Friday, July 22, 2011

Is Psychiatry Different From Other Specialties?

In the Clinical Encounters case featured here two days ago, I presented the story of a psychiatrist who goes for a urological procedure and discovers that one of his former patients is the nurse assisting.  People wrote in to suggest ways he should handle this awkward situation and I was struck by the idea that some suggested he tell the urologist that he knows the nurse in a social setting (because he can't tell the other doc that the nurse was his psychiatric patient) and the assumption that the urologist would be understanding, and that perhaps the urologist should have policies in place in case of such events.

Do surgeons think this way?  I assumed the urologist would be angry--his time had been allotted for the procedure, and it's a surgical procedure with professional staff, what's the big deal?  To a surgeon, I think you see the best, and if the best is your friend, then so be it, a body's a body.  It's not unusual for clergymen to be treated by their parishioners, for medical staff to be treated at their own hospital and by members of their own department, and for surgeons to operate on colleagues.  In small towns, there is often very little choice as to who delivers your baby or shrinks your head.

Traditionally, psychiatry is a bit different, and we maintain some distance.  In the program where I trained, this view was not felt to make sense: if you're sick, you go to the best, and we are the best.  Psychiatrists would have their family members come in for care, and there were times that people in the department were admitted to the inpatient unit (and yes, I mean psychiatrists as well as nurses, staff,  residents, and med students).  For those who insist that the stigma of a label or a treatment necessarily destroys you-- it ain't so. 

It all makes me, personally, a little uneasy-- I like my privacy, even for the most mundane of medical things, though I do think that if I had some unusual, or difficult-to-treat condition and the 'best' was someone close to home, I'd get over it very quickly.