Wednesday, February 27, 2008

Psychiatry or Sigh-chiatry?

My first full day on my psychiatry rotation was a minor revelation. Although each specialty has its own unique culture, I think in some ways, psychiatry is, um, "uniquer." This is not meant as a criticism or derogatory in any way; I just find it very intriguing since the approach to the patient and the manner in which they are discussed seems very different to me.

So, why do I say sigh-chiatry? Even though my one day of experience is hardly enough to draw any definitive conclusions, I did observe more sighing today than I feel I've seen in any other rotation. While medical specialties tend to always believe they are "more sinned against than sinning," the psychiatry team definitely bought into this to a higher degree. This is not to say that they do not provide quality care and a valuable service to their patients, or that they somehow infringe upon other services to a greater degree. In fact, to a certain extent, I agree with their claim that other services dump on them.

Yet, I feel there is more to the sighs than merely a sense of injustice. My sense is that, unlike most other specialties, psychiatry deals with the abstract, the gray areas, the parts of medicine that make most doctors uncomfortable. Doctors must acts with a presumption of infallibility to be effective. To do this, they are bolstered by hard science and objective fact. Psychiatry strives for this, but due to the complex nature of the problems they face, they are at a disadvantage. This vagueness is both a boon and a burden. It benefits psychiatry by forcing the doctors to treat their patients more holistically, but limits psychiatry's ability to offer definitive answers. The patients' frustrations to some degree become the doctors', if only due to human nature. As our attending was discussing today, the psychiatrist must integrate not only objective clinical data but also subjective emotional data. He described how humans have 'mirror neurons,' which are special neurons that respond to images of suffering (or any other emotion) by triggering an empathetic response in the viewer (think of a guy cringing when he sees another guy kicked in the groin). Furthering this idea, the human response of the doctor to the patient and his troubles is of course primarily empathy, but one cannot help share their exasperation as well.


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