Developing your "third ear" as a psychiatrist

[slowthai]

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I was reading about a psychiatrist that learned how to develop their "third ear", and the person defined it specifically as being able to recognize when a patient is NOT telling you something. Have you found this to be the case for yourself? If so, how did you develop this ability?

Are there any other abilities that you've developed from training/being a psychiatrist?

 

[Sushirolls]

Just vague words by patient descriptions.
Or change in jargon around certain topics. Sometimes pry to get more info. Sometimes save for another day.
Still I'm sure there is far more patients are lying, or withholding than I '3rd ear' detect.

 

[Ironspy]

When the story does not completely make sense after probing/clarifying it’s often bc there is important information missing

 

[Merovinge]

There is going to be some mysticism/psychodynamicy responses, but I approach this like an LLM with pattern recognition.

I actually just reviewed a case by our assessment team as a perfect example summarized below:
2nd generation A+ high school student begins to struggle with school following change to new friend group. Found to be asleep in car parking lot at school, not completing assignments, recently arrested for shoplifting. Tells parents he appreciates their hard work but also can't wait to leave home at age 18. Completes assessment indicating that he smokes THC 1-2 hits 2x per week and drinks 2-3 drinks a few times per month. Parents went through phone and all pictures of pt are him using THC and/or EtOH.

This is a particularly flagrant example but it also just happened in the last 24 hours so fresh in mind. You just need to develop an awareness of what the pattern of mental illness tends to be and then see where their are discrepancies. We aren't perfect, and you also need to have humility that you can be wrong, but a starting point should be looking towards the discrepancies.

 

[TexasPhysician]

Ever watch the show Lie To Me?

Many patients will demonstrate facial expressions or positioning that demonstrate lies, deceit, or hiding their emotions. It certainly isn’t foolproof as some are really good liars and not all expressions translate one way. Expressions can change my line of questioning though.

Sometimes the questions will lead me to do a M-FAST, TOMMS, etc. I may specifically state that the test demonstrates a lack of effort. Is it possible that you are focusing elsewhere right now? Often they jump on that excuse and miraculously their story changes.

These are some of the reasons why I rarely do evals online. It significantly reduces your ability to identify key issues that aren’t expressly stated.

 

[slowthai]

Ever watch the show Lie To Me?

Many patients will demonstrate facial expressions or positioning that demonstrate lies, deceit, or hiding their emotions. It certainly isn’t foolproof as some are really good liars and not all expressions translate one way. Expressions can change my line of questioning though.

Sometimes the questions will lead me to do a M-FAST, TOMMS, etc. I may specifically state that the test demonstrates a lack of effort. Is it possible that you are focusing elsewhere right now? Often they jump on that excuse and miraculously their story changes.

These are some of the reasons why I rarely do evals online. It significantly reduces your ability to identify key issues that aren’t expressly stated.

I LOVED that show! Lol, I was always fascinated by figuring out people's "tells", microexpressions, etc. I've even read a few books on body language. Do you think therapy training will make me stronger at this skill? I'm interested in learning how to convey a "healing" body language as well.

And I totally get it, that's the only hesitation I have with tele work; missing out on body language.