How does always being around depressed patients affect you mentally?

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For all the psych residents and attendings out there, I am wondering how constantly interacting with depressed patients, and patients with other mental disorders or traumatic life experiences resulting in overly negative and pessimistic personalty types affects you personally?

I know that for me I've found that just from every day social interactions and previous work experiences, that being around very negative and toxic people all day starts to take its toll on me after a while and I feel I start to get dragged down with them. Given the nature of the patients you are dealing with, do any of you find this is a problem or concern in psychiatry? If so, how do you mitigate the negative impact on your mental state?

 

[digitlnoize]

For all the psych residents and attendings out there, I am wondering how constantly interacting with depressed patients, and patients with other mental disorders or traumatic life experiences resulting in overly negative and pessimistic personalty types affects you personally?

I know that for me I've found that just from every day social interactions and previous work experiences, that being around very negative and toxic people all day starts to take its toll on me after a while and I feel I start to get dragged down with them. Given the nature of the patients you are dealing with, do any of you find this is a problem or concern in psychiatry? If so, how do you mitigate the negative impact on your mental state?

It doesn't bother me...no more than any other branch of medicine. I try to remind myself that we treat diseases, which I don't even have to do anymore.

Your question is kind of like asking an infectious disease doctor how they keep from catching MRSA (or whatever bug you prefer). Depression isn't contagious. Also, you'll see such a wide variety of psychiatric patients that it won't all be depression.

The usual rules for ones own mental well being apply. Have hobbies. Have support. Have fun. Don't work ALL the time. Decompress.

Just my 2 cents.

 

[Leo Aquarius]

We don't constantly interact with depressed patients. If we did, we'd become jaded and a bit unhappy ourselves I'm sure. As a resident, I see a diversity of patients from schizophrenic, intoxicated, delirious, anxious, OCD, PTSD, depressed, as well as those feeling happy and normal because their meds are working and they love to see me and there's this bond you feel which is very satisfying as a doctor (and rare in other specialties). So that therapeutic bond carries you pretty far. I love that aspect of psychiatry and it overcomes getting down from depressed patients. So when I see a very depressed patient, I think in the back of my head how this depressed patient will hopefully become less depressed and the therapeutic alliance will blossom. I'm happy to say that has happened with many of my patients thus far.

Good question by the way. One that I was wondering too as a med student.

 

[shan564]

I find it to be a constant reminder of how great my life is.

 

[rkaz]

I find this question very interesting, as I was just having this conversation with family earlier today (we have a lot of doctor friends of my family). Two of my family members were saying that they know of various psychiatrists whose personality changed as they progressed through their career. They aren't sure why anyone's personality would change, but that they have noticed it multiple times, that psychiatrists seemed a little 'crazy' after dealing with such patients for years. I have no idea if there is any truth to their observations. I was told by my family "to leave work at work, and not bring it home" so that I don't get emotionally burned out by the nature of the job.

 

[myPsychAlt]

This is tangentially related to the question I get from people in other specialties and from the "lay people." "How can you deal with crazy people all day in Psychiatry?" My response is that you deal with crazy people all day in any medical specialty, but in psychiatry I'm professionally trained in how to deal with them effectively. (plus, most of them are providers anyway)

when people say that it's no more than any other medical specialty, it's more or less true. You're going to deal with A LOT of depressed patients in any medical setting especially 2/2 their medical problems. Given the number of consults I receive with the CC of "depression" and the consulting service having no f-cking clue how to talk to their patients about this, I'd say we're less affected than other specialties.

 

[Jorje286]

I think the empathetic connection you build with depressed patients is very gratifying, and that is counter-intuitive for most lay people. But there's a lot of emotional intensity involved and that can take its toll. You do really need the time off you get in psychiatry, and it's really important you have a social life and hobbies you're passionate about.

 

[shan564]

I find this question very interesting, as I was just having this conversation with family earlier today (we have a lot of doctor friends of my family). Two of my family members were saying that they know of various psychiatrists whose personality changed as they progressed through their career. They aren't sure why anyone's personality would change, but that they have noticed it multiple times, that psychiatrists seemed a little 'crazy' after dealing with such patients for years. I have no idea if there is any truth to their observations. I was told by my family "to leave work at work, and not bring it home" so that I don't get emotionally burned out by the nature of the job.

I think it's selection bias. Psychiatry tends to attract more people who have a personal/family history of mental illness, which puts us at higher risk of being adversely affected by medicine in general, not by psychiatry specifically.

This is tangentially related to the question I get from people in other specialties and from the "lay people." "How can you deal with crazy people all day in Psychiatry?" My response is that you deal with crazy people all day in any medical specialty, but in psychiatry I'm professionally trained in how to deal with them effectively. (plus, most of them are providers anyway)

I say something almost identical. I thought I came up with it on my own, but now that you've mentioned a very similar statement, maybe I heard it from somewhere. My variant is "you deal with crazy people all day in every specialty, but in psychiatry we actually get to fix that part."

 

[Shikima]

Part of the process is also developing a 'thick skin' when it comes to mental health. Similarly to a surgeon who does bucketloads of ampulations due to diabetes.
We are also human and can/will act and react to normal work environment/home/family stress.

 

[doubledeuce80]

great question! my experience is that psychiatry is more emotionally exhausting then other medical specialties, even though other specialties may be more physically exhausting (i.e. i could do 60hrs internal medicine and be way less emotionally exhausted than 40 hrs psychiatry). that's why i think a lot of psychiatrists work ~35-40 hrs per week. i also find different psych pts affect me very differently. i experience some types of pts as draining (i.e. aspd, bpd, depression, anxiety), but my interest is addiction psychiatry and i find treating these pts highly energizing and gratifying. i also feel a kinship with other addiction psychiatrists that makes the work more rewarding.

 

[masterofmonkeys]

Secondary gain, malignant apathy, and neglect/abuse of their children are the things that get me down. Not the depression.

 

[shan564]

Secondary gain, malignant apathy, and neglect/abuse of their children are the things that get me down. Not the depression.

Which are all things that are abundant in most medical specialties.

 

[rkaz]

Part of the process is also developing a 'thick skin' when it comes to mental health. Similarly to a surgeon who does bucketloads of ampulations due to diabetes.
We are also human and can/will act and react to normal work environment/home/family stress.

I am doing a medicine rotation this month, and I recently had an elderly patient with dementia say abusive words to me when I was examining him. I was stunned when he did that, and I walked out of the room feeling angry and deflated, as I had internalized some of the stuff he said. Then later when I went with my attending to round on the patient, the patient said even more abusive words to the attending than he had to me (to the point of comedy), and it dawned on me that the patient might actually be mentally ill and paranoid. (As neither I nor my attending had done anything wrong, for anyone to snarl at us and insult us like that.) For whatever reason I had been doing my medicine rotation with tunnel vision, oblivious to their psych issues, and only focusing on their medical problems since it was a 'medicine' rotation. I realize that I clearly still have thin skin to allow a patient's abusive words hurt me like that.

 

[shan564]

I am doing a medicine rotation this month, and I recently had an elderly patient with dementia say abusive words to me when I was examining him. I was stunned when he did that, and I walked out of the room feeling angry and deflated, as I had internalized some of the stuff he said. Then later when I went with my attending to round on the patient, the patient said even more abusive words to the attending than he had to me (to the point of comedy), and it dawned on me that the patient might actually be mentally ill and paranoid. (As neither I nor my attending had done anything wrong, for anyone to snarl at us and insult us like that.) For whatever reason I had been doing my medicine rotation with tunnel vision, oblivious to their psych issues, and only focusing on their medical problems since it was a 'medicine' rotation. I realize that I clearly still have thin skin to allow a patient's abusive words hurt me like that.

I had that feeling the first time a patient yelled at me too. I think it's a bit of a rite of pasage for students. The other day a patient was berating one of the sub-I's on the unit (not my sub-I), and the student was just standing there in shock, visibly disturbed. After it got to the point where it was clear that she was incapable of extricating herself from the situation, I had to step in and tell her "hey, I need your help here" and pulled her away. The earlier this happens to you, the better it is for your long-term learning.

 

[ZAC.RAZ]

For all the psych residents and attendings out there, I am wondering how constantly interacting with depressed patients, and patients with other mental disorders or traumatic life experiences resulting in overly negative and pessimistic personalty types affects you personally?

I know that for me I've found that just from every day social interactions and previous work experiences, that being around very negative and toxic people all day starts to take its toll on me after a while and I feel I start to get dragged down with them. Given the nature of the patients you are dealing with, do any of you find this is a problem or concern in psychiatry? If so, how do you mitigate the negative impact on your mental state?

I think playing "savior" changes the game here. When you are interacting with depressed colleagues, friends or family members, then that might affect your mood. But when you're in a position that you get to the bottom of many mental disorders, it is more likely to be immuned against them IMHO. Of course this is just a theory, and if you want the best answer, then you should run a systematic study on some psychiatrist fellows 🙂

 

[OldPsychDoc]

I find this question very interesting, as I was just having this conversation with family earlier today (we have a lot of doctor friends of my family). Two of my family members were saying that they know of various psychiatrists whose personality changed as they progressed through their career. They aren't sure why anyone's personality would change, but that they have noticed it multiple times, that psychiatrists seemed a little 'crazy' after dealing with such patients for years. I have no idea if there is any truth to their observations. I was told by my family "to leave work at work, and not bring it home" so that I don't get emotionally burned out by the nature of the job.

I think that that "personality change" is really Burnout, and is equally (sometimes more) prevalent in other medical specialties.

 

[thoffen]

Boundaries are important here. You must be able to separate your feelings from your actions.

Generally it does not bother me. I am not disturbed by empathetic reactions to genuine depression. To feel that, you must also appreciate that, in these moments, you value the other person in a way that compels you to respond to your want for them to get better. That is pretty danged cool to me.

I think more people are burned out by the ones they don't have this empathetic reaction to -- the ones who would use their illness as excuse not to try harder.

 

[Shikima]

I think that that "personality change" is really Burnout, and is equally (sometimes more) prevalent in other medical specialties.

http://www.wsj.com/articles/are-burnout-and-depression-the-same-thing-1457366565

 

[nancysinatra]

I haven't read the whole discussion, because I'm too burned out, but I personally am tired of hearing about people's emotional problems, whether it's depression, insomnia, or whatever else. (Which isn't to say I don't TRY. When I'm actually at work, I think I have a pretty good attitude! On this forum I express more of my frustration.) Most of the problems people come to me with are not very interesting, if I can give my honest opinion. People complain of anger, mood swings, and poor sleep. Almost every single person endorses a history of abuse. So, what's going on? Is our society that bad, that everyone's been abused? All I know is: I can't fix THAT, and neither can big pharma. If psychiatry offered more variety, I might like it more, but that's not how it is. There's no diagnostic challenge either if you go by the book (i.e. the DSM) because it's a checklist. Once a year I see a case of hypothyroidism. That's a great day for me, because at least it's interesting - and best of all, it's treatable! A visit to the PCP and an rx for synthroid is so much more reliable than any psych med!

I try to do therapy when I can, and even then, few patients are really psychologically oriented, and some just get annoyed with attempts at therapy. (Then again, my job does not encourage therapy. My job is to do 15-min med checks.) Most of the patients are on SSDI. I have no idea why. (Often ,they don't either.) Almost all of them could be more involved in the community if they had an opportunity. Yet so very many are on SSDI. They are often on 6 or 7 medications already. Often I'm told that "none of them work" and they've "tried everything." I have to be honest - it gets tiring. If I could talk to patients honestly and figure out what they get from being on SSDI and 7 non-working medications - then the therapy might go somewhere. But there are factors in society pushing patients to resist these discussions. Hence you have the 15 minute med check, which I hate.

 

[Ceke2002]

I haven't read the whole discussion, because I'm too burned out, but I personally am tired of hearing about people's emotional problems, whether it's depression, insomnia, or whatever else. (Which isn't to say I don't TRY. When I'm actually at work, I think I have a pretty good attitude! On this forum I express more of my frustration.) Most of the problems people come to me with are not very interesting, if I can give my honest opinion. People complain of anger, mood swings, and poor sleep. Almost every single person endorses a history of abuse. So, what's going on? Is our society that bad, that everyone's been abused? All I know is: I can't fix THAT, and neither can big pharma. If psychiatry offered more variety, I might like it more, but that's not how it is. There's no diagnostic challenge either if you go by the book (i.e. the DSM) because it's a checklist. Once a year I see a case of hypothyroidism. That's a great day for me, because at least it's interesting - and best of all, it's treatable! A visit to the PCP and an rx for synthroid is so much more reliable than any psych med!

I try to do therapy when I can, and even then, few patients are really psychologically oriented, and some just get annoyed with attempts at therapy. (Then again, my job does not encourage therapy. My job is to do 15-min med checks.) Most of the patients are on SSDI. I have no idea why. (Often ,they don't either.) Almost all of them could be more involved in the community if they had an opportunity. Yet so very many are on SSDI. They are often on 6 or 7 medications already. Often I'm told that "none of them work" and they've "tried everything." I have to be honest - it gets tiring. If I could talk to patients honestly and figure out what they get from being on SSDI and 7 non-working medications - then the therapy might go somewhere. But there are factors in society pushing patients to resist these discussions. Hence you have the 15 minute med check, which I hate.

Honestly I think you have every right to feel that way. I know it's frustrating enough for me with some of my patient centred support groups when there are members on there who are still complaining about the same **** they were complaining about 10 years ago, and there answers to every attempt at a helpful suggestion are always some variation on "You just don't understand" "I can't do that" "I tried that for a week and it didn't work" "That won't work for me (even though I've never actually tried it)" "How dare you suggest I need to take some responsibility for my recovery, let me sing you the song of my people...BAAAAWWWLLL". At least I get to walk away from that when it gets too much and I'm about to put a fist through my computer screen, but you don't have that luxury and it doesn't sound like your current job is helping the situation either. I mean there's only so long you can sit there day in and day out listening to excuses from people that aren't prepared to really work with you to improve their lives, because stars forbid anyone should take responsibility for their own well being, and then to not even be given the time to effectively help those who may actually want to be helped - that entire situation would send me completely barmy!

As for the abuse thing, that is something I've wondered about myself. I know we have better recognition and understanding of emotional or psychological abuse, which may lead people who previously didn't consider themselves abuse survivors to realise that maybe they are - but at the same time I do also think that a) repeatedly playing the abuse card is a far too easy way to get out of taking personal responsibility for your actions (whether any actual abuse took place or not), and b) as much as it's great to see more awareness of child abuse and the impact it has, I do wonder how many people then go ahead and mistake something like growing up with strict parents or growing up in a lower socio-economic family environment as 'abuse' when it aint necessarily so. I could be wrong, and not to play oppression Olympics or anything, but being sent to bed without supper, because you refused to finish your homework, isn't abuse to me, neither is having to wear hand me down clothes, and receiving home made presents at birthdays and Christmas time -- however, being dragged out of bed in the middle of the night, carried outside and then thrown into a thorny rosebush, because you couldn't fall asleep by a count of 10, that I would consider abuse, or at least abusive behaviour. So yeah I think perhaps part of the problem is people may not actually realise what does constitute 'abuse' -- I don't know I'm in stream of conscious mode at the moment I guess.

 

[sunlioness]

Fifteen minute med checks are an abomination.

I mean think about it. 4 patients an hour for 8 hours. Some of them you know. Some of them you don't. They're all poor or they wouldn't be seeing you. They're all complicated. You get 15 minutes with each of them to try to sort out what's going on.

And eventually . . . You give up. It's just easier to fill what they're taking already. Deflect questions. Disengage.

And then congrats, you're now one of the terrible CMHC docs who "didn't even look at me. She just filled my meds and told me to come back in a month."




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[Shikima]

Fifteen minute med checks are an abomination.

I mean think about it. 4 patients an hour for 8 hours. Some of them you know. Some of them you don't. They're all poor or they wouldn't be seeing you. They're all complicated. You get 15 minutes with each of them to try to sort out what's going on.

And eventually . . . You give up. It's just easier to fill what they're taking already. Deflect questions. Disengage.

And then congrats, you're now one of the terrible CMHC docs who "didn't even look at me. She just filled my meds and told me to come back in a month."




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If I were in CMH with that level of disengagement, I'd say RTC in 3 months.

 

[sunlioness]

Six weeks is a favorite of mine.

I'm getting out in three months.

This morning was cool. I told a guy in intake that there was no circumstance under which I would be prescribing him Xanax so he got up and left. So I get an hour for lunch today.

To answer the original question though . . .

No. Being around depressed patients does not make me depressed. It doesn't make me burn out or tune out. What makes me shut down is when I feel I'm not making a difference, that my work is not valued, that I don't have the tools I need to do a good job, or people aren't invested in working with me.

But the finale of the Batchelor is on tonight. So I have that to look forward to.

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[WisNeuro]

This morning was cool. I told a guy in intake that there was no circumstance under which I would be prescribing him Xanax so he got up and left. So I get an hour for lunch today.

But it's the only thing that works!!! Why won't you help ease his suffering?!?

 

[sunlioness]

But it's the only thing that works!!! Why won't you help ease his suffering?!?

Because I'm a jerk. There can be no other explanation. I'm a jerk and I totally wasted his time.


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[smalltownpsych]

I haven't read the whole discussion, because I'm too burned out, but I personally am tired of hearing about people's emotional problems, whether it's depression, insomnia, or whatever else. (Which isn't to say I don't TRY. When I'm actually at work, I think I have a pretty good attitude! On this forum I express more of my frustration.) Most of the problems people come to me with are not very interesting, if I can give my honest opinion. People complain of anger, mood swings, and poor sleep. Almost every single person endorses a history of abuse. So, what's going on? Is our society that bad, that everyone's been abused? All I know is: I can't fix THAT, and neither can big pharma. If psychiatry offered more variety, I might like it more, but that's not how it is. There's no diagnostic challenge either if you go by the book (i.e. the DSM) because it's a checklist. Once a year I see a case of hypothyroidism. That's a great day for me, because at least it's interesting - and best of all, it's treatable! A visit to the PCP and an rx for synthroid is so much more reliable than any psych med!

I try to do therapy when I can, and even then, few patients are really psychologically oriented, and some just get annoyed with attempts at therapy. (Then again, my job does not encourage therapy. My job is to do 15-min med checks.) Most of the patients are on SSDI. I have no idea why. (Often ,they don't either.) Almost all of them could be more involved in the community if they had an opportunity. Yet so very many are on SSDI. They are often on 6 or 7 medications already. Often I'm told that "none of them work" and they've "tried everything." I have to be honest - it gets tiring. If I could talk to patients honestly and figure out what they get from being on SSDI and 7 non-working medications - then the therapy might go somewhere. But there are factors in society pushing patients to resist these discussions. Hence you have the 15 minute med check, which I hate.

I see these patients filing in and out of the PMHNPs office everyday. I feel for you as I wouldn't want to have to deal with them. I used to get referrals from her but after a 75% no show rate, I ended that. Some of my patients do derive benefit from medications, but when that is the only plan to "feel better" despite the fact that there are about a million more important steps that they could take to have a better life, then it's all over.

 

[Doctor Bagel]

I'm doing inpatient and have moments of burn out, but inpatient surprisingly shields you from a lot of this stuff (I know, I know, everyone hates inpatient, but it beats 15 minute med checks in my book). And yes, depressed patients aren't the issue. Personality disordered patients with depression diagnoses can be the issue, but depressed patients aren't. I feel exhausted, though, reading about our field. Someone signed me up for some private psychiatry discussion on Facebook (perhaps you guys are on this), and it's full of questions about little med tweaks for patients who already seem to be overmedicated. Is this where our field is right now? For example -- patients on 4 meds, has some tiny side effects, has some symptom that maybe shouldn't be addressed pharmacologically, what else should I add? Or should I just read Stahl and shut up?

 

[smalltownpsych]

I'm doing inpatient and have moments of burn out, but inpatient surprisingly shields you from a lot of this stuff (I know, I know, everyone hates inpatient, but it beats 15 minute med checks in my book). And yes, depressed patients aren't the issue. Personality disordered patients with depression diagnoses can be the issue, but depressed patients aren't. I feel exhausted, though, reading about our field. Someone signed me up for some private psychiatry discussion on Facebook (perhaps you guys are on this), and it's full of questions about little med tweaks for patients who already seem to be overmedicated. Is this where our field is right now? For example -- patients on 4 meds, has some tiny side effects, has some symptom that maybe shouldn't be addressed pharmacologically, what else should I add? Or should I just read Stahl and shut up?

Overmedication seems to be the standard of care for too many docs and NPs. I was seriously shocked a few months back when the patient that I had who was on 4 different meds was taken off all but one by the psychiatrist at the inpatient unit. The patients put a lot of pressure on us to do this though. I don't even write scripts and the patients are telling me how they need this or that med for this or that symptom. The strategy of targeting symptoms is like playing whack-a-mole. If you have more meds, then it's like having more hammers. You can keep those little suckers from ever rearing their ugly heads! 🙄

 

[Doctor Bagel]

Overmedication seems to be the standard of care for too many docs and NPs. I was seriously shocked a few months back when the patient that I had who was on 4 different meds was taken off all but one by the psychiatrist at the inpatient unit. The patients put a lot of pressure on us to do this though. I don't even write scripts and the patients are telling me how they need this or that med for this or that symptom. The strategy of targeting symptoms is like playing whack-a-mole. If you have more meds, then it's like having more hammers. You can keep those little suckers from ever rearing their ugly heads! 🙄

That's hard, too, because the patients and sometimes their families freak out if you take away medications while they're in the hospital. Then they head out to their outpatient provider who restarts everything.

Recent polypharmacy case -- guy with a raging personality disorder and probably an all around crappy life from day one who uses violence and intimidation to get his way. Shows up for suicidal ideation (really for secondary gain) and is on a mood stabilizer, an antidepressant, two different antipsychotic agents and yes, cogentin, for side effects from the two different antipsychotic agents.

The Facebook discussion page seems to focus on higher functioning people, though, so it's all polypharmacy (often not benzos) but polypharmacy all the same directed at anxiety and depression.

 

[smalltownpsych]

That's hard, too, because the patients and sometimes their families freak out if you take away medications while they're in the hospital. Then they head out to their outpatient provider who restarts everything.

Recent polypharmacy case -- guy with a raging personality disorder and probably an all around crappy life from day one who uses violence and intimidation to get his way. Shows up for suicidal ideation (really for secondary gain) and is on a mood stabilizer, an antidepressant, two different antipsychotic agents and yes, cogentin, for side effects from the two different antipsychotic agents.

The Facebook discussion page seems to focus on higher functioning people, though, so it's all polypharmacy (often not benzos) but polypharmacy all the same directed at anxiety and depression.

If I can keep the higher functioning people away from polypharmacy, the prognosis seems to be better. They also tend to stop taking the one medication that they were prescribed that did help them once they are past the crisis. This is especially the case if they are psychologically-minded and recognize that addressing their negative thought processes and interpersonal patterns can play an important role in improving function. These types of patients are the ones that keep me from being burnt-out. Heck, even if they are more severe, there is a lot of hope so long as they recognize that the pills alone will not fix their lives and make them happy.