Doctors diagnose, sometimes we dispense, often, we teach

“My grandson has HDHD.”

This was intriguing. I had just asked her one of my standard psychiatric interview questions about family history of mental illness. Maybe I hadn’t heard right, but it sounded like she was telling me about a new flat screen. Had her grandson just bought a fifty-two inch LED set in time to watch the Final Four this weekend? Had he mounted it on the wall on a swivel arm? Probably not, since she had also just told me that he was only seven and in the second grade. Maybe he had a killer paper route and really liked basketball.

“Oh, do you mean ADHD?” I asked, trying to clarify things.

“Yes, yes!” she beamed, “HDHD, that’s it, that’s it exactly. It makes it hard for him to pay attention in class.”

Having a fifty-two inch HD flat would make it hard for me to pay attention to anything else either, but I moved on. It was a small point, I knew what she meant, and I was only two-thirds of the way through the interview with five other consults behind her. Focus, Doc, focus.

As a psychiatrist, I interview, I listen, I diagnose, and I recommend treatment. I also do other things. Chief among them is teaching. You know, those of you who are real teachers, I’ve always secretly coveted your jobs. I’ve thought about what it would be like to instill knowledge, see bright faces looking up at me, see bright eyes lighting up after a new concept is grasped and fully understood. Then, I think about lesson planning and end of the semester grade posting and I wake up from this nice dream, my t-shirt soaked with sweat. Nah. Hats off to you and God love you all. I can’t do your job. Nope.

Seriously, though, doctors are teachers. We try to help our patients learn about themselves, about their illnesses, and about things they can do to live healthier, happier lives. It’s interesting to me to hear just how many illnesses are mispronounced and misunderstood. There are the funny ones, of course, like the “smiling mighty Jesus” (spinal meningitis), ” a hyena hernia” (hiatal hernia), and in my world the “scrizofremia” (schizophrenia). Often, it’s my job to teach someone that it would be very unusual for grandma to develop schizophrenia in her eighties, even though she is now seeing and hearing things, but that it might be possible that she is having a seizure or suffering the after-effects of a stroke or that she is septic because of an untreated urinary tract infection.

I have to tell people all the time that “Schizophrenia-bipolar-manic depressive illness” is not a DSM-IV diagnosis. I then gently tease this monster moniker apart and focus on whatever the true diagnosis is, outlining symptoms and teaching them how these usually fit into one diagnosis or the other. It’s then that I get to see the lights come on.

“Yes, yes, that’s what she does! She starts to stare into space. It’s like she doesn’t hear us at all for a few minutes. She licks her lips and blinks her eyes and acts all weird. The she kinda comes out of it. That’s not schizophrenia, huh?” No, mom is having seizures. She does not need me, but we need to get her to the neurologist down the road as soon as we can.

Doctors diagnose. Sometimes we dispense. Often, we disburse.

The more we give to our patients, the more we get back. The more we teach, the more we learn. The more we look for ways to do this every day, the more satisfying our jobs are.

The payout is the payoff.

Greg Smith is a psychiatrist who blogs at gregsmithmd.

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