Patient interactions

[EEGNeurofeedback]

I am wondering about this: when you happen to run into a patient as you are both heading to the office for an appointment (maybe in the elevator or hallway), do you not converse at all with the patient besides saying "hello." Do you walk with your patient to the office or walk behind or ahead of patient? With me I tend to walk with them and make small talk (weather, etc). I am fine with it as long as we don't get into what should be discussed in the office.

I know it is a strange question. I am just wondering what you all do in these situations.

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[Jester25]

Yup. Small talk. If they start to say something related to their care, I will usually say "Let's talk about it once we are in the office. I wouldn't want anyone to overhear and know your medical history" or something to that effect.

 

[EEGNeurofeedback]

Yup. Small talk. If they start to say something related to their care, I will usually say "Let's talk about it once we are in the office. I wouldn't want anyone to overhear and know your medical history" or something to that effect.

You know in residency I had an attending that believes providers (psychiatrists/psychologists) should not even be walking with the patient to the office. One should be behind the other. So, in his case, he would greet the patient and walk ahead of the person. And definitely no small talk. I thought that this was a little stuck-up for a lack of a better word.

 

[PikminOC]

Not stuck up. Maintaining boundaries. But everyone is different.

 

[Jester25]

You know in residency I had an attending that believes providers (psychiatrists/psychologists) should not even be walking with the patient to the office. One should be behind the other. So, in his case, he would greet the patient and walk ahead of the person. And definitely no small talk. I thought that this was a little stuck-up for a lack of a better word.

Yeah. I wouldn't do that. Like Grover said, everyone is different. I'm sure most of the analysts I know would do that.

 

[EEGNeurofeedback]

Not stuck up. Maintaining boundaries. But everyone is different.

How do you handle it? Do you make small talk with patients? The funny thing is this attending makes small talk with patients in the office. Unless the boundaries are so tight that patients and clients should only be interacting in the office.

 

[Ceke2002]

From a patient's point of view I'd say it would, or should depend on the individual patient. When I first started working with my Psychiatrist things were a lot more formal, I'd be in the waiting room, he'd usher me into his office, there was very little small talk or banter it was just straight down to business. After several years he's got more of a read on me now so if he sees me in the waiting room when I'm early he'll give me a wave and a 'hello', and when we're walking to and from his office we're usually engaging in some relaxed back and forth banter. It's still boundaried, but it's also just open enough to enhance the therapeutic alliance. If I was another patient though I might prefer a different approach and I'm sure he'd structure that accordingly.

 

[EEGNeurofeedback]

From a patient's point of view I'd say it would, or should depend on the individual patient. When I first started working with my Psychiatrist things were a lot more formal, I'd be in the waiting room, he'd usher me into his office, there was very little small talk or banter it was just straight down to business. After several years he's got more of a read on me now so if he sees me in the waiting room when I'm early he'll give me a wave and a 'hello', and when we're walking to and from his office we're usually engaging in some relaxed back and forth banter. It's still boundaried, but it's also just open enough to enhance the therapeutic alliance. If I was another patient though I might prefer a different approach and I'm sure he'd structure that accordingly.

I think you are right on when you mention that it depends on the patient. If a patient is one that would appear to be not aware of where and when office visits should take place, then a distance should be maintained. I have never had a patient like this, so I tend to make some small talk.

You know it is really helpful hearing it from a patient's perspective. Thanks!

 

[Ceke2002]

I think you are right on when you mention that it depends on the patient. If a patient is one that would appear to be not aware of where and when office visits should take place, then a distance should be maintained. I have never had a patient like this, so I tend to make some small talk.

You know it is really helpful hearing it from a patient's perspective. Thanks!

You're very welcome.

I've experienced both extremes of the spectrum of how Psychiatrists handle their patients, from the extremely boundaried type where you might as well be talking to an empty chair, through to the 'boundaries, what boundaries, I threw the hippocratic oath out the window years ago' type. One was extremely unhelpful, the other extremely damaging. It sounds like you have a good rapport with your patients, I think that's important. I know my Psychiatrist isn't a friend, but being able to just shoot the breeze with him for a bit does help me to enter the session feeling more relaxed and connected in a positive way, hence I'm more likely to be able to open up.

 

[Shikima]

I am wondering about this: when you happen to run into a patient as you are both heading to the office for an appointment (maybe in the elevator or hallway), do you not converse at all with the patient besides saying "hello." Do you walk with your patient to the office or walk behind or ahead of patient? With me I tend to walk with them and make small talk (weather, etc). I am fine with it as long as we don't get into what should be discussed in the office.

I know it is a strange question. I am just wondering what you all do in these situations.

Hallway is too narrow and I don't make small talk. The Chairman of my residency, who also was clinic director, was a real witch and would get on our case if we talked in the hall going to our rooms during 3rd year. Some habits are hard to break.

 

[Shikima]

Hallway is too narrow and I don't make small talk. The Chairman of my residency, who also was clinic director, was a real witch and would get on our case if we talked in the hall going to our rooms during 3rd year. Some habits are hard to break.

Ceke, I do give out my personal e-mail so often if the Patient is connected in the community. For instance, I wanted to know what the mass service was in my area and the patient was the church secretary and asked her to send me a listing.

 

[Jester25]

Well, I should be more clear with my response. I work in 5 different clinics including my moonlighting. The only two clinics I engage in smal talk is at my moonlighting gig because I take vitals before going into the office and patients will want to talk about something rather than being completely silent. The other is at the VA.

The other 3 clinics I usually walk in front of the patient, open the door for them and let them sit before I sit. No small talk there.

Weird I never thought about it, kind of just do what's natural.

 

[Ceke2002]

Ceke, I do give out my personal e-mail so often if the Patient is connected in the community. For instance, I wanted to know what the mass service was in my area and the patient was the church secretary and asked her to send me a listing.

Sorry I wasn't clear as to what aspect of my post you were replying to?

 

[EEGNeurofeedback]

You're very welcome.

I've experienced both extremes of the spectrum of how Psychiatrists handle their patients, from the extremely boundaried type where you might as well be talking to an empty chair, through to the 'boundaries, what boundaries, I threw the hippocratic oath out the window years ago' type. One was extremely unhelpful, the other extremely damaging. It sounds like you have a good rapport with your patients, I think that's important. I know my Psychiatrist isn't a friend, but being able to just shoot the breeze with him for a bit does help me to enter the session feeling more relaxed and connected in a positive way, hence I'm more likely to be able to open up.

I can really see what you are saying. I think it does depend on the patient and the provider. One of my colleagues is so focused on her work that she doesn't say "hello" to her patients or her colleagues. She just doesn't see people. I think it also depends on the mood of the provider too.

With certain patients, I wouldn't make small talk. I have one client that starts talking to me about her other medical problems. I don't make small talk with her because I know she will want to discuss her whole medical history with me. Overall, I enjoy making small talk with anyone just as long as we don't discuss any of their issues outside of the office.

 

[Shikima]

Sorry I wasn't clear as to what aspect of my post you were replying to?

This was in reponse to your variable interactions with Psychiatrists.


For general consumption, one of the big problems I see is that people tend to put Psychiatrists upon a weird pedistal expecting them to be counselor, philosopher, magician, and physician all at once and often forgetting we are all human and prone to mistakes that humans do.

 

[Ceke2002]

This was in reponse to your variable interactions with Psychiatrists.


For general consumption, one of the big problems I see is that people tend to put Psychiatrists upon a weird pedistal expecting them to be counselor, philosopher, magician, and physician all at once and often forgetting we are all human and prone to mistakes that humans do.

Oh no I agree, absolutely. You see it a lot on patient forums where a person's Psychiatrist is a champion and a hero one minute, but make one tiny mistake that show's they're less than god like and that's it, therapy's over. After working with my own Psychiatrist for nigh on 3 years now (give or take) I think I can safely say he isn't perfect, nor would I ever expect him to be. Just speaking personally, to me at least, there's a difference between throwing the baby out with the bathwater, because stars forbid your Psychiatrist shows they have human foibles like anyone else, and working with someone for a period of time only to realise you're not really making any connection and they're just not the right therapist for you. The example I gave as well regarding the extreme end of the non boundaried therapist, I wasn't talking about something as innocuous as the example you gave, I was referring more to the hands wandering where they shouldn't be kind of predatory Psychiatrist that brings damage to their patient population, and disrepute to the entire profession. Like I said, I've pretty much run the gamut when it comes to Psychiatry.

 

[EEGNeurofeedback]

You're very welcome.

I've experienced both extremes of the spectrum of how Psychiatrists handle their patients, from the extremely boundaried type where you might as well be talking to an empty chair, through to the 'boundaries, what boundaries, I threw the hippocratic oath out the window years ago' type. One was extremely unhelpful, the other extremely damaging. It sounds like you have a good rapport with your patients, I think that's important. I know my Psychiatrist isn't a friend, but being able to just shoot the breeze with him for a bit does help me to enter the session feeling more relaxed and connected in a positive way, hence I'm more likely to be able to open up.

This exactly! You took the words out of my mouth!

 

[EEGNeurofeedback]

Ceke, I do give out my personal e-mail so often if the Patient is connected in the community. For instance, I wanted to know what the mass service was in my area and the patient was the church secretary and asked her to send me a listing.

This makes a lot of sense especially if the psychiatrist and client live in a small community.

 

[Shikima]

Oh no I agree, absolutely. You see it a lot on patient forums where a person's Psychiatrist is a champion and a hero one minute, but make one tiny mistake that show's they're less than god like and that's it, therapy's over. After working with my own Psychiatrist for nigh on 3 years now (give or take) I think I can safely say he isn't perfect, nor would I ever expect him to be. Just speaking personally, to me at least, there's a difference between throwing the baby out with the bathwater, because stars forbid your Psychiatrist shows they have human foibles like anyone else, and working with someone for a period of time only to realise you're not really making any connection and they're just not the right therapist for you. The example I gave as well regarding the extreme end of the non boundaried therapist, I wasn't talking about something as innocuous as the example you gave, I was referring more to the hands wandering where they shouldn't be kind of predatory Psychiatrist that brings damage to their patient population, and disrepute to the entire profession. Like I said, I've pretty much run the gamut when it comes to Psychiatry.

Borderlines. Need more DBT clinics around.

 

[Ceke2002]

This exactly! You took the words out of my mouth!

Sorry it's taken me a while to respond. Glad you could relate. I also know that whilst we're 'shooting the breeze' my Psych is giving me the once over before we've even gotten into session. He's subtle about it, but I've been working with him long enough to see/sense that he's watching for things like my physical presentation, speech rates, speech patterns, do I seem tense, nervous, slowed down, withdrawn, relaxed, grounded, etc etc. Not only do I find small talk a good way to get into 'therapy mode' for myself, I also think it presents a good opportunity for my Psychiatrist to assess where the session should start from.

 

[Ceke2002]

Borderlines. Need more DBT clinics around.

Agreed, didn't do DBT myself when I was going through treatment for BPD but I've heard good reports from other (recovered and recovering) borderlines who have been through it themselves. From what I hear it can be tough at times, but I personally find those borderline patients who are serious about getting well will accept being challenged. They may not like it, they may fight against it and throw a fit from time to time, but in the end they'll always come back and say 'yeah, thanks for calling me on my BS, I need to work on that'. On the patient forums I frequent speaking in generalisations you tend to get three distinct borderline type patients - those who have just been diagnosed and are understandably concerned/bewildered and looking for information/people to relate to, those who have accepted the diagnosis, are in some type of treatment and will often come straight out and say 'hell yeah call me on it if you notice be acting out', and those who just want people to hold their hands and give them pats on the head and say 'there, there, all Doctors are just big meanies, you're so totally right about everything, I applaud your decision to fire your 10th shrink in less than a year'

 

[MacDonaldTriad]

It is really very simple. Don’t speak until spoken to, and if spoken to, behave like a normal human being. It is a patient’s option not to acknowledge a relationship with you in public, but if they are comfortable with it, so should we be. I have had many silent elevator rides with patients I have known for a long time, and I have had patients bring up sexual side effects in a packed elevator. If they bring it up, it is fair game and not our doing.

 

[¯\_(ツ)_/¯]

i'm intrigued if only because that had never happened to me and don't know how i'd react apart from saying sure i'd love to discuss those issues in detail once we're in the privacy of our office. how do you respond to those patients in the elevator?

 

[MacDonaldTriad]

I was a little stunned, but it really wasn’t all that big a deal. This was a guy who tends to be a little light in the frontal lobe department anyway. He complained of a decrease in libido so I changed his antidepressant. I think he said something like “you were right doc, my sex drive is back to where it used to be”. I think I organized my thoughts enough to respond with something profound like “that’s good”.

 

[Shikima]

I was a little stunned, but it really wasn’t all that big a deal. This was a guy who tends to be a little light in the frontal lobe department anyway. He complained of a decrease in libido so I changed his antidepressant. I think he said something like “you were right doc, my sex drive is back to where it used to be”. I think I organized my thoughts enough to respond with something profound like “that’s good”.

Good reply.

 

[Ceke2002]

I was a little stunned, but it really wasn’t all that big a deal. This was a guy who tends to be a little light in the frontal lobe department anyway. He complained of a decrease in libido so I changed his antidepressant. I think he said something like “you were right doc, my sex drive is back to where it used to be”. I think I organized my thoughts enough to respond with something profound like “that’s good”.

So you didn't high five him then?

 

[michaelrack]

This was in reponse to your variable interactions with Psychiatrists.


For general consumption, one of the big problems I see is that people tend to put Psychiatrists upon a weird pedistal expecting them to be counselor, philosopher, magician, and physician all at once and often forgetting we are all human and prone to mistakes that humans do.

I am no magician

 

[Shikima]

I am no magician

You just play one on TV, right?