Academic journal article Current Psychiatry

Does Psychiatric Practice Make Us Wise? Psychiatrists Develop Different Neural Circuits, Compared with Surgeons, Radiologists, or Internists

Academic journal article Current Psychiatry

Does Psychiatric Practice Make Us Wise? Psychiatrists Develop Different Neural Circuits, Compared with Surgeons, Radiologists, or Internists

Article excerpt

At a recent morning rounds, a resident presented a case of a do-not-resuscitate decision for an elderly patient, which our psychiatry consultation service received overnight from an internal medicine ward. Another resident casually mentioned how physicians from other services at our hospital habitually call on psychiatrists to "make the difficult ethical decisions for them."

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That got me thinking. Psychiatrists are expected to analyze conflicts, resolve dilemmas, exercise good judgment, provide advice to colleagues and patients, and display a transcendent and objective perspective about the complexities of life. Psychiatric training and practice prompt us to be thoughtful, tolerant of ambiguity, and willing to tackle the multilayered meanings and consequences of human behavior. Indeed, developing attributes related to the most advanced functions of the human mind is at the core of our professional training and clinical practice.

Medical specialties develop different skills

Consider the training consequences of other medical specialties: surgeons become adept at navigating structural anatomy with superb dexterity to extricate lesions, repair wounds, or transplant organs; radiologists excel at scanning complex black and white patterns in radiographic images to detect the subtlest pathologies or anomalies; pathologists pinpoint cause of death with autopsies and elegant tissue examinations; and obstetricians become virtuosos of birthing or repairing intricate reproductive structures.

We psychiatrists go well beyond the standard medical history, physical exam, and laboratory findings. Our major skills are detecting gross and minute deviations in the mental status exam and the range and nuances of patients' behaviors, insight, judgment, cognition, coping skills, internal conflicts, drives, compulsions, thought processes, personality traits, decision-making, resilience, social skills, interpersonal adroitness, truthfulness, emotiveness, impulsivity, ambition, perceptions, perceptiveness, verbal and nonverbal communications, defense mechanisms, and outlook on life.

We also integrate our complex observations and findings with the rich collage of each patient's unique cultural, religious, and educational background. We strive to find hidden or higher meaning in patients' symptoms, words, and actions. We assess their potential lethality toward themselves or others and examine the often tortuous course of their existence. And, unlike other physicians, we observe their transference toward us and simultaneously examine our own conscious or subconscious counter transference--channeled via thoughts, emotions, and behavior--and we scrutinize potential or real boundary violations by patients and ourselves and act judiciously. …

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