Vacation Times?

Allan Tasman, MD

From the Editor

It’s summer, normally time for us to get away from the usual hectic pace of our daily lives. I’ll try to make this column brief, so you can go to the beach, take a hike, read a book, or whatever helps you relax and get away from work for a bit longer. But, lately I’ve been thinking about how hard that is for most doctors and for the families of our patients.

The time we have to spend with each patient is generally short, but our importance to our patient is greater than can be measured in just minutes or hours. Our patients’ families spend lots of time with them and bear a good deal of the burden for their welfare. This summer I’ve been dealing with my mom’s very serious illnesses and have been thinking about a colleague with a young child who has a life-threatening illness and a friend who has a child with very serious health problems needing several hospitalizations. I also often think about a patient I treated for a number of years and my unwavering worry about her safety during most of those years whenever I was away. In all these situations, there are psychiatrists and family members who do their best to help someone in need cope with his or her problems, and in doing that they expend a lot of emotional energy.

Our ability to help our patients is tied to the fact that we develop a positive bond with them, something most family members already have, but for us it’s developing the therapeutic relationship we all live out each day. To some external observers, it may seem like we are just going through the complicated mechanics of making a diagnosis, developing a treatment plan, and prescribing needed interventions. On those days when the treadmill seems to be going too fast to keep up, we might feel the same way.

I know, as do all of you, though, that isn’t everything that’s going on. In whatever ways we do it, we’re forming an emotional bond with our patients with the aim of giving them hope, trusting in us, and willing to go ahead and try the treatments we’re discussing with them. That takes work, and above all, an emotional commitment from us. We can’t succeed with any patient unless we care about that individual person and, by extension, his or her family.

When I talk about this with medical students and beginning psychiatry interns, it’s common for them to have a misconception about this kind of caring. Nearly every doctor I’ve ever met chose medicine as a career because he or she wanted to help sick people get better. But somewhere along the line of professional training and practice, many began to think this was supposed to mainly be an intellectual enterprise. The idea of therapeutic neutrality was interpreted to mean- incorrectly-that physicians aren’t supposed to have any feelings about their patients.

We can’t succeed unless we care about our patients, and that means we have feelings about them. Compassion, concern, and empathy are usually a big part of that, but there is as complex an array of emotions as with any other person with whom we enter into any kind of relationship. The difference is, of course, that it takes a lot of emotional and intellectual work to ensure that we use our emotional responses only to help us better understand our patients-and to help them with their illnesses.

These emotional ties, just as for a family member, often make it hard to take time for ourselves-away from our patients. I think it only helps somewhat to know that someone may be covering for us when we’re out of the office, or that family members have promised to be extra vigilant. But every psychiatrist I’ve ever talked with about this issue has said there’s always someone they worry about when they are away, whether it’s someone whose condition might deteriorate or whose tie with us is tenuous. Meaning we never completely get away, and that is part of the hard work we do.

So, I want to give everyone a metaphorical pat on the back and thanks for that which is sometimes more implicit than explicit. The work we do is stressful, complicated, sometimes frustrating, and incredibly gratifying. Psychiatry, like the rest of medicine, is still an imprecise art. We don’t know enough about the causes of the illnesses our patients bring to us, we don’t always have the ideal treatments they need, and the health system often makes it hard to use all the tools we do have. But we try as hard as we can to help our patients. And although some people may criticize us, or seem unappreciative of our efforts, every-one deserves a little time away to recharge the batteries.

So my wish for you is that you’ve made time for a little fun this summer. I know that all your work, including your patients’ letting you know, one way or the other, that they missed your attention, will be waiting when you get back. And I hope part of that work includes our recognition of all the efforts our patients’ families make to help their loved ones stay on a path to recovery, especially when we aren’t available.