I’m peaking in my career

Supposedly, I’m peaking. And this isn’t about egg yolk and marenge pie. I’m 43 years old, have been in medical practice for fourteen years, and am looking at a canyon in 360-degrees from where I stand. That’s what the data says. I wonder if I am going to do the electric slide or how I’ll boogie through the next years of medical practice. I try to think, “This is the best moment of my life, right now,” any time self stigma and fear of mortality creeps in. (That’s not saying, “This is as good as it’s going to get!” Ha!) I want to cherish the gift of practicing medicine, for however long I am blessed with it. 

It’s a popular discussion amongst my colleagues these days, about how long a physician should practice. There’s a newer’ish respected program called, PACE, that evaluates physician competency to practice as they get old.  This is a huge shift in the culture of medicine. It’s meant to respectfully assist rather than discriminate with ageism. I try to imagine what it might feel like if I were approached and asked to take the test. 

So what does a psychiatrist rocking her best jeans have to show for herself anyway, you may ask. Well, (tapping the mike), “I’d like to first say thank you to my sponsors….” Wink.  I mean my patients! Thank you. 

…Hey! This peak is crowded! Give me some room!

Ahem. But at my “peak,” at the best of my career, I thought it would be fun to play around with, “Why?” What’s in my doctor’s bag that is so special?

  • Ask, “Why do you want to be alive?”
  • Start all work-ups with a medical work-up. 
  • Give full informed consent with the 5-Treatment Paradigms of Psychiatry
  1. chemical (medication), 
  2. psychotherapy, 
  3. hospitalization (inpatient and outpatient), 
  4. alternatives (such as acupuncture, massage, sleep hygiene, lifestyle change, etc.), 
  5. stimulation therapies (such as ECT or TMS).  There’s nothing else (that I know of ūüôā ) that anyone is going to offer you in psychiatry, no matter who’s clinic you go to. 
    • Push to full treatment response. 
    • Work toward quality of life, not cure, not perfect.  Ask again, “What makes like worth living for?” Design treatment toward those goals. 
    • Routinely and deliberately consider the flow of patient’s treatment agendas with physician treatment agendas. 
    • Mood journal. Nobody believes they were “that bad” after they feel better. Everyone wants to stop treatment when they feel better. (This is why there are so many repeat pregnancies, for example!). We all need our own voice (mood journal) to look back on and speak the truth. 
    • Fight for oxygen. If your patient has sleep apnea, don’t stop working toward treatment compliance. There are no medications that can take the place or make up for oxygen to the brain. 
    • Community. More community. 
    • The third eye – a therapist. None of us can be a mirror into ourselves. We all need someone outside of the “triangle” to speak.

    I’ll be thinking of more as I try to go to sleep tonight, but it’s bed time. I’m off! Sleep hygiene! Arg!

    Self-care Tip: Evaluate your position in your lifeline, and treasure where and who you are with deliberation. Keep on!

    Questions: Where are you in your lifeline? Are you struggling with ageism? What gives you value? Please speak! I, and the rest of us, really need your voice. 

    A Note of Thanks For Collaborating

    typewriter 1

    June 30, 2013

    Friend to Yourself
    Referral Sources


    I just wanted to send a note of ‚ÄúThanks!!!!‚ÄĚ
    Thank you so much for including us in the care of your patients.  I hope we continue in your and their trust.

    Practicing variety psychiatry brings me toward my quality of life experience and I am grateful.  I am not alone in this but blessed to be included in a fantastic team and community of treatment providers.

    We believe passionately that our own quality of practice experience is the first step to engaging in a patient-doctor relationship.  Connection brings change and so our patients become a changing force in our lives with their courage.

    Our patients work through multiple modalities, pressing toward healing and presence with electroconvulsive therapy, treatment-options awareness groups, medications, psychotherapy, and homeopathic remedies.  If there is more we might benefit from in practice, please let us know.  This is a life-journey we are honored to share.

    Keep on.

    Dr. Q

    951-677-2333 ECT Centers, Medical Director
    PrimeTelepsych.com Personal cell available, Concierge Telepsychiatry
    951-677-2333 Treatment-Options Awareness Community Groups
    800-670-4960 Pharmaceutical Research, such as, for those who cannot afford care otherwise – Principle Investigator
    PatientFusion.com or (951) 514-1234 Outpatient Psychiatry Clinic
    FriendtoYourself.com Us, you and I, Writing and Public Speaking

    Roughly What We Covered With The University Students

    Psychiatry logo

    Psychiatry logo (Photo credit: Wikipedia)

    What is psychiatry?

    Components intersecting at cross-point where stands Psychiatry:

    • The practice of medicine
    • The practice of business
    • The practice of one‚Äôs personal life
    • The doctor-patient relationship
    • The pursuit of Quality of Life

    Who should go into psychiatry?

    • Consider temperament
    • There are areas of medicine that are more procedural based versus more weighted toward patient-doctor exchange.
    • The medical system is incentivized by codes and governed by layers of administration.
    • But the question begins with Me; what am I incentivized by?¬† Again, consider temperament.¬† Temperament encompasses perceived moral values, and where pleasure comes from.

    What is brain illness?

    • It is not just one thing.¬† It involves the biopsychosocial components.
    1. Biological
    2. psychological
    3. sociological

    We are not in this to cure anything.  We enter psychiatry to improve quality of life Рthrough approach of the biopsychosocial model.

    Questions for you:  

    1. What is psychiatry?

    2. Who should go into psychiatry?

    3. What is brain illness?

    Self-Care Tip:  Approach brain illness w/o expecting a cure, but rather a process.

    Our Wanting Could Make Our Reality A Whole Lot Better

    Fantasy Garden Goddess by Tucia

    Fantasy Garden Goddess by Tucia (Photo credit: Tucia)

    Katalyn was forever bewildered by the contrast between the success of what she called her life and the failure of her relationships. ¬†As the assistant to the director of Polk Hill’s only advertising firm, she knew everyone. ¬†She was a blooming flower, her petals unfurled and her ability to know just where to turn the pitch was like opening to the sun. ¬†She had talent. But more than that, Katalyn was a darn good worker.

    Sitting across from me in the couch chair, her long and graceful fingers tapped the chair arm as if they were used to keeping time with her moving thoughts. ¬†“Here it comes,” I said to myself, and tried to relax into the complexity of her story.

    “Why am I alone? ¬†Why aren’t I in a relationship?”

    Katalyn chewed her lip and blinked a little faster. ¬†“I will not cry!” I could almost hear her mind say.

    Time cracked open there into reflection.

    We all have this¬†dissonance¬†in our life story. ¬†We make our choices with where we put our hard work. ¬†But we leave our¬†fantasies¬†disconnected from this investment of ourselves. ¬†We think that fantasies, (fantasy as in: contemporary, epic and/or paranormal – not necessarily fish-net hose,)… ¬†We think that fantasies should materialize via magical forces rather than deliberate efforts.¬†Irony, again.¬†¬†Qualifying accessibility to our fantasies, (or we could say, wants,) this way verses to what we think is real¬†is our own doing.

    Reminds me that we treat our loved ones worse than any stranger.  Put our best years and best hours of the day into impersonal labor, we give this way.  We think the least of our own beauty, success and intrigue, and the most in those we know little about.  Then we wonder about the disconnect.

    There is something raw and vulnerable about showing our wanting to ourselves.  It is one thing about our wanting in privacy, a place of personal ridicule and shame, and it is another to want in public life-process.

    Imagine if Katalyn deliberately allowed herself to relax into her wanting at work as well as in privacy.  What would happen?  How would she do that?  What is the worst that could happen?

    Imagine Katalyn as a woman who fantasized as she worked hard.  Would her work experience be different?  What would happen to her quality of life?  What would happen to her perception of reality?

    Self-Care Tip:  Let your wanting, (or we could say, fantasies,) out into public.

    Questions:  What would be different in your quality of life experience if you deliberately included your wanting into what you perceived was your reality?  What would happen if you worked hard to bring those together?  Have you seen this at work in your life?  Please tell us your story.

    Related articles

    Getting Yourself Healthy Protects The Freedoms of Others

    hey if you are too stinky we will ask you to l...

    hey if you are too stinky we will ask you to leave not really sorry (Photo credit: stevendepolo)

    Some of our most difficult cases are when we, the medical care-givers, think we know better how to take care of someone than we do take care of ourselves.

    When a person maintains decision making capacity, but whose brain health disables them, if we care, we care.

    Monty was one of these. ¬†He was ill! ¬†He was ill on so many tectonic plates, no one near him could keep their footing. ¬†His quality of life wasn’t what he wanted. ¬†He was disconnected from meaningful relationships. ¬†He was suffering. ¬†However, he couldn’t decide to engage in therapy.

    Monty wanted to go “natural” but couldn’t name any natural therapies he’d be willing to try. ¬†He didn’t want to continue suffering, but couldn’t accept medications “just yet.” ¬†We went into one option after another, invested time together learning about brain illness and coming to terms with the biological involvement in where emotions and behaviors come from, and we did it many times. ¬†Monty had a full informed consent.

    Deciding not to treat or to treat is not easy for any of us.  Watching Monty step away into the foggy chaos of sex abuse and obsessive compulsive rituals was really hard.

    We fight for our freedoms when we fight brain illness. ¬†I suppose we fight for the freedoms of others as well, simply by taking care of our own selves. ¬†Letting Monty choose even when his choices are affected by his illness is still his right and I defend him. ¬†We all who take care of ourselves have more to offer Monty than if we didn’t, including a defense against the losses that brain disease brings – like processing information.

    I’m not sure yet how to explain how taking care of ourselves influences the freedoms of those around us who are less¬†inherently¬†free by brain illness. ¬†I suppose like anything good, freedom is contagious, a little bit of light in any room, Love being stronger than death and the¬†Gettysburg¬†address – this is along those lines. ¬†It makes a difference to the Monty’s out there that we all take care of ourselves.

    Self-Care Tip: ¬†When frustrated that you can’t help others, get yourself healthy. ¬†It’s contagious.

    Question: ¬†Have you been in the place where you thought you knew what was better for someone else then that person’s own choices? ¬†How did you deal with that? ¬†Please tell us your story.

    Recommended Reading:

    Why not skip medication And Go Natural?

    Mistaken Expressions of Freedom and Medication Compliance

    What Must I Do To Be Happy?

    Today, I can’t get my thoughts away from the frolic in temperament-land.

    Teacher, what must I do to be happy? 

    Who hasn’t asked this?  I remember Nicodemus who asked Jesus,

    Teacher, what must I do to be saved? 

    A Certified Fresh logo.

    Image via Wikipedia

    I bet he was wondering, too, about happiness.

    I’m not equating happiness with salvation or morality.  I am saying this might have been a parcel of his question.  Happiness is an emotion per our language and cultural definition.  And we have enjoyed our path of discovery in seeing how emotions are tools we use to interpret the world around us.  They are not universal or constant between us.

    After I read,

    Individualism, a stronger predictor of well-being than wealth,

    in R. Fischer, PhD’s Meta-Analysis of Well-Being, I followed my thoughts toward the Jungian Typology of Temperaments.  Remember our pasture and barn people?  The Jungian Typology of Temperaments is our playground where we have a wish-basket equipped with supplies to become any variation we might choose of what our design requests.  Read the article and you might follow a similar path of thought.  Or not.

    In case you’re wondering, and per Dr. Q (who is a poor statistician so take this for what it’s worth,) a meta-analysis is a study of studies.  A meta-analysis brings together a number of studies that reflect a population of people and a methodology that is as objective as we can find.  We compare them and through the tools statistics and logic offer, we make a summary conclusion.

    If you are familiar with the tomatometer on RottenTomatoes.com, you already have a sense of what a meta-analysis does.  (I love rottentomatoes.com.)  There is more power in the indexed findings of many studies than in just one study.  There is also more power in a fresh tomato than a rotten one.


    1. Do you see happiness as something that reflects your condition of spirituality and/or your condition of brain health?  Why?
    2. What do you perceive brings you happiness?  Please tell me your story.

    The Pleasure That Should Be Ours In Emotional Health

    Cup of coffee with whipped cream

    Image via Wikipedia

    Some time, I’d like to come back to our bullying series as there is still some help to be had for us. ¬†However, today, my cherubs are asleep and it’s only seven PM. ¬†My feet are up. ¬†I’m sitting by lots of beauty colored in varied hues of sunset, shadow and dusk. ¬†Tonight will be short. ¬†I will let today end and indulge the coming together of these things. ¬†(I am even drinking reheated coffee with lots of whipped cream!)

    What I have thought of to share with you my friends, as I’ve enjoyed its friendly work on me today, is the pleasure that should be ours in emotional health.

    Bad things will come. ¬†We will have anger, lower communication and such. ¬†We will wish we hadn’t pushed the call button on the phone by accident when yelling. ¬†BUT. ¬†But (“Mommy you said a potty word!”). ¬†But it will pass. ¬†It will not define our day or our perception of self. ¬†We won’t¬†catastrophize and we will trust ourselves to show love and mercy to Me in our weakness. ¬†This is a pleasure to experience. ¬†This is what comes when we have brain health.

    If this is what has always been your reality, well great. ¬†BUT. ¬†But (“Mommy! ¬†Why did you say that?). ¬†But, many of us know what it is to crave for days when we can say that the blow-ups, outs and ins don’t blot out the sun. ¬†They shouldn’t. ¬†The pleasure comes with health. ¬†Go for it! ¬†You are worth it. ¬†You were made to feel pleasure.

    Questions: ¬†When was it that you realized that your emotions and behaviors didn’t rule you or someone you love any more? ¬†What did/does that mean to you? ¬†Please tell me your story.

    (Ah!  There goes the last of the sun and the trees are now silhouettes.)

    Self-Care Tip #257 – Go for the pleasure of trusting yourself to respond with healthy emotions and behaviors.

    You Might Find That You Are A Genius

    Did I do the right choice !?

    Questions:  What do you do when you are avoiding something?  When you have a job waiting under your nose, what is it that you find yourself using to procrastinate with?

    If you see a pattern in what you use to self-sooth with, to avoid with, to divert with and to ease the pain of doing what you don’t want to do, write it down somewhere else. ¬†It’s already written on your heart. ¬†This, with some introspection and purposeful hard work, might be your genius, your natural place of interest and where you are able to feel pleasure and quality of life. ¬†This is an activity, (now hold on – even resting is an activity, so put your hand down,) that is consistent with your hard-wiring – your genes. ¬†Get it? ¬†Genes. ¬†Genius. ¬†That’s why we need to know ourselves to get friendly with ourselves. ¬†Our self-care isn’t too friendly fighting our biology – our temperament.

    I noticed this tonight as I was¬†perusing and writing emails when I have to finish up a talk I’m giving tomorrow for the Rotary. ¬†I noticed this when I turned to write my post on this blog before working on that talk I’m giving tomorrow for Rotary. ¬†It’s 8:15 pm.

    This post is not glorifying the act of procrastination, avoidance or¬†shirking¬†responsibility. ¬†(Shame on me. ¬†Don’t remember this. ¬†Don’t let this imprint on your minds.) ¬†This post is simply saying, if you are, take a few to use what you’re doing for your self-care. ¬†In the future, you could then choose more actively to do those things that you discovered come so naturally to you. ¬†You might find that you are a Genius! ¬†Wouldn’t that be fun?

    Self-Care Tip # 210 – Use whatever comes your way, including procrastination, to teach you about becoming a better friend to yourself.

    Pain Doesn’t Define Life’s Potential


    Image via Wikipedia

    Self-Care Tip #196 – When you are hurting, remember the pain doesn’t define life’s potential. ¬†Be a friend to yourself.

    Yesterday we talked about giving and getting bad news without fear. ¬†This was received in a spectrum of ways by you, ranging from – no way is bad news something not to be scared of, to, bad news might be something we could face knowing we might find something good in the end. ¬†No one slammed the hammer down, dinging red at bad news equals good all around – except my dogs who don’t listen anyway and are pretty much always happy.

    Jjen was brave, saying,

    I would have to also agree that in some cases bad news can bring family members, or even friends together that have been estranged. This has personally happened to me. Kind of a bittersweet thing; good in result of something bad and mending a broken relationship.

    “Good comes out of bad.” ¬†Not everyone agrees and I don’t blame them. ¬†Some bad things are better left alone to rot and stink out of our lives entirely. ¬†It even sounds patronizing when someone is hurting to say this. ¬†This kind of discovery should be made by the parties involved, without the rest of us holding scripted cue cards for them.

    It is also something that is received easier from another who has been in, or is in their own¬†catastrophe(s), losses, abuse or grief – say Jesus for starters. ¬†I could hear this from Him without wanting to vomit all over the place. ¬†He’s been there, hurt bad, and has been blessed through and by it in ways I will be learning about even after Time unhinges.

    When my nine year-old adored niece suddenly died, I didn‚Äôt see that. ¬†It‚Äôs taken almost six years¬†to see anything good come “from” this unbelievable loss we grieve every moment. ¬†The bad doesn‚Äôt disappear for me, but as Jjen said, it is not a qualifier for the rest of life‚Äôs potential.

    Question: ¬†What has come “from” the bad in your life – more bad or what? ¬†Please tell us your story.

    Take Care Of Yourself to Give Love to Others

    Give, take 'n share

    Image by Funchye via Flickr

    Self-Care Tip #195 – Take care of yourself to give Love to others.

    Belen¬†came in, confident. ¬†She was comfortable in her element. ¬†Working in her area of specialty was her delight and she didn’t worry about clocking hours or mixing it up with family. ¬†Her work was part of what family meant to her. ¬†It was what brought pleasure to her life.

    “Wonderful!” you say. ¬†And yes, it is. ¬†“Why then did she come in to see me?” you ask. ¬†Glad you asked.

    This was Belen’s third marriage. ¬†Marriage was not where she felt confident. ¬†Talking marriage was when her lip surfaced, quivering on her face, transforming her. ¬†In the past, Belen had often dropped her husband’s name, laced him into stories she told and her ring was a favorite¬†finger toy. ¬†I had the impression that Belen was proud to be married to this man. ¬†But it wasn’t until today that Belen spoke about Ben directly.

    I sat up because I was curious about this emotion that had flickered behind it all until today, when it was front and center.

    In this case, Belen was afraid of her emotions in fact. ¬†She was aware of them, but they were in a foreign code to her. ¬†Tap-tap-pause-tap-tap-tap-pause… and so on. ¬†She started by telling me about their evenings together.

    Ben was a grazer who expected open time with her. ¬†Belen, however, was a barn girl. ¬†When she sat with her husband in their “open time” over a slow dinner, a drink, watching him read a book beside her – it took everything in her reserve each day to stay put. ¬†All her nerves were dancing, telling her to get up and work. ¬†It was what gave Belen her quality of life. ¬†Her work was her self-care. ¬†Ben’s time to meander through thoughts and play was in contrast, what gave him pleasure in life. ¬†He waited all day, pushing through a task driven job, to come home and do this.

    Potential negative energy was coiling up inside and Belen was afraid that she might be overcome by it.  Belen did not want to think about what that might end with.  Another failed marriage?  Losing this man she was so glad to be married to?  Dying alone?  She looked at me sideways, ashamed of her emotions.

    I’m turning into Crazy Wife. ¬†I yell at him for things that are no big deal.

    My answer came too fast this time. ¬†It wasn’t graceful or polite. ¬†I regret that. ¬†It’s never been a forte for me and one of the reasons I recommend my patients find a¬†psychotherapist¬†who will patiently stand beside them rather than collar them and drag them to water (like a certain psychiatrist I know.)

    Do what gives quality to your life. ¬†Claim it when you do and don’t hold him responsible for it. ¬†He’ll feel guilty and defensive. ¬†‘Oh, I have so much work to do honey. ¬†I can’t sit here…’ ¬†You are not a victim. ¬†This is your choice.

    Unfortunately, there was more along those lines, but like Kevin Blumer says,

    I wish the blog world was the same as the real world where people have a chance and can think about things before they (say) them.

    Alas, at least we have our keyboards, pencils and erasers.

    Belen was losing her lovely confidence to resentment because she wasn’t doing what she was wired to do. ¬†She wasn’t owning her choices. ¬†She thought loving her husband meant that she shouldn’t and because of that, she was only giving him her uncared for self. ¬†She didn’t realize that doing what gave her joy was the best way to Love others.

    Question:  How do you help the people you love realize that when you take care of yourself, you are taking care of them too?  (This should get interesting!)  Please tell me your story.

    What Is Your Most Core Desire? That Is Self-Care

    It's a Business Doing Pleasure

    Image via Wikipedia

    Self-Care Tip #191 – Do what you desire to get friendly with yourself.

    What is your most core desire?  I am learning more about mine.

    I wonder at the improvement in my quality of life since blogging with you.  It is More than the pleasure of writing; which I do love and have missed for years.  It is More than the pleasure of being productive; a natural high for my temperament.  It is More than the self-care tips listed off that roll back; a tide of all that is sent out comes in again to wash over me and change the shape of my life.

    This morning I ran into a newer friend. ¬†We came into each other’s lives, catalyzed by the ingredient that this blog provided. ¬†I am sure I would not previously have allowed myself the pleasure of speaking with her for long without it. ¬†My temperament has always been a driving force that pushes me into “the barn.” ¬†I often miss the journey for the end. ¬†This is “The More”¬†that has been given to me. ¬†Connection.

    Now people actually look different. ¬†Despite years of medical education, years of psychotherapy and my years of life, I never saw people to the extent that I do now. ¬†Each of us here for a time with our stories, our pearls to offer and each of us with our essence to share for eternity. ¬†It is one more time for me when I am open-eyed, open-mouthed gawking at the thought of “The More” that is still coming. ¬†Better than this.

    Think of your most core desire; what you are driven toward by biology, genes and higher intelligence.  What has given you access to that?  Now think about how to go for More.  That is self-care.

    Question: ¬†Oh, you know what I’m going to ask…

    Forget About Divisions In Knowledge.

    The World Is Flat

    Image via Wikipedia

    Self-Care Tip #103 ‚Äď Forget about divisions in knowledge.¬† Be a friend to yourself.

    Knowledge does not separate into parts of religion, diet, stars, or geometry.  It is one thing, although we may not see its entirety.  Like the blind men with the elephant, we might be standing by the foot or the trunk.  But it is one thing.  Spiritual truth, nature, physics, medicine, music, art, it’s the same story told in pieces and in different ways.

    Working in psychiatry, I’ve struggled with this because it so often affects my freedom in practice.  It so often affects people’s choices for treatment, people’s choices for lifestyle and their own empowerment with self-care.  It affects the choices people make in medication therapy and in physicians.

    Merging the tables of learning affects our quality of life either way.  If we are able to do this, we have less conflict, fewer chairs to walk around.  If we can’t, we find ourselves constantly checking the seating charts.  It’s terrible throwing a party where people don’t know what connects them.  There’s the same discomfort inside of us when our life paradigms are afraid of each other.

    Take Crystal.  She is a Latina Catholic.  Or make her protestant Filipina, or say White Texan.  Crystal grew up thinking that what was said by her tias (aunts,) or her pastor, or performed by her grit and spine, lay like bookmarks between human behavior issues and the rest of her life.  Behaviors may have something to do with the church, or emotions with the girls room, or nothing to do with anything in her mind.  Thinking behaviors and emotions might relate to what gave her black hair color, and to why water separates from oil is just bizarre to her.

    When, Thomas Friedman wrote The World Is Flat: A Brief History of the Twenty-First Century, he was talking about a leveling of the playing field of commerce.  To take it further, I hear him talking about a flattening of prejudices, knowledge, access to information and hierarchies.  The world is too flat to separate the brain from the rest of the body.  When the world is flat, working as a psychiatrist means enlisting all of science, religion, social issues, hobbies, food preferences, and all the other things that make someone’s life worth living for their treatment.  When the world is flat, a patient trying to get help for their emotional-behavioral illness doesn’t separate it from anything else in their journey.

    It turns out that we have a lot of information on where emotions and behaviors come from.  We should use it, don’t you think?

    Of course, we don’t have it all.  Not close.  We don’t know how the soul factors in.  We don’t know what miracles are.  We don’t know God face to face.  But we do know that it is the same table of knowledge.  It is the same elephant in the room.  It all comes from the same Love.

    Walk around.  Feel around.  Let your quality of life get better.  Don’t cut yourself off from another part of you if you don’t have to.

    Question:  How are you keeping your personal journey one that is connected?  Or not?  Please tell me your story.