The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
Jump in the discussion.
No email address required.
Notes -
I need better professional boundaries. I gave well-intentioned general advice to a Redditor back in India, after their brother had ended up committed to a psychiatric hospital in the UK. They'd commented in /r/India seeking advice on how to bring them back. I was surprised when I received a DM request from a new account, wanting to talk to me. I had assumed it was related, and was happy to guide them through things step by step or put them in touch with medicolegal aid.
No, as I found out, only after I assented to their request to get on a phone call with me. I have probably scandalized or traumatized half the compartment in my train back to Scotland, solely on the basis of what they could overhear of my end of the conversation. I am definitely conked. I did not expect to hear Soprano-tier drama, involving petty Indian royalty, murder, rape, arson, fraud, kidnapping and levels of familial dysfunction and violence beyond belief. Almost everyone in this story is an awful person who almost deserves the things that have happened to them. I have a new benchmark for generational trauma.
The only thing preventing me from calling the cops is that I'm not entirely sure that the lady I was speaking to was sane. Nothing I have said is an exaggeration, I have a splitting headache and need some sleep.
This deserves a long response for you but I have a busy day today.
The good news: you are in good company, all of us need to figure this out.
The bad news: your family will ask for medical advice. Your friend's partner will complain about her vaginal discharge. Your barber will start telling you about their suicide attempt in the 8th grade.
Since you are a psychiatrist you will probably work on polishing your presentation and bedside manner and unless you run into demographic issues or somewhat you will have insane interactions with the general public. The same response to you will be useful professionally.
Figuring this out is hard. In psychiatry it will be a core topic at least, which will help.
Also with respect to psychiatry - don't sleep with your patients. It sounds stupid advice but it isn't.
I appreciate it, and trust me, I know. In this particular situation, I was blindsided. I expected person A to call me to figure out how to potentially exfiltrate their brother from a British hospital (and I have a consultant uncle who works nearby, might even be the same trust). I was in very deep with Person B before I realized, hang on a second, when are we getting to your brother? By that point, I was concerned for her life.
In this particular case, everyone involved needs to be involuntarily committed, and the keys thrown away. A whopping two of them were, in fact, hospitalized, but had family pull strings to get them out. After they had made a good faith effort to murder said family! One of those incidents happened in the States! Half the people involved are American citizens! I knew the Indian psychiatric system can be... less than ideal, but this had me rolling around in the throes of a seizure.
This is just how it works in India. Doctors are expected to dish out advice for free, especially to friends and family. And you know what? I support this. It works fine. My dad and grandpa delivered me by c-sec, while my grandma would have been in there too if it wasn't for the fact that there was no more room for grossly overqualified assistants. The world didn't end, nobody died, and nobody can ever accuse my dad of not being there in the delivery room.
This is normal. This is good. In India, the expectation that you will treat your own kin is as natural as chai at 5:00 pm, and - at risk of being stripped of my NHS badge - I genuinely think it mostly works. The West, meanwhile, has spun this elaborate theory that doctors must not treat their own families because they’ll lose “clinical detachment” or “objectivity” or some other deontological talisman. This, in my opinion, is a spectacular act of collective catastrophizing. The reality is, my parents cared more about our family’s gynae problems because it was their family. They didn’t suddenly forget the Krebs cycle or lose their ability to prescribe antibiotics at the whiff of a cousin’s maiden name.
("I can't operate on that boy, he's my son!" - An absolute pussy, that's the solution to the riddle)
When I was back in India recently, I gently confirmed what I already suspected, my nephew had all the hallmarks of ADHD. I pushed, with the full force of my reputation and family standing, for my cousins to get him properly assessed. If I hadn’t, nobody else would have. He’d have spent another decade wondering why school was a personal hell designed for someone else. My family listened, partly because I’m a psychiatry trainee, but mostly because I’m family.
Let’s be honest: nobody objects when the family architect drafts blueprints for free, or the family mechanic fixes your brakes after dinner. Nobody gets a lecture on “professional boundaries” when Auntie fixes your tax returns. Yet somehow, doctors are supposed to recuse themselves because of the overwhelming risk that love and affection will erode our capacity to wield a stethoscope.
I consciously refrain from doing much of this, these days, at least in the UK, both because it's not the culture and because the GMC lacks a sense of humor.
Haven't fallen into that trap, and I don't intend to! The GMC had me remove "Grippy socks, grippy box" from my flair, on pain of death. Goddamit, are there any perks left in the profession?
Maybe we can at least have the family C-section, even if it makes for a very confusing set of post-op notes and insurance claims.
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