This is a love letter. It is an ode to clinical psychiatry from one psychiatrist to another, to all those who are seeing patients in hospitals whether they are on consult teams, in emergency departments, in solo offices, or on little screen scattered around the country. All of us psychiatrists, mental health clinicians, and therapists are listening to stories, absorbing emotions, and offering patients and families reassurance and positive action. Together, we are promoting healing and recovery.
Why would someone write a love letter to their specialty? Because after 2 decades of practicing medicine, I still find the intricacies of the human mind fascinating; I have the utmost respect for my field, which beautifully combines art and science. The scientific advances in psychiatry are fast-paced and intricate, and revolutions in conceptualizing mental illnesses are afoot. Yet, none of these advances or treatments can be meaningfully implemented without a thorough history-taking, an understanding of the patient's environment and family dynamics, and an assessment of their insight into symptoms and their willingness to engage in treatment. Most importantly, none can be implemented without the trust and connectedness that occur in a healthy patient-physician relationship.
The Art of Medical Conversation
The art of psychiatry goes back to the patient-physician relationship, the basic building block of medicine, as it has been for millennia. That relationship has evolved, of course, reflecting changes in our understanding of disease, wellness, and the roles of patients and physicians. Over the centuries, the physician has been transformed from a healer with quasi-magical powers to a partner in wellness and recovery. This evolution has been obvious through history, but only recently has scientific attention turned to what, exactly, physicians are doing that is so impactful.
In his seminal 1932 work, The Doctor, His Patient, and the Illness, Michael Balint, MD, PhD, (1) coined the concept of the doctor as drug. He highlighted the importance of therapeutic interaction, calling it vital to treatment while acknowledging that the dose of this treatment--the required number of visits and the duration of visits--was not clear. Later literature developed new terminology. Mainstream medicine labeled it the "patient-physician relationship," whereas the psychiatric field would call it nonspecific factors. Regardless of terminology, it is the je ne sais quoi that takes place in the intimacy of a real conversation between...