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).
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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.
One of the first things I encourage students to do is to look at the people around them and pillage them for things that they like and things that they don't. I still remember the names of the physicians who make up who I am.
You should also do the same for the environments you've experienced.
People don't like to admit it but the standards for care and for professionalism in the U.S. are higher than anywhere else.
Is this one of those times? Is being more strict here part of why? Or is it irrelevant. I don't know.
You could make an argument that investment compromises objectivity. You could argue it's sensible in India where knowledge and passion are much less evenly distributed. You could argue that investment trumps anything else. I don't know what the answer is - but you should actively think about it and make choices instead of falling into family involvement as your "this is water" where in the UK it may be more malpractice. Being deliberate will bleed into your professional skills in a positive way*.
I don't think one particular decision is correct, but it is one you want to actively consider.
Two additional points - it's much easier to be involved with family medical care in "medical" care. Psychiatry is inherently trickier for a multitude of reasons. It's also worth noting that it becomes easier to avoid boundary violations if you avoid boundary crossings. Some old school doctors will insist everyone refer to them as doctor so and so not because they are stuffy but because they find it helps with boundaries. Nobody talks back during a code with those guys...and of course there are costs for that.
I'd also note that based off of some of your other writings I suspect you have or will develop the "rizz" as the kids say. Many a young male doctor has gotten into trouble because of that (don't worry outside of work or with staff lol). Caution.
On a more prurient note, unironically disagree - lability is liquidity after all.
I agree that US doctors are among the best in the world. However, I do not think that this is in any way related to the restrictions placed upon them. It's down to selection effects and an abundance of resources for training/practice.
It is definitely harder. Treating a family member for depression would be more challenging than slipping them a PPI for their heartburn. I do not think it is impossible, just something that needs to be done with care.
Hey unc, I was born with the rizz! Well, not really, because I was a nerdy kid and only discovered I'm good at chatting up women while in med school.
Dating within the workplace is fine, back in India. It still happens a lot in the UK! People tend to be cautious about it, but I still do not know how much of that is actually warranted or overblown concern. I'm reasonably confident that one of the interns at my workplace had a crush on me, but I was in a committed relationship. Shame, because she was really hot, but I wouldn't cheat, and I knew she was going to move away from Scotland soon.
It gets more difficult when you're a consultant, not because you're less attractive, but because accusations of impropriety are more easily leveled against you, especially if you approach a junior doctor.
I have never dated an actual patient, or asked one out. At most, I've offered medical advice to people I'm seeing, but I'd do that for anyone who asks politely.
Not taking a stance (although I have one), just suggesting some deliberation and care and thinking - it will serve you well with deciding where to put the boundaries.
Haha it's less about dating in the workplace and more about "ooooh I can fuck this girl in the closet" type trouble. Increasing puritanism and declining doctor respect have thankfully hampered this, but its not uncommon for young male doctors to get into trouble just by following along with flirting - but it's a small unit and now its awkward because you made a (mutual) pass at 1/4 the nurses.
An additional but somewhat unrelated element is this - if you have personal presence, competence, and authority you will start running into other kinds of trouble - people will listen to you because you are the boss.
This is a lesson for anyone in manager roles, but when you are in charge and people respect you....your offhand opinions, tastes, and requests become reality.
Say: "I think this pathology is annoying" and it becomes gospel. Get frustrated with a patient and let it out verbally during a meeting? Now a good chunk of people are going to think of and maybe even treat the patient worse.
"Will no one rid me of this turbulent priest?" can be an accident with sufficient poise and authority and those are things we often try and cultivate because they improve care quality.
I knew this was a thing before becoming a boss, but experiencing it in action from the boss side is eye-opening. There is no escaping our primate brains.
Yeah it's frightening. Suddenly people take what you say seriously. How you feel about something is important to people. Offhand suggestions quickly become reality. Sometimes I wonder if it is what being a beautiful woman is like haha.
The more management work I do the more I realize that it is one of the hardest skills, mostly orthogonal to other skills, not something we bother to train...and almost everyone sucks at it.
I am acceptable at management, but it's leadership where I'm adrift (and so much information/training acts like the former is the latter). Part of that is the nature of the job (public defender office)--I've never worked where the office seemed to have anything close to leadership, and it doesn't seem to be unique to places I've worked since the outside appearance of other offices is just as chaotic.
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