The Practice of Medicine

Psychiatric TimesVol 37, Issue 10
Volume 37
Issue 10

In many clinical situations to "do no harm" requires us to know what we know, know what we don’t know, and consult with a colleague who likely knows more than we do.

John J. Miller, MD


For me, the fall has always conjured excitement about a new odyssey of learning. With the first days of school came both excitement and fear, wondering if I had the ability to learn all that was expected of me. During the previous academic year, I had listened with awe as students in the grade ahead of mine discussed their subject matter, and each year I wondered how I could ever learn that complex material. One memory in particular remains alive and well, and it visits me a few times each year.

I was in the first grade at St James Elementary School, a parochial elementary school in Salem, MA. An intimidating nun informed us we would be learning the complete alphabet. Fear filled me as I anticipated what felt like the impossibility of learning all 26 letters of the alphabet. Somehow, I succeeded, and these 26 letters have served me well over the years.

Each academic year had its own curriculum to be mastered, and each course of study initially seemed impossible:

  • Learning to construct a sentence with nouns, verbs, and adjectives.
  • Understanding the history of the United States as it was taught at that time.
  • Playing a simple melody on a xylophone.
  • Becoming familiar with the periodic table of the elements in chemistry.
  • Writing a complete term paper, with references expected.

It was not until the second semester of my sophomore year of college at the University of Massachusetts Amherst that something shifted inside of me, and the fear of learning new material transformed into a passion to learn more. The class was “Molecular Evolution,” the first course specific to my major of biochemistry. Walking from my dorm room to the classroom I felt energized and excited about what the next lesson would teach me. The course started with the accretion of the planet earth from stardust and moved through the theoretical processes that created the molecules that eventually would become the building blocks of life.

Reflecting on that experience, I realized that if the necessary elements were all present, learning could be fun, meaningful, and could actually be driven by passion. Several of these elements are unique to each person. Arguably, being exposed to a wide-ranging curriculum during the high school years increases the likelihood that each student will discover their passion, and hopefully they will be given the opportunity to follow it.

During my 12 years of study in college, medical school and psychiatry residency, I naively expected that I would ultimately learn all that I would need to become a competent clinical psychiatrist. Today, 29 years after completing my residency in psychiatry and applying great effort to keep up to date with our rapidly evolving field, I feel like I have only mastered the first 5 letters of the “alphabet” of psychiatry. I am intrigued and curious about the remaining 21 letters, and I try to remain aware of their current contribution and application to clinical psychiatry, but in all honesty it is hard.

Hence the term practice of medicine. Even with all the right elements of interest, commitment, passion, and effort, my view is that it is not humanly possible to ever master psychiatry. We simply must keep on practicing, learning new information, and honing new skills.

But such is the case in every field of study, and why should medicine be any different? Our primary responsibility is to do no harm. In many clinical situations this requires me to know what I know, know what I don’t know, and consult with a colleague who likely knows more than I do, when necessary. One of the many gifts of psychiatry as a field of medicine is its extreme diversity. The menu of specialty options we have in the field is vast, and each psychiatrist usually evolves into a specific area of practice that fits like a comfortable glove. It is our responsibility as physicians, however, to remain up to date with what is happening in our field of psychiatry in general.

Fortunately, there is no paucity of educational opportunities to support us in our ongoing, self-directed learning. We at Psychiatric Times® are excited to invite our readers, and in fact all psychiatric providers, to join us later this month in our Annual Psychiatric Times® World CME Conference™. It will be held virtually this year from October 15th through 17th. We feel privileged to have top-quality faculty who will present on a wide range of topics. The conference is directed to psychiatric clinicians and will offer a wide range of presentations that run from 15 to 30 minutes in length. Our hope is that participants will be eager to apply what they have learned immediately after the conference.

So please, we would love it if you would come and learn with us! ❒

Join us at the Annual Psychiatric Times® World CME Conference™, October 15-17th, 2020, to hear updates from key leaders in the field.

Dr Miller is Medical Director, Brain Health, Exeter, NH; Editor in Chief, Psychiatric Times; Staff Psychiatrist, Seacoast Mental Health Center, Exeter, NH; Consulting Psychiatrist, Exeter Hospital, Exeter, NH; Consulting Psychiatrist, Insight Meditation Society, Barre, MA.

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