Thanks for the (detailed) reminder of what it means to be a truly observant clinician. Reading this, I was reminded--in a good way--of the DSM, which at its best is a compilation of careful observations of the variety of ways humans tend to shift out of the "normal" range of the curve.
Great gem of a piece! I have shared w LMHC's and a recent (psychology) college grad who is working in a ground floor job w substance users in treatment. Great foundational work for all, thank you!
It's incredibly eerie how recognizable some vignettes are, either in my work as a public defender, or through personal connections. I've seen so much of this: the fixation over surveillance, insisting they're in relationships with celebrities, and the post-partum manic episode. Thank you for writing this.
I totally enjoyed reading your fairly detailed overview. It’s however amazing to me that one not infrequently encounters these days people who have this word “Fuck” tattooed on an arm or leg, or even sometimes a buttock. I must have been sleeping on the morning in medical school when this particular behavioral matter was explicated by some faculty member.
Well characterised and described. Was like being back at work. Worth saying (you may have already) that a well conducted interview and the (dated and timed) recording of the evaluation and MSE are the gold standard in the job. Nothing really proceeds without them and they are supposedly the unique skill set of the jobbing psychiatrist. Improved over time by repeatedly performing and recording the examination clearly and thoroughly. Nice and educational article. Thank you.
I love those labels. The first time I saw one, I was a sophomore in high school. I’ve read one all the way through, but it’s comforting to know there are bottles of soap out there wrapped in the meaning of life.
In my current role as a primary request service and crisis response manager, my window to assess a patient is very narrow and often doesn’t leave time for deep dive H&P conversations. Regardless, for me to be successful, I need to meet the patient where they are at comfort wise, and that’s usually prioritizing their concerns, legitimate or perceived. Finding ways to bond, empathize, connect quickly to establish trust have been my primary focus, and had been most successful. But that’s completely anecdotally driven.
Now that we got focusing on me out of the way, I agree with most of the approaches to assessment you suggested. I’m forced to make mine in an immediate superficial sense while establishing that climate of trust. I find casual conversation peppered with leading or open-ended questions that can usually answer my mandatory information well enough without having to resort to an interrogation during an otherwise dynamic and emotional moment, works pretty well. Thanks for taking the time to put this together.
And, I appreciate the Deadpool reference. Devil’s dandruff is a slippery slope for an old lady.
Thanks for the (detailed) reminder of what it means to be a truly observant clinician. Reading this, I was reminded--in a good way--of the DSM, which at its best is a compilation of careful observations of the variety of ways humans tend to shift out of the "normal" range of the curve.
Thank you for this fascinating essay. I feel so lucky to have a healthy brain and a very manageable level of neuroticism.
“Manageable neuroticism” is the best most of us can hope for.
Great gem of a piece! I have shared w LMHC's and a recent (psychology) college grad who is working in a ground floor job w substance users in treatment. Great foundational work for all, thank you!
It's incredibly eerie how recognizable some vignettes are, either in my work as a public defender, or through personal connections. I've seen so much of this: the fixation over surveillance, insisting they're in relationships with celebrities, and the post-partum manic episode. Thank you for writing this.
Like Part 1, very educational for an unaware layman. Again I am struck by the tangled mental phenomena we humans contain.
stumbled upon this piece while setting up my account—great read!
I totally enjoyed reading your fairly detailed overview. It’s however amazing to me that one not infrequently encounters these days people who have this word “Fuck” tattooed on an arm or leg, or even sometimes a buttock. I must have been sleeping on the morning in medical school when this particular behavioral matter was explicated by some faculty member.
Well characterised and described. Was like being back at work. Worth saying (you may have already) that a well conducted interview and the (dated and timed) recording of the evaluation and MSE are the gold standard in the job. Nothing really proceeds without them and they are supposedly the unique skill set of the jobbing psychiatrist. Improved over time by repeatedly performing and recording the examination clearly and thoroughly. Nice and educational article. Thank you.
Gee, maybe there’s some significance when your patient has a tattoo that says “fuck”.Doh.
Wilde had a thing for shallow people, "seriousness is the only refuge of the shallow". Somehow "shallow" has lost its standing.
I love those labels. The first time I saw one, I was a sophomore in high school. I’ve read one all the way through, but it’s comforting to know there are bottles of soap out there wrapped in the meaning of life.
In my current role as a primary request service and crisis response manager, my window to assess a patient is very narrow and often doesn’t leave time for deep dive H&P conversations. Regardless, for me to be successful, I need to meet the patient where they are at comfort wise, and that’s usually prioritizing their concerns, legitimate or perceived. Finding ways to bond, empathize, connect quickly to establish trust have been my primary focus, and had been most successful. But that’s completely anecdotally driven.
Now that we got focusing on me out of the way, I agree with most of the approaches to assessment you suggested. I’m forced to make mine in an immediate superficial sense while establishing that climate of trust. I find casual conversation peppered with leading or open-ended questions that can usually answer my mandatory information well enough without having to resort to an interrogation during an otherwise dynamic and emotional moment, works pretty well. Thanks for taking the time to put this together.
And, I appreciate the Deadpool reference. Devil’s dandruff is a slippery slope for an old lady.
Martin, this appears to be a duplicate of pt. 1 after the opening paragraph?
I just reused part of a paragraph or two to re-introduce/define the MSE.
My bad
Thank God for Paul.