Sabbath Psychiatry

While I sit in the third row of my synagogue on Saturday morning, reciting the traditional portions of the Sabbath service, I have running through my mind an additional and more intensely felt prayer-that none of my fellow congregants will approach me later to discuss their personal psychiatric care.

More often than not, this is a plea that goes unanswered.

As soon as the prayer books close, the questions inevitably begin. They cover everything from depression to marital disputes to my opinions of other doctors; with time and increasing familiarity, they grow more personal and specific.

In the course of 2 weeks, one fellow congregant’s question progresses from the wide focus (“What do you think about people with bipolar disorder stopping their meds?”) to the zoom lens (“I stopped taking my lithium this week. Is that safe?”).

Standing on the steps after services, a middle-aged woman approaches me for a diagnosis for her husband who earlier had shared with me that he was “the smartest guy around.” A particularly straightforward member of the synagogue board often asks bluntly, “Can I get a Xanax prescription from you?”

Although it is not uncommon for medical specialists to weigh in on health questions in social settings-dermatologists are forever examining moles at cocktail parties-there is something particularly personal and weighty about the questions that my colleagues and I field outside the hospital. Friends and acquaintances let us in on the intimate details of their personal lives and blur the line between a social acquaintance and a patient under our care. Most difficult to navigate are the questions about whether someone’s psychiatrist has prescribed “the right drug” or whether I agree with an interpretation made by his or her therapist.

Usually, when faced with a health question from a non-patient, I have a ready answer that I interject at the first appropriate moment: “That is something you really need to discuss with your psychiatrist.” “If you’re concerned about your husband, it may be worthwhile to get a professional evaluation.” “I am only a resident and cannot write prescriptions.”

People’s questions remind me that once my residency training is over, I will be on my own to figure out what to do in the consulting room, emergency department, or ward, depending on where my career takes me. I know that with my own patients, I will be able to draw on everything I learned in my years of medical school and rigorous training. I will also have established a network of contacts who can help me negotiate my more difficult cases.

What worries me, however, is what I will do in the future when approached in the nonprofessional setting. Will I have the humility to realize that I am doing no one a favor by giving partial answers that may deter a person from seeking formal psychiatric attention? Will I remember that a benignly intended comment can have a detrimental effect on a patient’s relationship with his or her psychiatrist?

On the one hand, I, like most residents, can hardly wait until the day when the daily restraints of life as a trainee are finally lifted. At the same time, I hope that when that day comes, I accept with trepidation the fact that increased autonomy will require increased humility and self-limitation. Gaining these attributes will be nothing short of an answer to my prayers.