When I was in medical school, I spent a great deal of time talking to patients about shared experiences. We talked about our childhoods, our hopes, our favorite places to visit. These bonds were critical to patient care, engendering trust between patient and caregiver, providing comfort in clinical settings.
Now that I'm a psychiatrist, I'm not supposed to do that anymore.
Psychiatrists are often taught to be like blank slates. When my fellow residents and I ask how much we're supposed to reveal to patients, supervisors tell us less is more. Avoid saying where you grew up or talking about where you live. If you have children, don't mention them. Spouses neither.
There are many reasons why psychiatrists choose not to reveal much about themselves. Doing so can muddy the waters of patient care. If a patient says she went to a certain college and the doctor says, "Me too!" what happens when the patient becomes quiet and withdrawn, later to reveal her anxiety and depression began after she dropped out of that school? The psychiatrist's untimely disclosure might have tarnished the therapeutic alliance between patient and provider.
Unfortunately, stalking is another concern when providing psychiatric care. Research suggests health care providers are at a higher risk of being stalked compared to the general population, and this risk appears to be even greater among mental health professionals. Some patients go to great lengths to learn about their providers, from researching public records to driving past therapists' homes. A desire to gather information commonly drives stalking; so the thinking goes, psychiatrists shouldn't encourage this behavior with unnecessary disclosures during treatment.
Lastly, psychiatrists shouldn't spend their time talking about themselves because providing mental health care isn't about the provider. It's about the patient. Talking can play a major role in treatment, especially in psychotherapy, but we should focus on the patients' lives, their symptoms, and their treatment. A psychiatric evaluation shouldn't involve providers talking about what they did last night.
As mental health providers, we seek to remain as anonymous as possible. But I sometimes wonder what that leaves to the imagination. When a psychiatrist is a blank slate, what does the patient project onto that space?
Of course, there's the Internet. Patients can Google us. They can find out where we went to medical school and much more. According to a 2011 report by the Pew Research Center, an estimated 44 percent of Internet users look up information on doctors and other health care providers online.
(Perhaps some of my future patients are reading this now. Hello there! I hope it's okay I'm greeting you in advance. I look forward to meeting you someday.)
Meeting with patients can color psychiatrists' supposed anonymity in many ways. I sometimes think about what the shirt I'm wearing says about me. Do they judge my watch? The coffee thermos that sits next to me? That I haven't shaved in a few days?
In hospitals and emergency departments, the scenery doesn't tell patients much about the clinicians caring for them. But this is very different in outpatient settings, where mental health providers can personalize treatment spaces. Some psychiatrists hang diplomas or pictures in their offices. Others buy specific furniture or frame favorite cartoons.
Earlier this year, I treated patients in an outpatient office shared by other clinicians. Our office had some paintings on the walls, a rug, and a potted plant. I'm not sure where these things came from.
But did my patients think they were mine? Did they imagine I had traveled somewhere exotic and brought those decorations back?
It's the ambiguity that unsettles me. I understand why psychiatrists have to restrain how much we disclose for treatment and safety purposes. But doing so often creates an artificial divide between patient and provider, one that strips away the healing effects of shared experience and complicates how we perceive one another. It obscures human connection in the medical specialty where humanity matters most.
Deciding how much to reveal to patients can be a matter of the obvious. You shouldn't tell a homicidal patient in the emergency department where your children go to school. On the other hand, if a patient is sobbing in front of you, you shouldn't sit still and expressionless like a robot.
Yet learning how to react to more vague situations, when a patient asks how your vacation went or compliments your haircut, takes more experience. As my fellow residents and I develop into trained mental health professionals, we'll each adapt our own styles of care. We'll test those boundaries, deciding the degree to which we'll open up or close our lives off from our patients.
Perhaps I've already said too much.
Nathaniel P. Morris is a resident physician in psychiatry at the Stanford University School of Medicine.