I may end up doing psychiatry after all! Yesterday we had an amazing discussion about the nature of psychiatry from one of the consultants who obviously remembers what it is to be a registrar and just starting out. He talked about when you get the patient who presses all your own buttons about your childhood traumas, and when you feel inadequate, or when you find yourself taking your work home and you can't stop thinking about it. He remembers.
Even better, he has answers! I recognize gold when I hear it, and this was 90 minutes of solid gold. He talked about boundaries and keeping them intact both for our sakes and also for the patient. He talked about our job as making the diagnosis and formulation of the problem, and the fact that this may include the patient's inability to accept help or to move past the problem - this is therefore part of the problem and not our fault. He very rightly said that if we were presented with a patient with small cell carcinoma of the lung, we wouldn't be talking about cure because we would have a realistic approach to what is possible, and psychiatry has these cases as well. Taking on multi-generational abuse and relationship dysfunction and expecting to fix it all in a six-month rotation - well, denial ain't just a river (for doctors as well as patients).
He reminded me of that old, old, but still true saying: the patient is the one with the problem. He reminded us that our job is to diagnose, formulate a plan, help and advise. If the patient doesn't accept the help, take the advice or follow the plan, that is the patient's problem. There is only so much that people can be helped. There comes a point (even with kids) where you have to either take them home with you and adopt them, or let them go.
They belong to their parents to take care of, and though the parents feel inadequate and want us doctors to take over, we can't. Even though we are nearly all compulsive care-givers (so true!) and we want to take over and make it all better, we can't do that either. Even when parents project helplessness and weakness and we just want to take it all on and fix the world and make it all better - we can't. At the end of the day, we make the diagnosis and the plan and give it back to the parents.
I hope this doesn't all sound too cynical, but this was a cold, hard shot of reality where I really needed it. I know that I do take too much on myself, and wonder why I feel inadequate and frustrated. Responsibility for the problem without power for change is the ultimate recipe for frustration, and one hour a week is just not enough leverage to change what goes on in these families every hour of every day.
Now I know that, I think I can get back to doing my job (and, I hope, doing it well) and leave all the emotional baggage at work, where it belongs.
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