Clinician Behavior

[Caldwell-Luc]

Do you yawn and look stressed out in front of your patients when they frustrate you? Do you hit your head with your hand out of frustration in front of your patients? I wonder if this is natural. I had a doc that did this.

Is this a sign of clinician burn out?

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[Shikima]

Or being human?

 

[erg923]

Do you yawn and look stressed out in front of your patients when they frustrate you? Do you hit your head with your hand out of frustration in front of your patients? I wonder if this is natural. I had a doc that did this.

Is this a sign of clinician burn out?

Do we think this is professioanl behavior (assuming its not done in overtly sarcastic manner with a patient you know well)?

 

[Caldwell-Luc]

Do we think this is professioanl behavior (assuming its not done in overtly sarcastic manner with a patient you know well)?

No, it wasn't done in a sarcastic manner. But, in one incident he sighed with annoyance when I wasn't agreeing with him.

I am just curious because I had a psych resident tell me that she felt it was unprofessional to show her annoyance in front of patients.

 

[Caldwell-Luc]

Or being human?[/QUOTE

 

[Caldwell-Luc]

Point taken

 

[erg923]

When I was a teenager, I worked fast food for a summer. Part of my training (at Mcdonalds...I repeat, at McDonald's) was to provide high quality customer service, which included not becoming overtly irritated with even very difficult customers. Do I need to go on here....?

 

[smalltownpsych]

If your perspective was that it seemed unprofessional, then it probably was. When I am working with clients and have solid rapport, then I tend to become more expressive. Expressing affect appropriately actually fits with my theoretical orientation, but I need to make sure that there is a level of attunement or it will have the opposite effect from my intent. i.e., invalidating I think of the kid coming home from school with an A on their art project and mom or dad not responding with appropriate and congruent emotional expressiveness. A little parental displeasure is also healthy, as opposed to an invalidating response, "No, I'm not mad" when clearly they are.

 

[whopper]

Depending on the circumstances and patients, very different behaviors could be acceptable or not.

I had a patient that I thought was malingering and his behavior was pretty much flat with almost frozen psychomotor activity. No muscle ridigity. I told the staff members to watch him carefully and I attempted to ballet dance (or my version of trying to do that) and he laughed momentarily and then tried to freeze himself up again.

Yep, he was malingering.

In general, most clinicians see patients in a context of being polite and cooperative, but in other scenarios such as a forensic setting, emergency psychiatry, inpatient, outpatient, my behaviors and what I and other clinicians would find appropriate could be very different.

I'd want to hear more context before I gave a judgment on someone yawning.

 

[Armadillos]

I distinctly remember one time when I was working with an outpatient psychiatrist and he phrased a typical type of question in a way I thought was rather insensitive and I arrogantly thought to myself that I would have asked that question way more tactfully.

Then when we were discussing the patient afterwards, without me saying anything he specifically mentioned he had heard the patient had been very irritable with previous providers and he was intentionally testing the patients response. Was a humbling experience for me haha

 

[Ceke2002]

Depends on the client/Psychiatrist relationship I think. I've been working with my Psych for 3 or so years now, and we've reached a point where I think we're both pretty expressively open with another. I've gotten used to his little "...the f**k did you just say?" *head!tilt* expressions, and then I'm like "Yeah, I know, that's an abnormal thought, I'm working on it" and we have a laugh and agree to work on things together. I know he was more careful to hide that sort of stuff though when we first started working together, because we were still establishing a therapeutic relationship and he knew I had a lot of trust issues, especially around working with a male Psychiatrist. But yeah, these days we have a really good back and forth rapport with one another so little things like funny expressions or the occasional awkwardly worded question or statement don't really bother me that much. At the end of the day the guy is still human, I don't expect him to be sitting there acting like Psychiatry's answer to the Stepford Wives.

I did have one Psychiatrist, years ago, in our first session who, when he wasn't huffing and rolling his eyes at the clock on the wall, kept dozing off with his hand in his lap cupping a very noticeable erection. Yeah I'd call that unprofessional. (And needless to say I never want back to see him again).

 

[erg923]

Unless its done in an obvious joking manner, I am not sure how one could view that as professional? Obvioulsy a big difference between being firm and directive vs pure emotional reactivity towards patients. Control of the latter is partially what seperates MH professionals from life coaches, friends, advice givers, etc, no? I too challenge and test patients perceptions everyday. I see no reason why you would keep that intention secret from the patient though?

If you do not want your practice's customer service skills to be equal to or better than McDonalds, go ahead then, I suppose.

 

[Shikima]

I'm reminded of an old saying; Beauty is in the eye of the Beholder.

 

[erg923]

I'm reminded of an old saying; Beauty is in the eye of the Beholder.

Thats just something ugly people say.

 

[whopper]

If I don't know if a patient would find something acceptable, I'd ask them. If it's an outpatient and I have an indefinite period of time to work with them, as time goes by, I modulate my therapy and expressions based on the person's individual personality.

I got a guy that is a former gang-member and a little on tough-guy side. We occasionally do joke with each other in a fraternity-wise guy type of way. I don't talk in a completely polite and Star Trek Data-like manner with him. He told me this is the first time he's had a doctor that he feels can relate to him and he feels more comfortable talking to me.



I had a female patient that is physically very attractive and very sexually active. A few times I thought she was flirting with me. With her, I do talk like I'm Data from Star Trek.


But no I never kissed her and I never intend to do so.

 

[Shikima]

Need a D&D reference in there somehow....

 

[AcronymAllergy]

Need a D&D reference in there somehow....

The ability to inconspicuously stifle an inadvertent mid-session yawn is the equivalent of a therapeutic Saving Throw, with modifiers applied based on how many cups of coffee you've had, how late in the day it is, and how much talking you've had to do thus far.

 

[shan564]

I think that showing some subtle signs of mild frustration can help you show empathy for certain patients, but only in certain situations and with certain patients. If I'm frustrated that a patient is getting EPSE on subtherapeutic doses of antipsychotic, for example, I think that it helps to let the patient know that I am bothered by the fact that they are suffering and that I'm taking it seriously... I've had a lot of patients express that they don't feel like their psychiatrist is cognisant of this fact, which often leads to poor compliance. In other words, if I'm frustrated because I'm empathizing with my patient's frustration, I think that it can help to express that in a subtle way while still maintaining a positive/optimistic outlook.

On the other hand, banging your hand on your head can seem insensitive in many other situations. And yawning is probably always inappropriate.

 

[Ceke2002]

I think that showing some subtle signs of mild frustration can help you show empathy for certain patients, but only in certain situations and with certain patients. If I'm frustrated that a patient is getting EPSE on subtherapeutic doses of antipsychotic, for example, I think that it helps to let the patient know that I am bothered by the fact that they are suffering and that I'm taking it seriously... I've had a lot of patients express that they don't feel like their psychiatrist is cognisant of this fact, which often leads to poor compliance. In other words, if I'm frustrated because I'm empathizing with my patient's frustration, I think that it can help to express that in a subtle way while still maintaining a positive/optimistic outlook.

On the other hand, banging your hand on your head can seem insensitive in many other situations. And yawning is probably always inappropriate.

My own Psychiatrist has done similar. Just recently it became apparent that I would need to be put on some sort of antidepressant and I was pretty much terrified because past experience has shown that me and antidepressants don't tend to mix (if anyone's going to get the rare, 'rush me off to hospital' kind of side effects, it would be me). He obviously didn't mirror my fear as such, but he was definitely mirroring my concern not just through his words, but his affect as well. Obviously he wasn't mirroring to the point that it was making me freak out even more, but I could tell he was taking my concerns/worry seriously. It definitely made me feel like 'Okay, he knows I'm not mucking about with this, he's going to be prepared if anything does happen', and it allowed me the confidence to break through that fear of taking the first dosage. If he'd just blown me off like, 'Oh you'll be fine, don't worry about it' it would have been a different story, but he didn't and it was a huge help. As a patient that sort of mirroring of concerns and frustrations that I might be experiencing really helps me to feel like 'okay we're in this together, we're working as a team now' and makes the therapeutic relationship feel more solidified.

 

[Ceke2002]

If it's an outpatient and I have an indefinite period of time to work with them, as time goes by, I modulate my therapy and expressions based on the person's individual personality.

I've definitely noticed my Psychiatrist doing the same, albeit on a minor level. I think it's a sign of a good therapist to be able to adapt to different personalities and needs of patients. Not that I sit in on other patient sessions or anything (obviously), but even just being at the reception desk when I'm booking in my next appointment and hearing my Psych call his next patient, he has a different tone and mannerism - the way he would call me in for my session isn't the same way he would necessarily call someone else. I've spoken to patients online who have observed the same sort of thing, and it leads them to believe their Psychiatrist isn't being 'real' with them - if they seem like they're being a different person with different people then that's just putting on a front and any therapeutic bond is based on a lie. I always try and point out that to a degree we all do it, modulate or modify our approach to different people depending on the situation. The way someone would speak to their friends, isn't the same way they would speak to their parents, isn't the same way they would speak to their boss, and so on. It isn't that the person isn't 'keeping it real', it's that they have enough awareness to know that what's okay in one situation might be ill advised in another.

 

[Brainlock]

No, it wasn't done in a sarcastic manner. But, in one incident he sighed with annoyance when I wasn't agreeing with him.

I am just curious because I had a psych resident tell me that she felt it was unprofessional to show her annoyance in front of patients.

This is unprofessional. At least it shows the clinician's inability to control his/her emotions.

Looking frustrated in front of patients could be a show of empathy.