I seem to have generated unexpected ire with my biographical information. This deserves more than just a few lines in the reply section. When I hear strong reactions, I suspect an iceberg. In this case, there may be two icebergs.
First, there are those who let me know they find it offensive that a good-natured and intelligent woman, as I see myself, could be drawn to the practice of psychiatry by the happy feeling of having fun at work and the desire to help others. This concept strikes them as unbelievable.
Second. The simple statement that I have a medical degree and professional title triggers angry reactions from some folks. For a few, this is not an innocuous reaction.
My understanding of the mission of Robert Whitaker’s webzine is to foster cooperative discussion and help move us beyond the current pill-based medical paradigm toward better models to reduce human suffering. I have gotten the feeling from a couple of participants in this discussion that the addition of my psychiatrist’s paddle to this boat is not entirely welcome. Still, we are all in this one boat.
First, happy and fun. Then, names and titles.
The idea that I could smile and have fun at work in a locked psychiatric unit and that I could enjoy my time with patients, for a few, paints me with the tar of Nazi genocide.
Wow. I had no idea.
I wrote about my sense of happiness and fun with the thought that people would like to know that I, as a human being and psychiatrist, have found my path though the same leadings of the spirit as others who enjoy their work.
I regret that my enjoyment of my work troubles people. However, I will not stop looking for ways to feel happy and have fun, whatever work I do. I don’t work any longer than necessary where there is no “fun” or “smiling”. I once took a mental health clinic job that lacked “fun”. I walked away on day two.
My dentist takes genuine enjoyment when he pulls teeth or drills cavities. I would not so I don’t work there. His obvious fun in his professional work makes it easier for me to go there when I need to. I have “fired” dentists whose motives to be at work did not include any obvious happiness.
I would feel sad if you told me you never have “fun” at your work and are not “happy” there. Whether I want help with a painful gall bladder or painful grief, I hope to locate a helping professional who is there because this is pleasant and fun for her.
I’ve met doctors who were not having fun. The results I’ve gotten in those situations were not useful. Even in non-medical settings, I’ve found the outcomes better if the person enjoys what they do.
The list of things that make me smile and happy at my work are pretty much the same as others in helping professions: seeing people take their personal power back, watching them find ways to feel happy and helping them suffer less.
Now, as far as names and titles go:
I do introduce myself to my patients as Dr. Keys. I tell them they may call me Alice and ask what they would like to be called. I think it’s clarifying to let people know my professional designation, especially in crisis work where this is not always clear because patients see many new “providers” in one trip.
I disagree with the assumption that stepping into my role as physician by calling myself a “doctor” when I am with a “patient” is inherently wrong or hurtful. When you go to professionals for help, you seek expertise. When you feel overwhelmed, out of personal resources and don’t know what to do, you want to talk to someone who has ideas about what to do next.
Back to my dentist. He is my doctor. I am his patient. I certainly do not feel “trivialized” or “infantilized” by this labeling in the context of our relationship. I go there because he has ways to help that I can’t manage alone. I call him “the doctor”.
I also call my dog’s veterinarian “the doctor”. Heck. I even call my doctor, “the doctor” and my kids’ pediatrician, “the doctor”. It’s what they are.
So am I.
A doctor, that is.
I’ve seen over the years, particularly in community mental health work, a constant re-naming.
Remember. Words create the world. Words matter. The naming of things makes a powerful difference.
In the early nineties, I was no longer called a physician or doctor or even a psychiatrist, but a “prescriber” in community mental health. I was introduced by first name only. No white coats. I was told that the “clients” were too “sensitive” for me to wear a white coat or be called a doctor in front of them. The patients had to ask me “So, are you a doctor?”
I find this “prescriber” designation to be an offensive trivialization of the depth and breadth of my skills and education. I was in school and professional training until the age of 31. I am licensed to practice medicine and surgery by the state. But with this “prescriber” label I am reduced to an interchangeable cog in the closet with a prescription pad attached to my hand.
These days I am referred to as the “LMP”. It stands for “licensed medical provider” to those in charge of such renaming. But to me, in routine medical history taking, it stands for the first day of your “last menstrual period”.
I suspect motives behind this professional renaming may include the desires of pharmaceutical purveyors to broaden the river of drugs that leads from their wellspring, through third party payers and to what we now call “consumers of mental health services”.
To increase patient “access” to drugs, there was a political movement that lead to prescription writing for nurses and, in Oregon now, for naturopaths as well. Psychologists have snagged this “prescribing privilege” in two states and the military. Social workers have lobbied to snag this “LMP” designation. I wonder where the money to back these agendas comes from.
If you lower the common denominator from physician to “prescriber”, then anyone can do this job. Perhaps the masters degree educators label individuals with psychiatric diagnoses in Oregon could also be given a prescription pad. Think of the improved rate of flow of psycho-stimulants to our school children (insert irony here).
My patients have also been renamed: “clients”, “CMI”, “consumers” and “SPMI”. I have heard the word “visitors” in use. One new name I learned recently is “citizen”.
Here’s my rant:
Architects have “clients”. “Consumers” eat and drink things. “Guests” come over in the afternoon for tea. “Visitors” drop by. “Citizens” have membership in a nation. I frequently treat patients that are not “citizens” of this country.
Prescribers only prescribe. LMP is the first day of your last menstrual period.
I am “the doctor” when I am with my “patient”.
Please call me “the Doctor.”
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.