Thursday, May 30, 2013

Editor at Large: As I See It, Some random thoughts about our plight part 2

Editor at Large: As I See It
A Column by Marvin Spieler
Some random thoughts about our plight part 2
Goodbye Dr. Welch
Yesterday I said my official goodbye to Dr. John Welch. I see him one more time next month, when he goes into retirement for good. I have been seeing him for the last fifteen years in an OMH Psychiatric State Clinic.
This is a totally unusual situation for a publicly run and funded mental health program. It has been my understanding that therapists, especially, but psychiatrists as well, usually don’t stay in any one program for an extended length of time. They either get a promotion, work in a more convenient location when an opportunity develops, or move on to another agency for better pay. Some mental health professionals leave the system entirely. The salary is not adequate compensation for the stress level of the job. Caseloads are overwhelming. Because of the aforementioned reasons the turnover is quite high. In the end, the client-patient-consumer is actually the one who loses out the most when the continuity of care does not have a chance to develop.
The mentally ill are most often very wounded souls. Whether due to the nature of their biochemical disorder, or being a victim of (verbal, physical, psychological, sexual) abuse, the issue of trust is a big problem. It can take years for a firm bond to develop between patient and therapist or psychiatrist. Change takes time and trust is crucial.
When therapists or psychiatrists come and go for their own benefit, it causes much harm to the client-patient-consumer. The point can be reached where the recipient of services builds a wall around themselves, never more to engage in anything less than superficial communication with a mental health professional. This, to my knowledge, has always been the case with the public mental health system.
For me to have the opportunity to see Dr. John Welch for so many years is totally extraordinary. I have benefited from a firm relationship that has taken years to develop and grow. I have always hoped for continuity of care, but rarely have had it occur. With Dr. John Welch, the journey together has been a good one, with no regrets. The time has been well spent.
Yesterday, I reminisced with Dr. John Welch for more than an hour. I went on and on, aware that I was spending beyond the usual hour he generally gives me. I also knew he could have cut me off, if he so desired, but he didn’t. I think we both desired and enjoyed our last real time together. I said all I wanted to say to him. Thank you, Dr. John Welch.
Foreign-born Psychiatrists Should Learn the Language
Psychiatry is an art and not yet a science. Psychiatry requires communication much more than medical care. Doctors, even specialists, rely primarily on lab tests. It is the interpretation of these tests that separates a mavin from the others.
Too many foreign-born psychiatrists think they can speak the language. Very few do unless they study the language and its idioms. A case in point: a foreign-born psychiatrist is frustrating a patient admittedly unintentionally. The patient throws up his arms and says, “I've had it!” The psychiatrist then wanted to hospitalize the patient as suicidal! Sounds impossible? No, because it happened. The psychiatrist did not know that idiom causing a miscommunication. The patient spent the rest of the session trying to assure the psychiatrist that he was okay.
Foreign-born psychiatrists would be well advised to go to night school for immigrants to really learn the language.

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