What makes a good psychiatrist

[NeuroKlitch]

What exactly makes a psychiatrist "great" or outstanding as opposed to just good. There is so much overlap in diagnosis and treatment that is one able to even differentiate between who is skilled and who is not . And what does it mean to be a leader in the field. In procedural fields I feel like it is pretty clear cut . But how can someone stand out to demonstrate their value as a psychiatrist to potential employers. Least number of completed patient suicides ? Hope this isn't a silly question . Answers will vary , and appreciate all of them .


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[Mad Jack]

What exactly makes a psychiatrist "great" or outstanding as opposed to just good. There is so much overlap in diagnosis and treatment that is one able to even differentiate between who is skilled and who is not . And what does it mean to be a leader in the field. In procedural fields I feel like it is pretty clear cut . But how can someone stand out to demonstrate their value as a psychiatrist to potential employers. Least number of completed patient suicides ? Hope this isn't a silly question . Answers will vary , and appreciate all of them .


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Reputation. You develop one over time based on the interactions other people in your area have with you- are you prescribing well, do your diagnoses fit, do you handle referrals properly, etc.

 

[Stagg737]

Totally anecdotal, and an n=1 experience so take it for what it's worth:

I'd say a solid foundational knowledge of diagnostic criteria and treatment is essential, but what is even more important is actually adhering to those standards. I was fortunate enough to rotate with a psychiatrist that many people (including other psychiatrists in the city I've talked to) consider the best psychiatrist in the area. When it came right down to it, he really wasn't doing anything special with his patients from what I saw, but he knew and adhered to diagnostic criteria closely, and knew the indications and contraindications for prescribing X vs. Y med inside and out. He had his go-to meds for conditions like most docs, but he wasn't stuck on one or two meds as a first-line therapy like some docs I've seen. He'd preach that to us pretty much every day, and I've actually ended up teaching some of my other (non-psych) attendings a few things about psych meds/treatment because of what I learned from him.

The one thing that he was better than other psychiatrists about was that he knew his neural pathways and neurotransmitters/receptors and how they relate to different conditions like the back of his hand. He also kept really updated with new research and publications that came out.

Sounds kind of corny, if I hadn't rotated with him Idk if I'd have chosen to go into psych. I really felt like he blew any expectations I had out of the water and I felt like I learned far more on that rotation than in almost any other class I've ever taken.

 

[dl2dp2]

I'd say a solid foundational knowledge of diagnostic criteria and treatment is essential, but what is even more important is actually adhering to those standards.

100% agree. Based on my anecdotal experience and data from large surveys, the majority of community psychiatrists actually don't adhere to evidence based practice very well. If you just do what you are supposed to do you'd be above average.

It's NOT true that "the overlap in diagnosis" makes it unclear what's the right thing to do--at least not more so than any other field of medicine. It's a common misconception that psych diagnoses are more variable across different provider. But it turns out that the inter-rater variability on major psych diagnoses are similar to things like cardiac cath. At this point there are also fairly clear guidelines for most of the garden variety diagnoses. The problem is people refuse to follow them. Why this is and how you can fix it is actually an active topic of research in mental health service delivery.

As to what is "a leader in the field", usually this is taken to imply someone who has developed a niche expertise either through research or more commonly a longstanding focused clinical practice.

It's actually not very different from surgery. You eventually become known in the community as "the guy" who gets all the difficult borderlines with opioid use problems (say), like the surgeon who gets all the terrible liver procedures no one else wants to do.

 

[psychMDhopefully]

Are there any type of personality characteristics that would make someone better at psychiatry? Does a wide variety of life experiences matter at all?

 

[bedevilled ben]

Are there any type of personality characteristics that would make someone better at psychiatry? Does a wide variety of life experiences matter at all?

Of course. The better you're able to connect with your patients, the easier you can build rapport and trust. Building trust is critical in psychiatry. Our treatments are painful, in some cases both psychologically as well as physically. You're asking someone to go out on a limb and trust you that you're operating with their best interests at heart. In our age of cynicism and gullibility, that is a big ask. Perhaps it's a highly primitive response, but we are not keen on making ourselves vulnerable in any situation.

Just speaking personally, I value trying to listen attentively and actively, whilst avoiding overt judgment, and offering sound rational advice without excessive emotional response. I try to be a neutral and reflective voice for my patients, an objective and non-judgmental sounding board for them. I mostly try to absorb their emotion and reflect the modulated rational bits (filtered of course through my own experiences....womp). Often, they provide more insight into their own mental health than I could ever offer. I'm ashamed to verbalize it, but I'm often surprised by the level of self-reflection that people engage in, when provided with the appropriate environment for doing so. Kind of makes me feel exploitative, honestly.

Also, sometimes I give them medication!