So you’ve finally made the leap and sought out help for a psychiatric or mental health concern in your life. You’ve gone to the psychiatrist, who has asked you a lot of questions over the course of the past hour or so, and you feel a little exhausted.
The psychiatrist turns to you and says, “Well, we could approach your treatment from a number of different ways. We could do this, or we could do that. There are pros and cons to each…”
You try to listen, but you really don’t understand the differences, or what the likelihood is that one treatment is more beneficial than the other. Your eyes begin to glaze over as the psychiatrist keeps talking, oblivious to your zoning out.
“So how would you like you to proceed with your treatment, this or that?”
At the end of his little talk about treatment options, you’re left a little dazed and confused. You have no idea how to proceed with treatment, so you ask the question millions of patients before you have also asked, “What would you do if you were me, doc?”
Will the psychiatrist answer honestly (e.g., what he, personally, would actually do?), or professionally (e.g., give a standard treatment recommendation based his experience and the research)?
Researchers writing in the British Journal of Psychiatry decided to find out, and so conducted an experiment that included 515 British psychiatrists (Mendel et al., 2010).
The study gave the group two scenarios — one for a diagnosis of depression and one for a diagnosis of schizophrenia. The group was divided into three sub-groups: giving a treatment recommendation for a patient asking the question, “What would you do if you were me, doctor?”; giving a regular treatment recommendation without the prompting question; and imagining answering the question as if the psychiatrist themselves had just been diagnosed with depression or schizophrenia.
The researchers found that psychiatrists responded similarly in both treatment recommendation sub-groups. Whether a psychiatrist was asked the question, “What would you do if you were me?” didn’t actually change the way the doctor responded — they responded with the standard treatment recommendations in both sub-groups.
When the tables were turned and the psychiatrist was recommending treatment for themselves, personally, they chose a different set of treatments than the what they would recommend to patients. These treatments tended to be more conservative than the treatments they recommended to patients — watchful waiting for depression and oral antipsychotics for schizophrenia (versus an injection).
In other words, psychiatrists in this study did not actually answer the question, “What would you do if you were me” in the expected personal manner when asked by their patients:
The question ‘What would you do if you were me, doctor?’ does not motivate psychiatrists to leave their professional recommendation role and to take a more personal perspective. Psychiatrists should try to find out why individuals are asking this question and, together with the individual, identify the most appropriate treatment option.
You could try and figure out why patients are asking this question, but you could also take the question at face value — that the patient is looking for the personal opinion of the psychiatrist because they value an honest response. Or perhaps the patient thinks they want a personal opinion, but what they are actually looking for is a professional opinion — the question is simply masked as a personal question when it’s not.
Psychiatrists seem to take the question — not at face value — but simply as another form of “Which treatment option is best for me?” Obviously what might be appropriate or what might work for the psychiatrist personally may not work or be an appropriate treatment option for the patient.
I imagine that if you actually wanted the psychiatrist’s personal opinion about what he or she would actually do for treatment, you’ll be hard pressed to get it.
Reference:
Mendel et al. (2010). ‘What would you do if you were me, doctor?’: randomised trial of psychiatrists’ personal v. professional perspectives on treatment recommendations. The British Journal of Psychiatry, 197 (6): 441-447. doi: 10.1192/bjp.bp.110.078006
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From the book “AN AUTISTIC WORLD (1)”
Since the beginning of time, every man has had to deal with those two choices. When is it appropriate to stay? When is it suitable to leave? At what point is it adequate to say enough is enough? These and other similar questions arise from the same controversial dilemma, shaping a great deal of our lives. Curiously, I wouldn’t be surprised if the majority of us leave most of the critical decisions to a third party, after all, the world around our bodies also influences our minds. Otherwise, how could we understand the inside without the outside? How could we make a decision without accepting that, even for a split second, most of what we do and what we say, is subjected to an exterior effect?
When I’m in the situation of the petitioner, I phrase it more along the lines of “How would you help someone you deeply cared about decide this issue?”
I don’t really want someone’s advice on what to do as much as I need some support in deciding for myself. And I think that’s really true of most people, even if they don’t articulate it that way.
In my own practice (psychotherapy), I don’t give clients advice. I elicit their ideas, mention other options I’m aware of, and support them through a process of deciding from their own wisdom. I think that’s the most respectful thing to do.
Sigh. Professional distance can be a lovely thing, but can also be a terrible thing.
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