So I'm dull. It's not such a bad life

Apparently Mr. (Ms?) Anonymous hasn't been too thrilled with my opinions in the comments over on the Shrink Rap blog and felt the need to come over here and make a couple of snide remarks. He/she seems to be someone who feels like psychiatrists are misanthropic snake oil peddlers (which seems like a strange sort to be lurking around a blog written by three psychiatrists, about mental health issues).

It's not a unique viewpoint. And you know, in a way, we are. Well, maybe not misanthropes, but a lot of our treatments are based on anecdotal evidence of what works instead of hard biological data. I mean, you can say that about a lot of things in medicine, but it's even more prominent in psychiatry, I think. Each patient is such a unique mixture of chemicals, experiences, conditioning, and genetics, that one size fits all treatments are usually inappropriate. Now, I concede, that doesn't mean there aren't shrinks out there that think the answer to everything is higher and higher doses of Seroquel or that dole out SSRIs like candy. I quite often get patients who are followed by providers outside our system whose med lists leave me scratching my head (or occasionally outraged). I got into quite a battle last week about a patient who has a diagnosis that not everyone believes in, and how everyone then blamed her therapist for destabilizing her with this voodoo instead of admitting they didn't know much about or understand her diagnosis. I had a doctor send me a patient yesterday -on whom he hadn't come close to exhausting all her medication options, who wasn't catatonic, who wasn't suicidal - and more or less tell me that if I wasn't going to give her electroshock therapy, I might as well send her home, because that's the only reason he was involving us.

Which is not to say I'm the best doctor ever. Far from it. I have a lot to learn, but at least my knowledge is sound on one point: these are the lessons I'm going to learn from my patients.

And let me say this...you know, I'm actually relatively slow to medicate people, but I do think drugs are an important adjunct. Otherwise it's kind of like withholding insulin from a diabetic - you can monitor their labs and check their retinas and take meticulous care of their feet and watch their kidney function and they can do everything else right, but if they don't have the chemical that makes things work, things are going to go wrong. And like diabetes, brain chemistry comes in a spectrum of qualitative and quantitative deficits. Also like diabetes, if you supply the chemical but the patient does all the wrong things, then you're still aiming for disaster. Mental hygiene is exactly the same - balance the chemicals to provide relief and remove any biological impairments, and then find the therapy to move things forward. But where mental health veers from the diabetes analogy is in that afore mentioned idiosyncrasy of being human. Despite our best efforts to diagnostically lump patients, each one is a singular event. The choice of which chemical or combination of chemicals to alter, the utility of what kind of therapy is appropriate or potentially harmful....it's as different as a fingerprint. The DSM is useless as anything but a guidebook.

And since I've beaten that to death...I will concede that even I think my posting of late has sometimes been lackluster. I think it's mostly exhaustion and a touch of being compelled to daily blogging by this Blog 365 business (i.e., you get more verbiage, but it's less profound). Blame the pox. Or the not-court. Or the Flu not-A. Or life as an intern. Or maybe I'm just boring. You know, there's something to be said for leading a life that isn't overrun with drama. A life of contentment with what is and little complication.



I wish I felt like I was living such a life right now....