Psychiatry and Personal Life

[EmpathMan]

Hi all! Ever since I chose psychiatry as my intended specialty to match into, I’ve had changes in my relationships outside of academics/work. Friends and acquaintances have chosen to disclose their mental health diagnoses and this has affected our friendship in ways I hadn’t anticipated. Before, when I just wanted to do primary care, I thought it would be nice in the future if I could assist family and friends with my knowledge. Now people with anxiety, depression, and substance use disorders have latched onto me and expect me to act like their psychiatrist. I’ve tried to explain to them that I just want to act as a friend should and not their mental health provider, but this answer isn’t met with open arms. No matter how much I redirect, they mostly just want to talk about their problems. I think the difficulty lies with the feeling that, before if I gave advice, it was as a friend without any psychiatry knowledge. Now if I am asked for advice, it’s as if I’m straddling this line between friend and psychiatry-hopeful. I personally have some difficulty choosing my words carefully, but on top of that, people are expecting me to respond a certain way now.

For example, I have a friend with severe anxiety problems and nowadays I feel like our friendship involves me placating his anxiety more than us just hanging out. If I ever get short with him or disagree, he becomes angry/disappointed and always states that, “You’re supposed to be a psychiatrist!” This is actually a statement I get commonly now when I do something whenever I’m in disagreement with a friend, acquaintance, or family member.

Any advice would be fantastic, as I have been struggling with developing ways to establish proper boundaries in my personal life regarding their expectations.

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[MacDonaldTriad]

“You’re supposed to be a psychiatrist!”

"No I'm not, at least not yet, and when I am, I will never be your psychiatrist. I'm your friend and I can never be both."
Do not establish a doctor patient relationship with friends or family. It isn't a good idea with any specialty, but it is nothing but quick sand in psychiatry.

 

[Stagg737]

Thanks for the thread. I'm interested to hear responses as I've encountered this a few times as well. Not so much about people asking for treatment advice, but a few people have now decided to disclose their extensive mental health history after finding out I'm entering psych instead of just being friends/acquaintances. I don't want to be dismissive or come across as apathetic, but it can definitely make the situation uncomfortable when they seem to be wanting more than just acknowledgment of their struggles. This is especially true now that I've matched psych.

 

[Candidate2017]

Hi all! Ever since I chose psychiatry as my intended specialty to match into, I’ve had changes in my relationships outside of academics/work. Friends and acquaintances have chosen to disclose their mental health diagnoses and this has affected our friendship in ways I hadn’t anticipated. Before, when I just wanted to do primary care, I thought it would be nice in the future if I could assist family and friends with my knowledge. Now people with anxiety, depression, and substance use disorders have latched onto me and expect me to act like their psychiatrist. I’ve tried to explain to them that I just want to act as a friend should and not their mental health provider, but this answer isn’t met with open arms. No matter how much I redirect, they mostly just want to talk about their problems. I think the difficulty lies with the feeling that, before if I gave advice, it was as a friend without any psychiatry knowledge. Now if I am asked for advice, it’s as if I’m straddling this line between friend and psychiatry-hopeful. I personally have some difficulty choosing my words carefully, but on top of that, people are expecting me to respond a certain way now.

For example, I have a friend with severe anxiety problems and nowadays I feel like our friendship involves me placating his anxiety more than us just hanging out. If I ever get short with him or disagree, he becomes angry/disappointed and always states that, “You’re supposed to be a psychiatrist!” This is actually a statement I get commonly now when I do something whenever I’m in disagreement with a friend, acquaintance, or family member.

Any advice would be fantastic, as I have been struggling with developing ways to establish proper boundaries in my personal life regarding their expectations.

A few ideas:

1. Treat them like a manic patient (listen for 60 seconds, nod, walk away).
2. Relate everything they say to an oedipal complex. Grill them about their sexual desires for their mother. Do not let up even if they deny.
3. No matter the topic, discuss the differences between various 5HT receptors ad nauseum.
4. Tell them they need CT head w wo contrast.
5. Dictate a note on them as they're talking ("Pt is a 25 y/o WM who presents for anxiety. He is well known to me, long standing h/o minimization, denial, noncompliance...)

These should work.

 

[NickNaylor]

Whenever someone I have a personal relationship with starts to discuss psychiatry stuff, I usually just say, “you know, going to meet with a therapist and/or psychiatrist about this may not be a bad idea.” If they pester further, I tell them that it’s just not appropriate for me diagnose or treat them because of our personal relationship.

Think of this as a good initial exercise in setting and maintaining boundaries. Being able to do this will serve you well in the future.

 

[birchswing]

"My brain just doesn't work right when I'm off the clock."

Maybe too passive, but I heard an MFT use that once (not with me).

 

[Bartelby]

You can listen and offer sympathy and empathy like any other human, but as others have mentioned you should not be pushed into offering informal diagnosis or treatment. If I see concerning signs, I will tell friends they should go see a mental health professional. I have even made suggestions to direct the person to people/clinics who may be good fits for their issues. Occasionally, I offer some general education about mental health or medical issues without opining about their issues in particular (I tell them I would need to know a lot more than either of us would be comfortable with me knowing to diagnose or treat them). That's as far as I go.

 

[smalltownpsych]

I just stay away from people. If I'm not getting paid for it, why go through all the effort?

 

[TexasPhysician]

The fix: get married and have babies.

Limited time for friends

 

[MacDonaldTriad]

, ,

 

[EmpathMan]

I appreciate all of your responses! With just acquaintances or people I’ve recently met, establishing the boundary is much easier. It’s the people I’ve known a long time already who try to make it difficult.

 

[Crayola227]

With those people it's also OK to point out that you can actually get in professional trouble if you do too much outside of work that falls under the umbrella of your work. So you can maintain a close friendship, listen with empathy, but it's not appropriate for you to talk in depth about their mental health in ways that are more appropriately brought to a professional. This policy isn't your idea, but there are good reasons for it, and it is the way you are expected to act. Anyone that cares about you wouldn't ask you to compromise your professional integrity or put your career at risk when they can seek appropriate treatment and you can act as an appropriate friend. You don't help anyone when you act outside of these considerations.

That is what I say when I need to.

 

[Crayola227]

Every doctor has to deal with this, it's just easier to convince people why you can't manage their diabetes without being their doctor than to explain why you can't deal with their MH stuff.

 

[splik]

your friends suck.

 

[EmpathMan]

Thank you for the reply! You brought up a good point about professional integrity that I’ll definitely remember. Really appreciate your insight.

With those people it's also OK to point out that you can actually get in professional trouble if you do too much outside of work that falls under the umbrella of your work. So you can maintain a close friendship, listen with empathy, but it's not appropriate for you to talk in depth about their mental health in ways that are more appropriately brought to a professional. This policy isn't your idea, but there are good reasons for it, and it is the way you are expected to act. Anyone that cares about you wouldn't ask you to compromise your professional integrity or put your career at risk when they can seek appropriate treatment and you can act as an appropriate friend. You don't help anyone when you act outside of these considerations.

That is what I say when I need to.

 

[Liquid8]

I've had the opposite experience. A lot of friends who thought I'd be good for an easy medical certificate had second thoughts when I told them it'd have my psychiatric qualifications written on it. It's a take on the Jedi mind trick - "This is not the medical certificate you're looking for."

While a lot of my other medical friends have mild levels of neurosis or depressive symptoms, we have a few mutual acquaintance or former classmates who are incredibly messed up (and much more interesting than us), so it's easy to divert discussions to them instead.