The Reluctant Psychiatrist

The Reluctant Psychiatrist

When I was a resident physician in training, I remember my excitement in mastering the principles of psychopharmacology. I was so eager to diagnose patients" problems and apply the right treatment.  The treatment plan consisted of addressing biologically correctable facets of the illness presentation and supportive psycho social therapies. This model neatly fit my medical training and the prevailing medical model. Over the years of my practice, I have given many presentations on new medications and disease states to physician groups.

As I age and hopefully become a wiser clinician, I find myself questioning the pure medical model for many psychiatric and chronic medical conditions. I am also more averse to the risks of various therapies for my patients. I am much more aware of temperamental differences among individuals. Many people are leading hard lives and have real existential challenges to their safety and existence. Some have been badly scarred at an early phase of their lives. I am happy that I can still maintain the medical model but apply it in a much more nuanced way that takes into account the patient's experience, individual variability, and possible alternative and holistic therapies.

1 year ago
1 year ago

I saw the young man for the first time last month. He could not sit still for more than a few seconds and was constantly fidgeting. His life was a classic example of setbacks and unfulfilled dreams...

1 year ago

ADHD-affected individuals often have trouble reading for long periods. Many report trouble concentrating, experience headaches, sleepiness, and restlessness while attempting to read. The problem is...

3 months ago

By the time we are adults the condition we call ADHD in children morphs into a particular style of living and relating that the term itself does not imply at all. What was formerly a childhood lack...

1 year ago

Recently a patient whom I had not seen for almost a year showed up in my office demanding that her antidepressant prescriptions be filled for another year. She made it clear that she had no interes...

1 year ago

When a physician claims a holistic/ integrative approach to medical care, she usually faces either admiration or incredulity and disgust. I can attest to that from personal experience and my additi...

1 year ago

One of the more challenging aspects of my my work as a psychiatrist is when patients with good intentions come in to the office with a self-diagnosis of ADHD.  They are completely convinced af...