Shirah Vollmer MD

The Musings of Dr. Vollmer

Speaking To Patients

Posted by Dr. Vollmer on June 24, 2015

 

Talking drugs, as I call it, is a favorite pastime of mine. By that I mean that I like to talk about psychopharmacology in the context of human suffering. This, one might say, is my dog and pony show. Usually my audience ranges from medical students, psychiatric residents, child psychiatry fellows, art therapy students, or master level clinicians. Each group brings a unique perspective to my talk. Today, I expanded further by talking to patients, a group of folks who are on psychotropics, prescribed by other clinicians. “I used to talk to my psychiatrist for an hour, but now I see him for fifteen minutes. I say a key word, and he jumps to a particular medication. I do not know what happened,” says an audience member, illustrating my persistent point that psychiatry has lost its way. To prescribe medications, the first order of business is to establish trust with the patient, I explain, articulating the physician’s side of the street. I continued with a frequent example. I see patients in a substance abuse rehabilitation facility. “How are you?” I ask, “Fine,” they respond. If I were to end the session at that point I would have documented that the patient is doing well. However, if I wait, and follow-up with a few probing questions, I learn a different story, often involving some major life event, like a relapse, or a break-up, or a family member with a new diagnosis of cancer. Time is critical to uncovering the details of the patient’s interior. I continue explaining  my dismay over the fifteen minute appointment, and once again there is a sense of gratitude, that someone wants to listen and prescribe medication. So, if you readers want me to come to talk about psychotropic medications, I would be happy to. Just know that I maintain my stance that listening and prescribing  are both critical to the experience. Anyone listening to that?

6 Responses to “Speaking To Patients”

  1. mimi lind said

    i’m listening and agree!!! thank you so much for giving your drug talk!!!

  2. Shelly said

    Wish I could have been there. I’m sure that while most people want the meds for the relief they bring them, others also want to unburden themselves in the safety of the therapist-patient space. That place is sacred and helpful and if they are willing to learn about themselves and what brings them to that place in the first place, can be life changing. Can you blog more about the psychotropic medications?

    • Yes, indeed. For some, the medications are the ticket to psychiatric care, and for them, this can mean a special relationship in which they can begin to see themselves from a new perspective. That is the essence of my spiel. I can and will blog more about psychotropic medications. Thanks for the encouragement.

  3. Eleanor said

    Shirah, in psychiatric residency these days I seem to remember you mentioning that residents don’t begin any training in psychotherapy until about year 3 or so. Is this correct? (Is residency 3 or 4 years?)……If this is the case how in the world can a psychiatric physician just out of training know enough to begin psychotherapy on someone he or she has just prescribed medication to? Do they have any psychotherapy for themselves personally during their training? Are they really qualified to do any in-depth psychotherapeutic work just out of residency? Just wondering….

    • Hi Eleanor,
      Yes, at some programs, particularly the ones I am familiar with, the formal psychotherapy program begins at year 3. For most, it is a 4 year program, but some folks add on child training, either at year 4 or year 5. I started at year 4. Some may have psychotherapy during their training, but this is not mandatory. In general, their psychotherapy training is limited both by time and depth, but for those students who are motivated, they can ensure they get good training. The problem is that the consumer does not know who is who, so the variability in psychotherapy skills is tremendous. Thanks.

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