Asking the Right Question

Psychiatric TimesPsychiatric Times Vol 28 No 1
Volume 28
Issue 1

Reflecting on my internship year evokes anxious feelings, despite the fact that I am separated from it by time, distance, and hundreds of positive experiences.

Reflecting on my internship year evokes anxious feelings, despite the fact that I am separated from it by time, distance, and hundreds of positive experiences.

After my initial anxious reflex, I am calmed when my thoughts about the year turn not toward a favorite lecture by an attending physician or a particularly rewarding patient interaction, but rather to a question posed by a senior psychiatrist with whom I had only a tangential relationship.

Working as an intern at a major urban hospital center, I often admitted patients who received their outpatient psychiatric care at one of the numerous other training clinics in the city. One evening, I admitted a man with paranoid schizophrenia whose outpatient psychiatrist was the chief resident of a program just down the street from my hospital. The chief resident and I talked several times to ensure that the patient’s hospital care would be compatible with the outpatient treatment setting to which he would be discharged.

When the patient was ultimately discharged, I got a call from the chief resident’s program director, Dr M, who thanked me for the care I had given the patient. Dr M and I knew each other because I had interviewed with him when I applied to his residency program. That interview had been quite memorable. We hit it off, and I found Dr M’s passion for the science and art of training future psychiatrists electrifying. The 2-hour interview had felt like 15 minutes.

Our phone call on that October day would be much shorter but would seem much longer than our initial conversation. Although Dr M’s voice had the same enthusiasm I remembered, he must have had insight into the muting of mine. I recall the disappointment I felt on the phone with Dr M because the last time we met, we had spoken about my plans and goals for the future. Now I was thinking about how to trudge through each day of work.

When Dr M simply asked, “Are you happy?” I was silent and could not answer right away. To answer untruthfully did not seem right, and to answer honestly meant admitting something of which I was greatly ashamed. Dr M ended the silence by telling me, “If you ever want to come to my office for guidance, please feel free to give me a call.”

A month later, I took Dr M up on his offer and was sitting in the same office in which I had interviewed about a year earlier. After we exchanged pleasantries, he asked if psychiatry was still the right career choice for me. After I said yes, he asked me what had changed in the months since our first meeting. He listened and inquired, “Have you thought about moving to a new program that may be a better fit?”

Although I had not previously thought about it and did not even know if it would be possible, Dr M encouraged me to consider switching programs. He made it clear that if there was anything he could do to help me, he would be available. He said it seemed like I had changed a great deal and that it was sad to see me without the eagerness he remembered from our first meeting.

Eventually, through a string of good fortune, I was able to find a second-year spot at my current program. Although it is premature to declare a victorious ending to this story (I am at just about the midway point of my residency training), I can say with a great deal of gratitude that I am at a “happy middle.”

From my perspective, there is one thing that makes this more than a purely feel-good story of a senior doctor who owed a neophyte nothing and gave him so much. It is the impact that Dr M’s guidance continues to have on me. Dr M did not set me on a better course with a brilliant interpretation; he helped me see things differently with the shortest, most succinct question: “Are you happy?” Possibly most important, he communicated sincere concern and a desire to help.

Dr M’s elegance was in his simplicity. Thanks to him, when I feel those anxious pangs thinking about intern year, they are quickly relieved by consideration of one of the most important lessons I learned that year. Simple words and basic kindness are necessary therapeutic components that can help me direct my patients to the places in life that are the right fit for them.

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