My Compliments to the...

When I thought about making a major job change in October of 2009, many things went though my mind. I thought about my safe and comfortable routine, my comfortable office, my comfortable work load, and the good and competent staff who worked with and for me. I thought about my patients, some of whom I had already been seeing for twenty years. I thought about my responsibilities to treatment plans developed, medication trials started, side effects diagnosed and managed, suicide attempts and psychotic breaks and those times when I was so privileged, and I mean this with all my heart, to see some of my patients at their absolute worst, their absolute depths of despair, only to witness them rise back up and get on with their lives again. I was so fortunate to be there to do just a little something to help some of those patients. I felt that I had helped a lot of people, but I saw this as just the natural consequences of the profession that I had chosen to pursue. After all, why else would someone go into medicine, and especially psychiatric medicine, unless they wanted to do everything in their power to help those folk who came to them with stories, heartbreak and brokenness. If nothing else, we are trained in medicine to diagnose, treat and do our best to fix things. We try very hard to do that every day.

Of course, I did make the decision to pursue a major change in job circumstances, and in February of 2010 I began seeing patients all over the state of South Carolina via telemedicine equipment. We are now working on privileges in almost thirty hospitals, and the depth and breadth of problems we encounter in any one eight or sixteen hour shift is truly amazing at times. I have seen little children who text suicide notes to their flabbergasted parents, I have seen eighty year olds who give up after the death of a spouse, and I have seen people with blood alcohol levels so high that technically they should not even be alive, much less talking to me. It is truly cutting edge, hard hitting, exciting, stimulating work, but it does have its limitations.

It is terribly isolating. Working in one room by yourself for that many hours, even when other people are in the clinic during the first part of a long shift, takes its toll. Seeing patients via high definition monitors and T1 lines and being able to focus in close enough to see muscle fasciculations or very fine tremors or to hear softly whispered responses to auditory hallucinations is truly wonderful. Unfortunately, it is not, and probably never will be, exactly the same as sitting across from someone in a consultation room in an outpatient mental health center clinic.

You know where I'm headed with this, right? About a month ago, I went back. Not full time, heavens no. I like the high tech stuff too much for that. Part time, one day per week now and maybe two soon if things work out that way. Nature abhors a vacuum, and hard working doctors abhor day-long holes in their schedules, so it was bound to happen. I'm back to seeing some of the same patients at a clinic I had covered one day per week for many years. A strange thing happened as they started to come back to see me. I started to get compliments and thank yous and little bursts of gratitude here and there that made me a little uncomfortable. After all, when I left a year ago, there were other doctors who picked up the colors and kept marching toward the faraway ridge called Mental Health. Patients were seen. Prescriptions were written. Appointments were kept. Life went on, and would have, without me there if I'd never come back at all.

My patients, and I call them that not to be possessive but to show that they do indeed matter to me a lot, were truly glad to see me come back. They wanted to work with me. They wanted me to take care of them, to help them, to teach them, and to learn from them. They had valued the relationship we had, they had felt a great loss when I left, and they were truly happy and excited when they heard I was coming back.

What more can any professional ask for? That sacred bond of trust and goodwill and caring that indeed flows both ways between patients and doctors is worth more than any high priced piece of technology that I will ever have the pleasure of using. That little spark of excitement that we both feel when we keep the therapeutic bond healthy and positive and moving forward does not have any price tag associated with it.

We both, my patients and I, know what it is truly worth.