By Marvin Ross
And that is a rhetorical question as I have no idea. It was a question raised the other evening at a presentation I was at with fellow blogger Dr Dawson. The presentation was put on by the group Home on the Hill Supportive Housing in Richmond Hill Ontario as part of their ongoing Robert Veltheer Lecture Series.
At this presentation, two women with schizophrenia talked about their experiences with the disease and how they coped. Dr Dawson answered questions about the nature of schizophrenia and the video will be available soon which I will post. Both women received standing ovations from the audience when they finished describing their struggles and their successes. I have to admit that I was very moved.
The question of a good shrink was raised and people struggled to answer it so I would be most interested in how the readers of this blog might answer that question.
Dr Dawson, if I remember correctly, talked about the need for all doctors to focus on their patients. Evidence based plus Electronic Medical Records (EMR) allows for the efficient input of great quantities of data gleaned from a q and a with the patient. But, while inputting, so much if not all of the appointment is spent with the doctor staring at the monitor or back and forth between patient and monitor. This strict adherence to evidence based medicine is unsatisfying for the sufferer and thus probably a reason more and more, in this era of science and information, are turning to acupuncture, naturopathy, chiropractors all of whom provide some comforting magic and the promises we all want to hear.
Another important component of psychiatric support is ongoing support for the patient at fairly frequent and regular intervals. This can actually be done (and is often done in good programs) by case managers. The case manager will meet with the patient and discuss successes, failures and activities. If there are problems, then the psychiatrist can be brought in.
Most of the time, we do not get to chose the psychiatrist but have one assigned to us by the hospital or agency based on who is available. There is little room for choice given the shortage of those in this specialty. If I get referred to a cardiologist by my family doc and I do not like that person, I can always go back to the family doc and request a referral to someone else. This is not a luxury open to psychiatric patients.
Another problem, in Ontario at least, is that if you are hospitalized, the treating outpatient psychiatrist is replaced by whichever psychiatrist is responsible for that unit. Most of the time, the in patient doc will consult the chart and talk to the regular psychiatrist and caseworker but not always. I’ve seen that happen with disastrous results. And, like a crap shoot, you may actually get an exceptional psychiatrist which, thankfully, I’ve also experienced.
So from my perspective, a good psychiatrist is one who understands the disease and its treatment, listens to the patient and interacts with them, the family and provides regular and frequent support from a qualified and empathetic case worker.
I’d love to hear what you think.