Shirah Vollmer MD

The Musings of Dr. Vollmer

Can A Patient Have A Bad Attitude?

Posted by Dr. Vollmer on December 14, 2016

Image result for bad attitude

A bad attitude can be a symptom of depression. Depression is a mood state we psychiatrists treat. So, is it possible that a psychiatrist says to a patient “the reason you are not getting better is that you have a bad attitude,”? As the story relates to me, I have no way of knowing the validity of that tale, but I want to take a moment to consider the notion of a psychiatric patient with a “bad attitude”. The idea feels so shaming and so blaming to me, I can hardly believe a psychiatrist could express this notion, and yet, at the same time, as more psychiatrists are “pill-mills” and as we know that our pills have limited efficacy, the frustration from the psychiatrist could translate to blaming the patient. Maybe we do not understand our tools, or for that matter, the human mind, enough to understand why people either get better or do not get better. Can we accept that amount of humility in our profession, or do we need to assume that a poor outcome has to do with the patient? The absurdity makes me laugh. If the patient had a “good attitude” what is he doing in our office? We treat “bad attitudes,” not by being accusatory, but by trying to understand the underpinnings of this “attitude,” or to put it another way, we try to understand it in historical context. Of course, historical context takes time and energy, along with carefully honed listening skills, a set of strengths that are no longer taught in Psychiatry Residencies, leading, to what I see, as professional suicide for all of us. The hard truth is that when our pills fail, which they often do, we must be able to use listening skills to help patients sort out their mental suffering so that they can have a narrative which helps them navigate their life, both past and present. If we lose these skills, the job satisfaction will be poor, and patient satisfaction will also be poor. The result, as I see it, will be a complete disillusionment with the field. There, I have ranted again. I just cannot say this too many times or too many ways. The state of my profession is dire, and we need to have an open discussion before we die completely. That is my hope, that these posts will stimulate a forum to push back and encourage psychiatrists to listen deeply, to learn how to listen in a therapeutic manner. The “good ol days” were indeed better than our present. I maintain that point of view and I am open to talking about that further. The gauntlet has been laid. I wait.


2 Responses to “Can A Patient Have A Bad Attitude?”

  1. Shelly said

    Why do pills fail? Pills are made to increase dopamine (in the case of depression). They do the job. Today’s psychiatrists don’t have time to listen unless they are in private practice. As you have so often blogged about, the average patient visit with a psychiatrist is about 10 minutes, where he/she listens to how the medications are working and either tweaks here or there and the patient leaves. The psychiatrist doesn’t listen in depth to what’s going on in the patient’s life and generally doesn’t want to know if the patient is in crisis or not. The psychiatrist may WANT to listen more but with today’s health model simply cannot do so. So who has the bad attitude, the patient or the psychiatrist?

    • We do not know how our medications work. We know some of them increase dopamine but this is not necessarily the mechanism of action. I understand that the current system of care is that the psychiatrist spends little time with patients and prescribes medication, and I think that for many patients, that is bad care. The question comes down to is bad care better than no care, and it seems that both are bad and so we need to re-think the delivery of mental health care. Thanks, as always.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: