And so it begins…
A new blog. Another amongst thousands. Is there particular utility or reason to follow this one? I’d like to imagine that this will have usefulness to your life. This is more than just thoughts on psychiatry, but really the thoughts of a psychiatrist who is both enamored with and annoyed by his own field. And with modern culture. So everything.
Which raises the question – should a doctor really be blogging? Within medicine there’s a culture of secrecy. We protect our own, not letting on about our problems. Our venues of criticism fall into “peer reviewed journals,” which themselves are prone to problems like publication bias. Those in charge perpetuate thinking in line with their own. Which reflects how medicine functions – by majority opinion. We are expected to practice within the “standard of care,” which is the normal practices of other doctors in our area. Practicing medicine is after all a privilege, granted by the state medical board. Best to not ruffle feathers.
But doctors are not robots. We are people. People who think for ourselves. We’ve gone through four years of medical school and further years of specialty training, and during that we’ve seen through the fallacy of the omniscient physician. We don’t know everything. You can drive a bus through what we don’t know.
And that raises a different responsibility. With all that training comes the ability [probably] to study science critically, to be literate in science and read between the lines. Medicine is not science. It is a craft, or at best an art informed by science. Doctors have the responsibility to use that science as best they can to help others. That may be in a clinical setting, but can also be in public opinion. It’s a social responsibility for doctors to speak up. Pharmaceutical companies and others have their pulpits, funded by much more money than I do. The internet is a venue for others to express their opinions, and it seems a doctor should share his thoughts as much as anyone else.
Now, I know my patients might read this. And showing actual opinions might shatter the neutrality that some choose to believe is necessary in treatment, especially in psychotherapy. Patch Adams challenged that, amidst its flaws. I don’t particularly buy that neutrality is essential to all psychotherapy. In medical circles it’s talked about as “professionalism,” to present a specific image of the profession. That’s fine to be professional. I’m not endorsing sharing personal lives with patients. But the illusion of neutrality should be shattered. At least a little.
I ran into a patient at the gym the other day. He didn’t know I saw him. But if he did it shouldn’t matter. I have to hope he’d respect my expertise even if he saw me on a weight machine. Then maybe we can all start having more real conversations.
I’ll be writing about my thoughts on the field of psychiatry, on medicine, and on challenging the idea that any one view is the most valid. Hence the quote and title of the blog, which is as applicable to medicine as it is to religion, or anything else.
“There are [at least] 21 paths to the top of the mountain. If anyone says he is on THE path, he isn’t even on the mountain.”
Stay tuned.
Paul R. Puri, MD
