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.

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    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.