Friday, December 14, 2007

Preconceived Notions

Roy referred a patient to me the other day. Thanks, Roy!

The patient made a point of telling me both on the phone and when we met that Dr. Roy had given her a list of psychiatrists, but he'd circled my name. Of the docs on the list, I was the one most highly recommended, or so the patient says.

When I was a new-be psychiatrist and someone came to me saying, "So-and-so says you're really good," I felt a bit uncomfortable, worried I'd disappoint. Sometimes patients came after 3 other shrinks didn't fix them, and I was fresh out of residency: it was a bit intimidating.

I've not done any research on this-- it's more anecdote and if I had real data, I assure you it would be useless---but now I like it when people walk in with the idea that I'm an extra-special shrink. A lot of treatment, especially the beginning of treatment, is about hope, and if people believe they're seeing someone good, someone better than the rest, they walk in hopeful and it seems to me that they're more likely to both connect with me easily and to get better.

There are lots of good psychiatrists in Baltimore, I'm nothing special. But if the patient comes expecting to be helped, chances are better that I'll succeed than disappoint.


Anonymous said...

Dinah, you ARE something special! Your patients and your family are both very lucky to have you in their lives!

Anonymous said...

Doesn't this imply that the placebo effect has more impact on psych treatments than the practitioner's skill?

ClinkShrink said...

Meg: Her co-bloggers are pretty lucky to have Dinah too.

Dinah said...

Meg and ClinkShink: Awww...thank you. I love compliments.

Airwick: Yup. I bet it works in every other medical specialty as well.

Anonymous said...

your last sentence is funny. because you used the word "then" instead of "than", you are saying that you will first succeed, then disappoint. oops :)

Rach said...

Dinah, i think it says a lot if a provider refers you to someone else - it really says that provider a has confidence in provider b's abilities and skills. Which, clearly, Roy has in you.

And I think it works in other areas besides medicine, teaching for example. I used to refer my students to other teachers that I thought could help them. I was usually right about 85% of the time.

Sarebear said...

Woohoo, Dinah!

Anyone else thinks it is funny, when the darn thing doesn't remember you were logged in so's you can comment on Blogger, that it asks you to "choose an identity".

I think I'll be Stan Lee today, he's got a Super imagination.

Oh, plus I like to swear cartoon style like this $#$%^#$%^ it and W$%#%# the @$#$@ing @$@#$itty @#$@#ing @#$@$@.

janemariemd said...

Nice post! This is because the relationship between a patient and a physician matters (is really the medium by which a patient can improve), and if there isn't any trust (which I guess has to be two-way), then it will be hard (if not impossible) for the patient to get better. Plus, if the patient comes in already trusting you, s/he might get better faster! I think this goes for any clinical specialty, and thank you for inspiring me to think about this.

Anonymous said...

"if the patient comes in already trusting you.." I can see a patient being optimistic for certain reasons but trusting a total stranger coming in is a disorder in itself.

DrivingMissMolly said...

My last apt. at the health center, I asked the resident for a list of docs he recommended. There are 4 names on that list which I still carry around as a talisman of sorts.

I methodically went through the list. The top doc didn't take my insurance, doc #2 did, but because she was the only one with insurance she had a 2 month wait. I can't remember the deal with the other two.

Then, I read at "The Last Psychiatrist," I think...that academic psychiatrists "do nothing." Now I have also wondered whether he is burned out after 34 years. When he gets that "far away" look in his eyes, is he trying to remember what his wife wanted him to pick up from the grocery store on the way home from work, or is he accessing data from so long ago in his brain that the glazed expression is really just a thinking one?

I went back to one and made an appointment. He sort of "knew" me from the residents' presentations. He didn't want me to wait the two weeks he would be out. HaHa! I said I would gladly wait the two weeks and pay cash.

A quick look at the Texas Medical Board confirmed his age (60s), years practicing (34), and that he spoke Hebrew.

Originally I had not wanted a psychiatrist of a "certain age," convinced that they were going to be sexist and too old fashioned for me. He proved this by calling me "Mrs. so-and-so" for the better part of a year, but now he just calls me by my name.

At first I had high expectations based on the reverence the resident spoke of him with and his impressive titles at the med school PLUS all of his article writing. I have a thing for professors :)

Now, well, I've seen him a year, I guess I'll keep going, but the luster that was once on him has worn off.

Maybe he finds me boring?

I really need him so I pretend it's Ok or will be. I fear his death, retirement, or moving and we've talked about that.

When I think of him and I think of me, I imagine myself on the floor with my arms around his ankles beginng him not to leave me, but at the same time, I'm not sure we're making progress.


DrivingMissMolly said...

Sorry, I'm not sure that made sense. One of the paragraphs got out of order and I don't think I'm thinking very clearly.


Anonymous said...

This is what I've been starting looking at for my Master's thesis (except from the angle of chronic pain patients)! I think the more patient-doctor trust you have, the better the treatment outcomes people with chronic pain will have, particularly those with "mystery syndromes". That could translate into fewer ER visits, less prescription pain med use, less pain related disability, lower depression scores, etc. I'm just starting out in this line of research, but I'm glad to hear dr's have the same notion.

NeoNurseChic said...

Dinah, We always knew you were special!! :)

I agree that it works that way in other areas of medicine, as I saw it clearly with my first headache-specialist neurologist. I didn't go to the ER the entire time I was under his care. He never once led me to believe we were running out of options or that I should lose hope. I think that made such a huge difference!

When he left, I went to one of his more experienced colleagues. I don't think we hit it off on the first appt, as I was coming in with a new headache symptom, and he brushed it off as no big deal... I went to the ER for the first time in years the next day with a 4 hour cluster headache attack. I went to the ER several times for various problems during the 1st year or 2 that I saw him. I even went to a different doctor for awhile trying to find somebody I could match better with.

The last few years, though, we get along beautifully and now I'm not going to the ER and not having as many problems as I was having before in terms of emergencies. It doesn't mean that my problems were made up or not serious - but I think that trust and hope in a doctor greatly impacts the course of treatment.

My psychiatrist friend once went to a conference on the placebo effect, and she came back saying, "What's so WRONG with the placebo effect? It just highlights our body's amazing ability to heal itself." I agree with her. It doesn't mean that because some things can be helped by attitude, outlook, whatever that they are less serious or less real. I just think that attitude, outlook, etc play a role. If you have hope and trust in a provider, then I think the treatment often goes better.

My .02!

Take care,
Carrie :)

Anonymous said...

I am a new-be patient. I found my doc from a published article with picture. I felt more relaxed seeing who I was going to deal with before starting anything. I've only been 2x and I really enjoy going. It's been great. I talk the whole time. We're opposite genders though and I've read about transference. Is that why I enjoy going?

Could you do a blog post on transference?