I knew this already, but I feel that it bears repeating -- people are so darn different, unique and surprising. I can't be specific about patients but I've heard such incredible things over this month. Someone really professional, polite, relaxed sits down, you close the door, and they dissolve in front of you as they talk about growing up with an alcoholic father that beat them, their resulting serious drug problems, their failed relationships, and the depression that's hounded them. It's quite something to pull out that little pad and offer relief. But it doesn't end there, of course. One of the reasons I respect Dr. Smith so much is that she pretty much insists patients see an individual therapist. The meds lift the fog so that you can sleep, function, and face your work in therapy. Therapy helps you make changes that last. Do all patients thrill me? No. I particularly don't like it when I sense someone isn't truthful (which happens a lot....sigh). The range of people's responses are so wide. I've heard from a patient, my Dad's friends sexually abused me but I'm in therapy and I'm coping (true) and then another patient will say, I've had such a terrible year, you absolutely wouldn't believe it. What's so bad? Job stress and elderly uncle died. Hmmmm.
The prescribing is starting to come. I did so much on my own today while the doc watched -- three psych evals (new patient intake -1 hour) and three follow-ups. She asked which meds I'd choose for each, and (yay) I was right most of the time. One I missed was recommending Viibryd, it's very expensive. We went with Effexor because cost mattered to the patient. Another big learning is how common sleep problems are. If you have a mental health concern, you probably have sleep troubles. I got to give a sleep hygiene lesson twice today.
Another thing I'm learning is how to confront or "go public" with my internal dialogue to patients. If your story doesn't add up, I say that, "This just doesn't make sense to me, explain why you refuse therapy, won't take your meds, and keep coming to me. How can you move forward?" luckily that conversation doesn't happen often. But it works even with little things - you say you're fine with your marriage but we've spent most of our time talking about your wife's failings.
I spent 3 days with an NP at nursing homes, seeing demented patients. I like older people, and after working in NJ on a medical unit, I'm used to dealing with ill elders, but this was not my cup of tea. It was the same feeling I had when I worked in ICU -- so many patients can't really communicate with you, it just takes all the fun out of it for me. And it's just plain hard trying to figure out how to treat dementia (short answer: you can't. You end up medicating to control negative behaviors).
So I have often talked about how much people's weird behavior at the gym bugs me (yes, I know, I spend too much time there). But listen to this. At one of the yoga classes I go to regularly, a woman comes in late. She's older than me and very thin, wearing tight little short shorts. She has a strange double-wide mat, which she proceeds to lay out front and center (strike one - if you're late, stay in the back). She brings big hand weights with her, I'm wondering why. She's now way too close to another woman's mat, who looks irritated. We do our first down dog and I purposely don't look at her ass, knowing those shorts are not covering it. Strike two. Things seem OK, until we get to the abdominal work song, then she starts doing strange things with her weights and they are noisy. Guess that's strike three, because her neighbor picks up her mat and moves to another spot. I had never seen someone do that before. (I sure have wanted to.) I thought to myself, wow, lady, you have no no idea how much you're wearing your obsession. Stick-thin, inappropriate clothes, ridiculous efforts to ramp up the ab work, you might as well post a sign saying "Eating Disorder". Future patients, they are everywhere.
The pic is from the Austin Animal Center. Someone must've donated the cat bed. This little fella sure liked it.
