WHY PSYCHIATRISTS ARE PHYSICIANS FIRST
As Gilbert and Sullivan wrote, “Things are seldom what they seem, skim milk masquerades as cream.” Medical disorders may also masquerade, not as cream but as psychiatric disorders, as occurred in Maureen’s case.
Maureen had every reason to be depressed. Her live-in boyfriend left after 5 fitful years. Since then, her energy waned. She rarely slept through the night and couldn’t make it to morning team meetings.
Not surprisingly, her job was in jeopardy. Worse yet, her company was also in jeopardy, for the fashion industry had been floundering ever since “fast fashion” priced out their designer dresses. Her once-prestigious brand would be “cutting the fat” to stay afloat. They hinted at lay-offs to come.
Even when she was in time for the morning meetings, Maureen couldn’t concentrate. She made careless and costly errors. She received a formal warning from her boss, who said that her “presenteeism” was worse than her absenteeism. He referred her to HR, expecting them to do the dirty work of dismissing her.
Maureen left a voice message for me, saying that she had explained her situation to Eileen, the head of HR, who suggested a medical leave of absence, rather than the immediate termination recommended by her supervisor. She received my name from the company’s Employee Assistance Program (EAP). To me, this sounded like a generous offer, especially since it came with short-term disability benefits; however, there was one caveat. Maureen needed to seek psychiatric treatment while on leave. Maureen was told in no uncertain terms that she needed a psychiatrist to “sign off” on the disability and to prescribe medications as needed. HR would not accept a note from the texting therapist whom Maureen had found through a subway ad.
I knew from the get-go that there would be plenty of papers to sign, and annoying insurance forms to complete, along with regular clinical care, should I schedule her appointment. The EAP staff knew that I would not endorse questionable disability papers, and I made sure that Maureen knew that I could promise her an evaluation but could not promise anything more before completing that evaluation.
1. Drexler P. Millennials are the therapy generation. Wall Street Journal. March 1, 2019. https://www.wsj.com/articles/millennials-are-the-therapy-generation-11551452286. Accessed June 20, 2019.