“Both doctors and patients know best.”
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SPECIAL REPORT: PSYCHOEDUCATION
If you are of a certain age, you will recall the saying: “Doctor knows best.” After the civil rights era and the social justice advances of various groups, including patients, the saying became more like: “Both doctors and patients know best.” Actually, it is even broader than that when you go beyond an individual private practice office to treating more complex patients with serious illnesses. Then we have something like: “The team know best.”
The Importance of Avoiding Implicit Bias in Advocating for Patients
Natasha Massoudi, MD, MPH; Agata Piotrowska, BS; Kayla Behbahani, DO
Affirming Evidence-Based Care for Young Patients Who Are Transgender or Gender Diverse
Valeria Roldán; Z Paige Lerario, MD, NYS CRPA/CPS-provisional
Following doctors’ orders in psychiatry has always been a challenge. Stigma, denial, confusion, and misinformation often contributed to the reluctance, or nonadherence, of patients. That was what led me early on in my career to try to empower patients. What follows is what a colleague remembered from sitting in on my patient interactions in the early 1980s1:
“Dr Moffic was a coleader with the patient in the room. He found ways to ask his patient what the patient thought about his/her treatment. This may sound like a small thing, but it was rare. . . .I had never heard another psychiatrist ask his patient what medication they thought would work best. . . .He was empowering his patients to have a voice in their treatment and medication. I believed this partnership approach also improved his patient’s [adherence] with taking their medication.”
This caseworker, Herb Bateman, started and empowered one of the earliest patient peer services.
As patients with severe mental illness are involved with their families in one way or another, families were brought in with the permission of the patient because their positive expression was therapeutic and they needed to be empowered too.
Education had similar feedback loops. Though we psychiatrists were usually the most thoroughly educated and had much to teach, we had to try to follow what other clinicians wanted to learn and also what they could teach. This feedback was especially important in recognizing and reducing structural racism in our clinics.
Back in the early 1990s, I was asked to be the medical director of a clinic specializing in working with those with gender concerns, which was, at that time, the only such clinic in the Midwest. I asked, “Why me?” I knew virtually nothing about such patients. The head of the clinic responded: “Well, you have a good reputation in helping the underserved minorities. If you come here with the same attitude, we and the patients will teach you most everything else you need to know.” And they did. And that is what Valeria Roldán and Z Paige Lerario, MD, NYS CRPA/CPS-provisional, and the other authors in this Special Report, do in their articles.
Nowadays, that is called cultural humility. Psychiatry, like the rest of medicine and other fields, is a work in progress. We are all wrong at times, have to admit that, and move on. I would call that psychiatrist humility.
The informative and empowering papers in the Special Report follow this same spirit and model. Learn from them!
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.
Reference
1. Bateman H. Pathway to Treasure: Discovering the Hope Empowerment Can Bring Toward Recovery From a Serious Mental Illness. Herb Bateman; 2022.
