My Odd Experience with a Psychiatrist

[nighthawk3]

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So I'm a first year medical student at a reputable school. I've been struggling with severe anxiety since I started school, and was referred by a counselor to a psychiatrist at the teaching hospital we are affiliated with. When I got there, I first met with a resident for about half an hour, and all was well. He then came back in with the attending physician, and things went south immediately.

I'll preface this now by saying that my father is an alcoholic, albeit functional, successful and pleasant. I revealed this to the resident during the history taking, as well as saying that I drink occasionally and very occasionally (once or twice a year) get pretty drunk. Because of my family history and my "excessive" alcohol intake, the attending physician spent the first 20 minutes in the room telling me about the dangers of alcohol, how you can never drink and succeed in medicine, and how I am "destined for failure like my father" if I ever drink. When he found out that very occasionally I get pretty drunk, he remarked "we were wondering if your last name was Irish."

After telling this guy politely several times that I was no longer comfortable talking about alcohol, he kept going and going with it. Finally, I just stood up and calmly walked out of the room to leave. That said, what do you guys think of this type of interaction? Is it normal for psychiatrists to hammer on and on about topics that patients explicitly state they don't want to talk about? Should I be expected to pay the bill? Can I file some sort of complaint about his odd behavior, and ethnic slur? I really just don't know what to think...

 

[sikegeek]

That's ridiculously horrible. I've seen a psychiatrist hammer someone even after they said they didn't want to talk about it, but not that bad. Besides that, I don't think you even come close to meeting the criteria for being an alcoholic. If I remember correctly, you have to drink more than 4 drinks on one occasion at least once a week (I think.) Of course if some people say "occasional" they mean 2-3 times per week.
The racial comment is DEFINITELY inappropriate. There has to be a way to report that to someone.

 

[whopper]

Ouch.

In defense of this psychiatrist-we weren't there to see the actual interaction, but I can't think of any situations that justify the responses you got--in a first meeting. I have seen doctors do a confrontational session (appropriately), but I don't think its justified on a first meeting.

I would be concerned about someone with a history of alcoholism in the family drinking, but I wouldn't bring up race.

What to do? I don't know if bringing up a complaint will be worth it. Politics are involved, and there's a lot of he said/she said. It depends on the situation & the institution's feedback processes. Several times patients are given evaluation forms and can evaluate their satisfaction with their doctor. That'd be a good option (if its available to you.)

I hope as a medical student, that this does not turn you off to psychiatry & the behavioral sciences. There's good & bad in every field. Sorry you got more of the bad in this experience.

 

[MBK2003]

I second the comments above about it not being an appropriate first interaction with a patient. Even when I am worried about a patient's substance use bordering on abuse or dependence, if it's not the chief complaint I don't keep hammering on it in the intake. It's about relationship building at the start.

More glaring in my eyes, is the fact that your medical school refers you to treatment at an affiliated residency program. This is a huge no-no in my eyes. You should have the same expectation of privacy and confidentiality as a person walking in off the street, but unfortunately you run the risk of potentially working with or being evaluated by this resident or attending when you're a MS3/4. That's just an uncomfortable situation that you should never have to be put into. I would bring this up with a dean at the school. My medical school had worked out an arrangement for medical students to be seen by a community clinic and a psychiatrist who did not have clinical or teaching afffiliations with the medical students. In my residency program, we had an arrangement with another medical school/teaching hospital to send our medical students to their residents' clinic and vice versa.

Do others see this as a problem?

 

[billypilgrim37]

Do others see this as a problem?

Absolutely. We have one faculty member who has minimal interactions with med students and residents on a teaching basis, so she serves as the main go-to for student and resident mental health. There's also no problems referring outside, but the initial eval by the above faculty member is free.

Point being, they have an actual system set up to address these (very prevalent) issues. From the "stats I pull out of my tail" department, probably a quarter of your class will be on antidepressants before Step 1, and probably up to 1/3 by the time of their M3 surgery rotation.

To the OP, we honestly can't address the particulars of this encounter in this forum; it's simply not appropriate ethically and borders on patient advice. But it does sound like the system within which you were offered mental health care has some serious flaws.

 

[whopper]

edit-double post

 

[whopper]

the fact that your medical school refers you to treatment at an affiliated residency program.

True, and I forgot to consider that. There are issues to consider with that.

And yes BillyPilgrim, offering therapy to someone is a no-no unless they are our patient. I thought my answers were outside of that, but I can see that yes, there is a fine line with borders.

Nighthawk, see what other options your institutions & healthcare policies can offer.

 

[billypilgrim37]

I thought my answers were outside of that, but I can see that yes, there is a fine line with borders.

Oh, I didn't mean I thought anybody had said anything wrong, but just that in general, the OP, who ain't around here much, should know we can only talk about this stuff a limited degree in a responsible way.

 

[whopper]

No problem,

Actually based on something going on in another thread, and a total emotional brou-ha ha ruckuss going on in a different dept in the hospital I'm at over emails*, and the redundant psychology vs psychiatry fights, I'm just trying to be diplomatic. I didn't think I did anything wrong or you were pointing anything at me.

Just that there's a very fine line sometimes. Sometimes people cross it unintentionally.

*(someone's giving out group emails written in a manner where-others are just totally offended, and the other half is wondering why eveyone else is so offended. With the internet, you can really get people misinterpreting you.)