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10 Hallmarks of a Great Psychiatrist

10 Hallmarks of a Great Psychiatrist

 

A great psychiatrist knows the disease, the person with the disease, and the way the two interact. Here are tips, from a clinician who has devoted his career to treating psychiatric disorders.

Michael Sperber, MD is a Consulting Psychiatrist, Neuropsychiatry/Behavioral Neurology Service of McLean Hospital in Belmont, Mass.

Each "hallmark" is accompanied by a corresponding "related link" to articles of interest to psychiatrists. To view in PDF format, click here.

Comments

People as patients seek people as physicians. Both share the capacity to suffer. Knowledge and training with experience create wisdom which gives doctors the tools to repair the presentations of brokenness. A thorough history based in medicine and phenomenology provide the foundation. Once combined with a complete examination, the collective data may be used to provide care to the one who suffers more. To know only symptoms is insufficient. Even signs observed are incomplete. The best result comes from a collaborative experience between the physician and the patient's worldview. Done well, the results are both good and efficient, A mindful way to accomplish this is to liberally apply the 10 principles written above.
We must all engage this process with humility, temerity and passion. The soul of our profession depends upon the exchange of data and perspective. The distillation of these ideas will form the basis of the knowledge which provides the much needed evidence to improve our craft.
Samuel Gary Lusk, MD
Austin Neurobehavioral Medicine, Austin Texas

Samuel Gary @

Dr. Sperber's timely article reflects the heart of what many of us old-timers have been thinking as we approach the twilight of our careers. In February of this year I published on my modest website (http://johntalmadge.com/philosophy) a casual essay reflecting on what it means to be a good psychiatrist. I'm reminded of a practice in Alcoholics Anonymous, where many of us repeat steps four and five every year or so, taking inventory and sharing it. It also reminds me of a sign posted in the old days above the portal as we entered the medicine wards at Duke: "Doctor, your patient is trying to tell you something." Thank you, Michael, and thanks as well to others who have offered comments. -- John M. Talmadge, M.D.

John @

I would agree and also feel they would apply to any medical professional except for the last one.
Love is important in anyone's life but as so many people believe that mental illness is due to people not having enough friends or families not caring enough, I fear that this one reinforces this view that mental illness is something very different from "real" illnesses like cancer or heart disease or diabetes. I doubt we'd say that the application of love by the physicians caring for patients with these to be of much importance.

Steven A. King, M.D.

Steve @

Beautiful, touching and insightful.

Barbara @

Thank you. The basics, that should never be left behind. Great. Uplifting. With very realeaning and intention. Bravo.

Susan L. @

Well, I found the top 10 list uplifting. I'm not sure why this would be controversial for some of those posting here.

The inner voice can be quite an ugly thing. I had a patient recently tormented by demons. He said he was pretty sure he needed an exorcist not a psychiatrist prescribing psychiatric medications. Horrid associations, sick memories, taboo emotions, voices from everywhere and nowhere, pursued in sleep in dreams, lying in wait when waking, tormented without rest.

I was privileged to have a brief glimpse into the maelstrom of the psychosis. All I had to offer was my effort to make a human connection, an offer of my hand in help, and the offer a pill that he'd rather not take. Is that hope? Or is it hype? Is it something else? Simple as caring.

Anthony Peckham, NP

Richard Anthony @

Entirely reasonable and fair apart from the first slide, which errs mostly in one word. As others have pointed out psychiatrists and psychologists generally do not treat 'diseases'. We do indeed treat people and perhaps conditions. In the case of psychiatry the person and the condition are difficult if not impossible to separate.

Both statistically and theoretically it is hard or impossible to ask what would the person who experiences psychosis be like if they did not have their experience. Its the same neurons. They would most likely not be the same person without their condition.

That said we can see what a person is like when they do not have florid symptoms and this may feel like the 'real' person. Yet traits in thinking styles tend to persist, the person's experiences don't dissappear. And sometimes how a person is when they are very ill can tell us something important as well.

'Know the disease' also has significant problems. While we can always pick out patterns (a human gift in psychosis and medicine) they are not always valid or useful. We can say for certain that 'schizophrenia' is not a unitary concept as we know that two people with this same diagnosis can theoretically share no symptoms. We may consider it a useful shortcut for communication and research but this is very debatable.

Thus know the person, their experience, their symptoms, their environment, their social network their history - and try to work out how this complex mesh fits together. Nothing less is sufficient.

Fergus Kane
Clinical Psychologist.

Fergus @

Great points
Thanks

Mona @

I spend at least 3 hours a week fighting the "prior authorization" stupidity. Honestly when that's done I want to crawl into a hoe & never come out. It's a travesty. Shame on us for allowing this to happen!!

Darlene @

The title "The Greatest Psychiatrist" was a bit misleading, because I didn't find this to be an article about Shakespeare, who offered more wisdom and brilliant insights clothed in such powerful; language 400 years ago than most people do today.
But regarding Dr Sperber's points, there are good suggestions and more problematic ones.
Those of us who work with a psychodynamic framework don't 'treat diseases', we try to help people. We try to listen carefully, and help people reach an understanding of some of the factors that lead them to think and behave in the ways that trouble them - and then help them find the better paths and remove some of the obstacles that have interfered with their being able to be content and reasonably happy.
Most will find along the way that they are not going to be able to fulfill all sorts of hopes and dreams and fantasies that they might have had or still have, and we hope that our compassion and caring will help them overcome those disappointments.
We also know that other than for the most seriously disturbed people pills are essentially placebos at best, and more usually are diversions away from greater self-insight and self-discovery.
Having had the privilege of serving on the APA Assembly for some years, I have long been aware of how hard it has become to help the general public understand the differences between the professionals who work in this field, and even harder to acknowledge that even within our own fields - mine is psychiatry - we have very good people and quite lousy and harmful people. Joseph Berger

Joseph @

[comment edited]
Shakespeare... offered more wisdom and brilliant insights clothed in such powerful; language 400 years ago than most people do today.
But regarding Dr Sperber's points, there are good suggestions and more problematic ones.
Those of us who work with a psychodynamic framework don't 'treat diseases', we try to help people. We try to listen carefully, and help people reach an understanding of some of the factors that lead them to think and behave in the ways that trouble them - and then help them find the better paths and remove some of the obstacles that have interfered with their being able to be content and reasonably happy.
Most will find along the way that they are not going to be able to fulfill all sorts of hopes and dreams and fantasies that they might have had or still have, and we hope that our compassion and caring will help them overcome those disappointments.
We also know that other than for the most seriously disturbed people pills are essentially placebos at best, and more usually are diversions away from greater self-insight and self-discovery.
Having had the privilege of serving on the APA Assembly for some years, I have long been aware of how hard it has become to help the general public understand the differences between the professionals who work in this field, and even harder to acknowledge that even within our own fields - mine is psychiatry - we have very good people and quite lousy and harmful people. Joseph Berger

Joseph @

I was fortunate enough to find a really great psychiatrist-Dr. Vernon Kratz-at Penn Foundation,Sellersville,Pa.-J LaterM.T.(ASCP)

Josephine @

I would simply like to encourage those who agree, or disagree, with Dr. Sperber's comments--or with my own--to show a modicum of professional responsibility and courtesy, by signing your full name and position/profession at the bottom of your message. And, please--anonymous invective is neither the hallmark of a great clinician nor the sign of a civilized sensibility.[1] Thanks very much!

Ronald Pies MD
Editor-in-Chief Emeritus

1. http://www.psychiatrictimes.com/articles/it-time-end-anonymous-and-abusi...

Ronald @

Marcos: Marcos Hardy, MD, PhD.
Retired Associate Professor of Psychiatry.
Retired Associate Professor of Physiology and Biophysics.

Marcos @

[The comment by "Peter" has been deleted. We do not allow disrespectful comments on this site. Furthermore, in the spirit of professionalism, please include your full name and title at the bottom of your messages in the future.
Laurie Martin
Digital Managing Editor
Psychiatric Times]

Peter @

So far Dr.Rubin's response is the best one.

Thank you Dr.Rubin,

Sincerely,

Robert S.Baker,M.D.

Robert @

Well "himself" excludes me and almost half of all psychiatrists -- but that does not matter because this is about treating diseases - and I don't treat diseases, I treat people.

Carolyn Quadrio

Carolyn @

Thank you for sharing your 'words of wisdom' from your experience, which agreeably lead toward a successful & enjoyable practice, and which are congruent with the principles of medicine that all physicians should follow.

1. First Do No Harm - primum non nocere
2. The Healing Power of Nature - vis medicatrix naturae
3. Discover and Treat the Cause, Not Just the Effect - tolle causam
4. Treat the Whole Person - tolle totum
5. The Physician is a Teacher - docere
6. Prevention is the best "cure" - praevenire

Dr. Chris @

Before #10:

Continually studies advances in all realms of psychiatry, biological to psychosocial, with an open mind. Adopts those advances shown to have clinical utility. Remains a lifelong student of the profession.

Robert T. Rubin, MD, PhD

Robert @

A great psychiatrist? No brainier... we were trained to be once upon a time... we were HEALERS... we were everything for our patients... their psychiatrists... physicians... psychologists... advocates... sociologists... social workers... clergy... we were interested in our patients' total well being... Now? Rx medications only, seeing each in fifteen minutes called "med checks" leaving therapy to our non-medical associates... we became "curists" obsessed to "cure" rather than "care..." now, insurance companies are dictating us what and what not to give our patients and we do nothing... whoever practices reminiscent of that beautiful era is being admired as a great psychiatrist... fame to him/her... shame to us...

[Please insert your full name and title by the end of the day (7/20/2015) or this comment will be deleted. Thank you. -The Editors]

Mehmet @

Thank you for this thoughtful post Dr Sperber. I wholeheartedly agree with your tips and propose only two alterations:

- in #1 reverse the order of disease and person; a subtle difference that can speak volumes about a psychiatrist's perspective and priorities when "seeing" their patients

- and make Dr Pies tip #11!

J @

Thank you for the kind comment and interesting suggestion! Please add your full name and position in reply to this note, and I'll be most eager to exchange views. --Best regards, Ron Pies MD

Ronald @

The comment by "Marcos" and ensuing replies have been deleted. We do not permit comments of a disrespectful nature on this site as they are in violation of our Editorial Policy. Please be professional in the future.
Thank you,
Laurie Martin
Digital Managing Editor
Psychiatric Times

Marcos @

What you do not allow is dissent. Nothing new in current Psychiatry.
The comments were professional and respectful. It is you that is disrespectful and unprofessional, not the people that commented here, including myself. You just did not like, or did not understand, what we said.
Marcos Hardy MD PhD
Retired Associate Professor of Biophysics and Psychiatry.

PS: Please, fell free to continue deleting comments, unless they slavishly toe the current psychiatric party line

Marcos @

Dear Dr. Hardy,

I have been associated with Psychiatric Times since 1985, eventually becoming Editor-in-Chief from 2007-2010. This publication has always welcomed debate and dissent. What it does not welcome, and should not tolerate, are ad hominem attacks, insulting remarks, and a failure to address ideas in a collegial and constructive spirit. (By the way, I do not decide what comments are permitted or deleted--but I fully support Ms. Martin's judgment in this matter). I think you will find that spirited debate is possible on these pages, while preserving civility, respect, and, yes-- a modicum of humility. --Ronald Pies MD

Ronald @

Well-said, Dr. Sperber. Let's continue to keep in mind that a major therapeutic factor, and the foundation of the doctor-patient relationship, is treating the patient with respect and compassion. In recent years, we are tempted to downplay the importance of this connection when we are faced with the demands to collect and document so much data in so little time for reimbursement purposes. Our challenge is to remind ourselves that the true richness in our profession derives from how we connect with our patients.

Dan Gardner, MD

Daniel @

The greatest psychiatrist is the one who is able to prevent the patient from going away feeling himself less sick than he was when he entered the room.

Rogerio @

Sort of goes against the "do no harm" rule though...

Jennie @

Re-writing: The greatest psychiatrist is the one who is able to prevent the patient from going away feeling himself sicker than he was when he entered the room.

Rogerio @

Thanks to Mike Sperber for a wonderfully succinct set of teachings that help define the "great psychiatrist"--and, indeed, the great physician. I have no doubt Dr. Sperber embodies these traits, and I also thank him for including my paper ("What is Disease"....)in reference to his first slide.

I will venture to add one more feature of the great psychiatrist: he or she serves as a "midwife" to the poem gestating within each of our suffering patients.*

Best regards,
Ron Pies MD

* The origin of my metaphor is a comment by the poet-physician William Carlos Williams, to the effect that, inside every patient, there is a poem trying to get out—trying to make itself heard.

Ronald @

Well said both Drs.Ron Pies and Mike Sperber.
Rajendra Trivedi,M.D.

Rajendra @

Many thanks, Raj! --Regards, Ron

Ronald Pies MD

Ronald @

Well said both Drs.Ron Pies and Mike Sperber.
Rajendra Trivedi,M.D.

Rajendra @

Experimental psychology it is a "science".30 years ago Dr.Sperber's advice was part of any psychiatric resident "needs be done" while sitting across patients and talking to them. Today in the era of 15 minutes "medications checks", managed care and litigation neurosis they look like the essence of clinical psychiatric wisdom. Dr Pies who never misses the opportunity of a debate about the soul of psychiatry added his own personal wisdom. The acrimonious duality and debate soul art vs cold science reflects "the essence" of psychiatry identity struggle. The biological psychiatry did not deliver 15 years after the human genome was deciphered. There is no major breakthrough in the understanding of the psychiatric illnesses. The DSM V is accused of blurrying the difference between the normal and pathologic. The futurologists predict the "Death of Psychiatry". Unitl this very day Dr Pies did not succeed to refute in a Socratic debate the "Psychiatric Abolitionist"- Dr Szasz. The Psychiatry is in crisis. The Psychiatry is living an hour of self critique, self determination, perhaps self demolition.

Just a clinician.

Theodor @

Dear "Theodor,"
Please insert your full name and credentials at the end of business, July 20, 2015. With proper identification, clinicians can respond in a collegial manner and according to our Editorial Policy.
Thank you
Laurie Martin
Digital Managing Editor
Psychiatric Times

The @

Most of the blogging places in the Web allow people to express themselves without titles and shining academic associations. For some people not exhibiting their titles is that "Humility" Dr. Pies is mentioning here. I used to live behind the "Iron curtain" and over there they would also not allow anonymous comments. The most important quality of a comment is to address a group of readers. The subsidiary comments are like oral art. They are meant to survive only if they have value. They need not be repressed. Thank you very much.
Theodor Rais MD,MS

Theodor @

Thank you for providing your name, Dr. Rais. I don't want to distract further from Dr.
Sperber's contribution, so I will be brief. First, I respect your experience working
in iron curtain countries; fortunately, we enjoy a free press in the U.S., and the
spirited exchanges in this journal are good examples of that freedom. But with freedom comes
responsibility, particularly in a professional journal aimed primarily at psychiatrists
and other mental health professionals. The general policy of providing name and
profession--no fancy academic titles are required!--is based on the concept of taking
professional responsibility for one's statements, particularly when they include personal
comments about colleagues, such as yours did. Anonymity is sometimes understandable
in circumstances when disclosing one's name would pose a serious threat of reprisal,
stalking, job loss, etc, but this is almost never the case, in my experience over 30 years
as a writer and editor. Usually, people who post anonymously simply don't want their hostile
or offensive remarks linked with their name. Indeed, there is no question among most editors
and newspapers that anonymity and abusive postings are correlated with a remarkably high
frequency. This journal has made exceptions in certain rare instances, such as when we
published a piece by a psychiatrist who had undergone ECT, and who remained anonymous for
reasons relating to her employment. For more on this issue, please see:

http://www.psychiatrictimes.com/articles/it-time-end-anonymous-and-abusi...

and:

Wolf C. Sunday Dialogue: Anonymity and Incivility on the Internet. The New York Times.
November 26, 2011. http://www.nytimes.com/2011/11/27/opinion/sunday/sunday-dialogue-anonymi... - See more at: http://www.psychiatrictimes.com/articles/it-time-end-anonymous-and-abusi...
internet#sthash.qkRKjB17.dpuf

Best regards,
Ron Pies MD
Editor-in-Chief Emeritus

Ronald @

Psychiatric Times has lost its value(s) in discarding the opinions and input of para-professionals and 'patients'; caretakers and consumers. I mourn its loss.

Captain Tedde (all of the above, and more!)

tedde @

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