Volume 23, Lesson 22

Treating Medical Students and Physicians

Michael F. Myers, MD, and Leah J. Dickstein, MD

Dr. Myers is Clinical Professor, Department of Psychiatry, University of British Columbia School of Medicine, Vancouver, British Columbia.

Dr. Dickstein is Professor Emerita, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky.

Editor's Note

In this lesson, many of the concerns that we should be aware of in treating fellow professionals are discussed, whether medical students, residents, or practicing physicians. But there is another message here as well. We may be the physician-patients and no less subject to feeling stigmatized, anxious about being found out by colleagues, and fearful of what the diagnosis, treatment plans, and prognosis may be.

The authors give us very specific guidelines for managing the initial interview. As with any patient, we are expected to take a full and complete history and evaluation, including confirmation that a primary care physician is attending to any physical concerns. But when the patient is a medical student or doctor, special considerations come into play. For example, its important to be welcoming, reassuring, compassionate, and respectful, realizing how difficult it may be for the health care professional to assume the role of patient and all that implies. At the same time, we must make it clear from the start that we are in charge of all aspects of treatment, and this includes prescribing medications. Confidentiality must be discussed in detail and clearly guaranteed, since the patient has undoubtedly overheard cases being discussed randomly in hospital elevators and dining rooms.

Mood disorders, alcohol and drug abuse, and anxiety disorders are among the most common conditions seen. One should never hesitate to explore suicide risk factors in detail and to be guided accordingly. And, since psychiatric illness and alcoholism and substance abuse can cause significant impairment in cognition, memory, and judgment, we should familiarize ourselves with state resources and reporting requirements.

There is a positive side to being treated for a psychiatric disorder: the physician can approach his or her own patients with more empathy and sharper diagnostic skills, and become more effective in recognizing and managing stress in his or her own professional and personal life.