The Arrogance of Parenting

‘Nonessential Medications:” Another Rant

Teaching Primary Care Residents, I learn so much. I also get frustrated, angry, and fantasize about going on the rooftops to let others know of my unhappiness. “Sometimes, when a patient comes in the hospital, and we are not sure what is going on, we stop the SSRIs and all the nonessential medications to see what is going on with the patient,” an excellent, smart, hard-working resident says to me. “Who says the SSRI is nonessential?” I ask, thinking that no one is checking in with the patient to see if he feels their SSRI is “nonessential”. “Well, you know, it is not life and death,” he says, understanding my discontent. “No, it is usually not life or death, but it is quality of life, and this can determine if the patient is motivated to help himself get better,” I say, knowing that the resident does not need an education about the importance of SSRIs, but that he is reflecting back to me the feelings of the team-the medicine team, composed of interns, residents and attendings. “I am sorry,” I say, “but I think that behavior suggests a dismissiveness to mental health. I think that the team is believing that SSRIs are relatively trivial medications and so they can be stopped, similar to vitamins.” He agrees, but looks at me with some sense of regret for bringing this to my attention because he can see my upset. I wonder how to push through this arrogance, sometimes seen in primary care, where they believe that physical health trumps mental health, every time, as if they are not closely linked. Medicine, as a field, has a lot of room for growth. Openness, as with all growth, has to be the first step. For now, I am stuck.

‘I Am Willing To Talk To You’

“I am willing to talk to you,” Marla responds to Monte upon his request for supervision. The arrogance overwhelms Monte. The words reverberate in his head. Monte, disturbed by this interaction seeks help from me in psychotherapy. “Yep, it sounds like arrogance,” I affirm. “Why does the grandiosity bother you so much?” I ask Monte. “We are colleagues. I am asking for help, but she treats me like she is doing me a favor.” Monte says with internal turmoil which appears to exceed the current interchange. “You are so disappointed with Marla, over and over again. Why do you keep going back for more disappointment?” I ask, thinking that Monte might be replaying an experience in his life where he gets his hopes up, only to be met by crashing devastation. “I really don’t know,” Monte says, almost pleading with himself to come up with an answer. “Maybe you feel you deserve to be disappointed.” I say, trying to gently suggest that he set himself up for this by calling her up. “Maybe,” Monte tentatively says, with a sense of personal disgust in his voice. “I am willing to talk to you too,” I say, trying to make light of this situation as the time comes to an end. We laugh, but we know the pain is still there.