Wednesday, September 25, 2013

On being a psychiatrist: Is an MD sufficient?

Sigmund Freud LIFE
Freud argued that a psychoanalyst did not necessarily need to have a background in medicine. One might argue that to properly understand the dynamics of the psyche one might be better served by studying anthropology, sociology, history and, of course, the proper way to think about things, i.e. philosophy.

At odds with this view, like it or not, psychiatrists are physicians first.  Following graduation from medical school they enter a one year internship, followed by a three years residency in psychiatry. During internship, a psychiatrist typically splits his time between medicine and neurology (for six months) and six months of inpatient psychiatry. For the next three years, the future psychiatrist gains experience in treating a variety of patient populations (inpatient and outpatient, patients with major mental illness such as schizophrenia, bipolar, major depression or Alzheimer's dementia, illicit drug users, or severe personality disorders). As a trainee, a psychiatric resident learns how to use a variety of psychotropic medications and psychotherapeutic interventions.

It is a lot to master and that leaves relatively little time for anything else.

At the same time, psychiatry is so much more than just making a diagnosis in accordance with the medical model and then prescribing an evidence-based intervention. When it comes to psychiatry, an evidence-based appraisal of data should be the beginning, not the end of a psychiatric assessment, formulation and plan.

By allowing itself to be reduced to a medical model only perspective, psychiatry loses the ability to meaningfully translate and enrich the complexity of human experience. This is a complex discussion (HERE for a link) but the point is fairly straight forward.

I would like to propose that psychiatrists should aspire to be more than just evidence-based physicians.

We agree that a psychiatrist's expertise in describing a mental illness and then offer an evidence-based intervention should be equal to the expertise of any colleague in any other medical specialty. But while the study of philosophy is irrelevant to the outcome of an appendectomy, philosophy plays an organic part in understanding and treating any form of mental illness.

Critical thinking, good humor, perspective, skepticism, and a dialectic understanding of complex facts are as essential to good psychiatric practice as the skills of carrying a psychiatric review of systems and mental status examination.

Thus, a good psychiatrist, always a physician first, also needs to have a working knowledge of philosophy. Which should exude throughout the course of a visit with a patient.

You are not sure where your psychiatrist stands on the above issues? Not a problem.

Email this post and ask for an opinion. If you get a response, please bring it back here.

Discussing, debating, trying to understand each other's perspective will make us all better patients, better doctors, better fellow beings.

© Copyright Adrian Preda, M.D.

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