence and empowerment in my patient.
That is my style as a physician. What I can say is that my own approach has been welcomed by patients over the years. It is gratifying for me to see them go one to thrive in their lives, not just survive, as they were doing at the outset of our journey together.
Can your psychiatrist make a difference? I think so, based upon my own life experience and approach as a physician of over 20 years. I will continue to spread this hopeful mantra to all.
