Chapter 10: Much More than Diagnosis - How I Practiced Psychiatry: Part I
Diagnosing my patient’s disease or mental health problem and being able to name it is important. However, to help a patient achieve better health, the patient must go deeper, and it is my job to help him get there.
I learned early in my career to focus on understanding a patient’s story, and I learned I could not program his or her story. I wanted my patient to be his own editor – to figure out who he is, where he came from, and how he might write his next chapter with better outcomes for his problem(s) by first taking stock of his assets and liabilities. My first goal as his psychiatrist was to help him get his narrative right, with me as his consultant in the translation process. Then, I wanted to move
on to a bio-behavioral analysis, keying on what is possible and achievable.
I helped my patient answer the questions, “Who am I? Why am I here? Where am I going? What can I do to get there?” This is what a good doctor does; he gets the patient to express his own view about what’s bothering him and what is bothering him the most. Then the doctor will accept the patient’s priorities and, with the patient, will come to agreement on a strategy to address them.
To be effective as a psychiatrist, I had to understand the patient’s words and their meaning to him and how he had become emotionally attached to his narrative. I needed to understand his priorities and what stimulated and motivated him. I paid close attention to his nonverbal cues.
I needed to read the person, not an EHR. A psychiatrist cannot look in a book or manual to be able to help a person in distress; he has to read the heart and mind of the patient himself. Then a psychiatrist can help equip the patient to gain better control of his own life.
For me, the nature of my interchanges with my patients were discussive, not judgmental. My authority came from my position, knowledge, and experience, not some guidelines that were to be imposed on the two of us. The patient and I had a collaborative effort.
Lee Beecher, MD
Psychiatrist, Advocate for Patient Care