To think most psychiatrists are quite cold

[Forpetslikethecats]

Just that I’ve had psychiatrist from around the age of nine now in my late 20’s and most have been cold and uncaring

Who said anything about wanting a cuddle. Nobody wants a cuddle from any NHS professional. People just want professionals to work in a warm and professional manner. Being cold isn’t professional it’s lazy and unnecessary.

Warm and cold are rather subjective at best - and I would expect a professional to remain cool rather than warm

Sorry but that’s very simplistic and unfair. They have to make life and death decisions everyday. There are probably thousands of suicidal people but they can’t section them all. How would you determine which ones would actually kill themselves beforehand? It is obviously easy afterwards!
I’ve been sectioned myself and kept in hospital for over a year. I saw hundreds of other suicidal people discharged in that time and I didn’t understand how the decisions were made but I didn’t envy the staff at having to make those decisions.

In my professional capacity I must have attended hundreds of psychiatry appointments down the years, encountered dozens and dozens of psychiatrists, locums, old ones, young ones, the whole gamut. In my view the vast majority sit somewhere on a plane of being professional and diligent, but not overly familiar with patients, and I put this down to pressure of work because they all invariably seem to clock-watch to one extent or another, and I respect this about them because a lot of the people I attend with will sit and talk for hours when in reality it's supposed to be a 30 minute or 1 hour appointment.

I've met a few I really didn't think much of, the old guard, "my way or the highway" types who believe that as a "doctor" they are infallible and nobody has any business challenging them. The way I see it, if you are uncomfortable with someone standing up to you, then you surely can't be that confident in your own ability in the first place otherwise you'd have no reason to fear it.

Anyway, it's not about what I think of shrinks, it's about what their patients think and my opinion isn't relevant. When I have encountered them as a patient I appreciate the ones who are willing to engage but still keep it relatively perfunctory. I don't need a counsellor or a therapist, I have plenty insight into my own mind, I simply want a plan, some agreement on action, and not to be condescended to by someone who thinks they know better than I do what goes on inside my own head. They don't, and none of them ever do. There's a reason why it's considered the arse-end of medicine and derided by other disciplines.

Nope it isn’t simplistic. It’s what they’re paid to do.

I give up. Can’t reason with stupid.

I beg your pardon. I’m far from stupid.

Utter tosh.

Psychiatrists are not responsible for a course of action embarked upon by another individual any more than any other third party in their lives. Someone following through on suicide is no indication whatsoever their psychiatrist is "negligent".

No it is not.

They’re not paid to make wrong decisions, be unapproachable and cold or to lose patients . No consultants are and I’d love to see people be so glib about consultants making wrong decisions in other sections of the NHS. The care my dc has had from a particular consultant psychiatrist was frankly appalling and lead to a patient being far more ill and using up way more NHS resources .Its not just me who feels this way but other professionals and patients too. For some reason psychiatrists can get away with being shit in a way other consultants can’t and it needs to stop.

You're gonna run out of Consultants of all types pretty quickly if you just start firing any who ever "lose" a patient.

Ill people dying on you is a hazard of the job. Psychiatrists don't have magic wands, and the particular discipline they practice isn't much more than conjecture, hypothesis, and guesswork. Hardly a surprise then they sometimes go barking up the wrong tree. There is no failsafe diagnostic test for most psychiatric conditions, it's a case of observing, listening, and then proscribing, often without any sort of formal diagnosis precisely because most of them accept it IS just literal guesswork.

I certainly don't fancy doing it myself given I have plenty of professional experience of just how unreasonable and uncooperative mental health patients can be, and if you are going to start demanding 100% perfection you'll soon find there is nobody willing to go into the discipline at all. It's not like surgery where there is no excuse for amputating the wrong leg.

Well said!

Psychiatrists hold a HUGE amount of risk, they are trying to assess patients in thr briefest of times and decide what freedoms to allow them whilst holding on to their GMC registration. It's a tough old job.
But about 90% of the Psychiatrists I've worked with (there have been many) are NDor just very odd.... very different breed to most medics.

From my professional experience (MH nurse) very few seem to have good interpersonal skills. Which is a real shame as the ones that have decent people skills tend to get better engagement from patients and improved outcomes.

Exactly, it’s a completely different level of risk than that borne by most other medical consultants. For example, an oncologist can physically see the tumours on a scan whereas psychiatric illness usually can’t be identified by objective tests.

They can come across as cold.
i think they have to keep a professional distance to prevent them from coming across as harsh, in saying that I find doctors can be like that, depending upon the title.
A bit of warmth and empathy can go along way.

They are paid to make the best clinical judgement they can with the information available at the time. They have to constantly balance their judgement of the risks with the patients rights which include the right to be treated in the least restrictive way. It's incredibly hard to do and I dont see how anyone could get it right 100% of the time.
Of course if there is harm to a patient (or anyone else) it should be investigated and if there is genuine negligence then there should be consequences.
But the only way to ensure no-one with suicidal thoughts ever acted on them would be to admit all of them (and possibly put them under supervision on the ward). That is neither in the best interests of the vast majority of those people or financially viable.

It’s really not helpful to be overly warm or friendly.

sooner or later your psychiatrist will have to make a decision that you really don’t like, and find hard to see is in your best interests, such as detaining you in hospital against your will or enforcing a treatment regimen

The sense of betrayal this engenders if you believed your psychiatrist really cared about you and was your friend, is actually quite damaging, particularly for patients with previous trauma or dysfunctional attachments. Feels so much worse than if a ‘detached’ psychiatrist does this

Much better (for the patient and the therepeutic relationship) to be pleasant but professional, even if the patient thinks they would prefer otherwise

That’s ridiculous. I think brain surgeons and others who operate or deal with all sorts of physical issues hold a huge amount of risks.

Psychiatrists aren’t always dealing with people at the point of imminent suicide but seem to get away with leaving patients until they get to that point. Then there are the ones who sit there clearly bored reciting from a list of medications patients can look up themselves…. The whole sector needs a big overhaul with quality of psychiatrists examined.

It's not ridiculous at all.

Again, the reason why you perceive psychiatrists not to to be held to the same scrupulous standards as consultants in other disciplines is precisely because what they do is tantamount to an esoteric black art where mistakes are absolutely inevitable.

A brain surgeon can cut someone's skull open and operate on their brain forearmed with knowledge of precisely what the purpose is and how they need to treat the patient because physical ailments can be detected with scans and imaging.

There is no such equivalent for psychiatry. You can not cut someone's head open and take a slice of their brain matter to determine whether what you are dealing with is CTE or a schizophrenic illness. There is no blood test for CPTSD. They will run tests if you are being investigated for Bipolar, but only to check thyroid function, it doesn't come back with a marker saying "this person is Bipolar". Without an extensive knowledge of a patient's personal history, it's impossible to tell if an agitated or depressed state is due to an environmental factor or some underlying health condition. How is a psychiatrist who has met you for the first time five minutes ago supposed to know? Especially so when your agitated/subdued state means they aren't going to get anything meaningful out of you anyway, and you've had no prior engagement with mental health services to offer any leads?

Psychiatric medical model is far from perfect and there isn't really any serious opposition to that contention, but the mistakes made are more often a result of an imperfect understanding of the human brain and an absence of diagnostic tools compared to disciplines concerned with physical health, and not just the sheer incompetence or intransigence of mental health professionals. To coin a phrase, you can only work with the tools at your disposal, and if the tools are inadequate you will end up with unsatisfactory results. What is needed in order to improve psychiatry is far more serious investment in all aspects of mental health provision, not just chasing after existing psychiatrists with a shitty stick because of perceived wrongdoing. Where there is obvious shortfall in care it needs addressed, but the vast majority of psychiatrists are, like the overwhelming majority of other doctors, genuinely trying to help despite the fact they frequently get things wrong. That isn't a personal failing, it's part and parcel of psychiatry.

Wow - did that cut a bit close to home for you? That’s really cold…

You don’t get to see a psychiatrist on the NHS with only 5 minutes worth of info. You’re lucky if you see one after years of well documented history and diagnoses. They would have a hefty amount of info and longer appointments than 5 minutes if investigating CPTSD and if they can’t diagnose something like that properly what on earth are we paying them for?

You don’t get to see a psychiatrist on the NHS with only 5 minutes worth of info

Yes you do, it happens all the time when there is an EDO on the horizon.

A 5 minute appointment with an EDO on the horizon - I think not.

How many EDO's have you been present for?