What we’ve said about Talking to patients

“This problem you're having with concentration, these issues that you're having with sleep, that's what I'm medically calling a bipolar 2 disorder. And I'm expecting that with this medication, we're going to see improvements on both of those major issues”

“i said you know i don't know what you have i don't know if you have anything at all you could have something you might not there's definitely some stuff we are seeing here uh in the past from you that suggests there's something but i can't tell you what it is”

“I'd rather a patient safely taper off and safely be monitored than tell a patient they need to be on a medication and have them not follow up. Autonomy is one of our guiding principles”

“I strongly believe that psychotic disorders are not a matter of personality or development and are a matter of just something that happens to the brain, like epilepsy”

“I pull up the criteria. And I say, let me just read some things and see if these are things that you resonate with. So I'm looking at criterion E. And I do that because I think it's helpful for the person to think like, this isn't just me saying like, oh, you can't concentrate. That's probably trauma”

“Instead of telling someone, hey, you have a personality disorder, sucks to suck, you can say this is one way to think about your problem. And the good news is calibration can change. You can engage in the process”

“It's not that the whole system of personality is broken. It's this one thing that's causing much bigger problems than it needs to. And then they're constantly kind of making up for it”

“You have to tell patients how not getting this can result in missing diagnoses or making the wrong diagnosis and therefore getting the wrong treatment and bad effects from it”

“I tell every patient, this medication is not going to solve your problems. This medication is not going to take over, take over, take away the fact that you had these traumas, but it'll help”

“You really got to know what the general effect size of SSRI is. You shouldn't oversell it, right? Because if you oversell it, you're going to give people the false impression that this is a powerful medication that's going to change your problems”

“I like to link the mechanism to things that empower them rather than making the mechanistic explanation sound like something that makes them depend purely on a drug to boost their serotonin”

“even for the most biological mental disorders in psychiatry, treatment is something that really happens on the order of, at minimum, two or three months. OK, if you get a major effect within a few weeks, most of the time, that's a drug, not a medication”

“the onset of effect of lithium takes at least two weeks most of the time. So that's the problem with the mood stabilizers. I think that's why a lot of people don't use them today, because they want instant gratification as a clinician and a patient. You have to set expectations”

“8 out of 10 anger, not 10 out of 10 anger. I don't know. You'll have to tell me what you feel. This might be a good effect. If you have one less big fight with your partner a week where you yell at your kids less, this might be a good medication for you”

“I tell them it's antipsychotic, but I also tell them the truth. And the truth is that second generation and first generation antipsychotics are indicated and used in a variety of different conditions, right”

“I literally say to the patients, like the way I think about it is we don't do labs because this medication is unsafe. It's because we're doing this labs, this medication is extra safe”

“even if you have guaranteed decline in renal function, that is not the same as renal failure, okay? And if you told me that over the next 20 years, I had the choice between 30% worse kidney function and 30% less brain function, I'll tell you this. I'm going to take the better brain function every single time”

“Sometimes with all this talk about hydration, when you first prescribe the lithium, people take it upon themselves to actively change their amount of water intake. I think I want to be clear to patients and say, you don't need to change what you're doing, but talk about any changes you notice at the next visit”

“I made a little page sheet that I share with the patient. And what I would do the first few times I prescribed lithium, and I still do this with patients that I feel like need to hear it. I share my screen and I walk through the, it's a Google Doc”

“We're talking about a rash that is new and that you haven't had before and that's different. If you get any new rash while we're starting this medication, I want you to stop the medication and go to the ER. That's how I do it”

“Incredibly, incredibly, incredibly sedating. Warn your patients that they will feel like a zombie. Now, why do I think it's important to warn patients”

“I pretty much say, hey, this works great for a lot of people. And for some people, it doesn't work at all and might even make the sleep worse. We don't know. Why don't you just try it out”

“if we are going to trial it, I recommend they try it for the first time on a weekend or something or when they have nothing to do”

“I say, look, I ask this of every patient, every time, every visit, and I really do. I make sure I do because I don't want that to be a lie because it is important to ask”

“often it's their support, the support around them, husband, wife, parents, that has the most resistance to the idea of doing ECT because they've heard that it's going to wipe out their memory, it's going to turn my loved one into somebody completely different”

“I'm inviting the patient to really be in charge. They've got their hand on the knob. So as you turn it up, if something bad happens, turn it back down a step”

“what I like about doing the step from 100 to 150 is that you can say, listen, if this doesn't work out for you, take the 100 and half of the 50, giving the patients real control”

“I try to take a non... authoritative stance and that like, I'm not wagging my finger and saying this is, I don't have a moral problem with you going and doing these things. But you're saying you have a problem and I can see the problem”

“You have to explain to the patient, like, I'm hurting you if I were to prescribe these things long term. I'm preventing you from getting better”

“if people come off a benzodiazepine, they tend to have greater self-confidence, better concentration, less depression, and all that's from clinical observational studies. That correlates with what we see on the PET scan, which is that the brain is healthier six or 12 months after coming off of benzodiazepine”

“I understand you really think that the medication is going to help you, but I don't really see any medical indication today. And so unfortunately, I'm not going to prescribe you anything”

“I know that you can go to another provider and get this diagnosis and get put on Adderall if you wanted to, but I'm worried about you. And I'm worried that, yes, maybe the Adderall will help you today and tomorrow, but these things have consequences”

“I think you need to dial back people who are in this situation and ask, what is important to me? What do I value? And what do I want my life to look like outside of work or outside of whatever I think these stimulants are going to do for me”

“When I explain things to patients, it needs to be super duper simple. You don't want to add all these other layers of Buddhist thought and your own experiences of mindfulness because it can be too confusing and complicated”

“I think this is a practice that's really going to help you. The medications might help you somewhat, but I think this is really going to help you in the long run in terms of getting better”

“is to practice when things are calm and easy so that it helps during the more stressful periods. If you only practice during the stressful periods, you're going to be too ramped up to really kind of get the benefits or see it work”

“You want to process those emotions and reorient towards the major purpose of the mindfulness practice, which is long term change. Just like the way we counsel patients on that, you know, this SSRI is not supposed to make you feel happy right away”

“before I check in on it, I always go like, and by the way, often most patients don't follow up my recommendation. So no worries at all”

“I don't need to modify the content of my primary affective experiences. I don't need to change when I feel fear or feel grief or feel suffering. I'm trying to help them build that capacity to observe these things and not be forced to act on them”

“the motivation is not to stop or remove the intrusive thoughts or the feelings. ERP doesn't remove the thoughts or the feelings. So I teach patients they shouldn't be doing it with the hope that they'll be cured or that they'll stop having the thoughts”

“telling patients that OCD is a chronic condition. It's not something that is cured. So, you know, patients who have successful rounds of ERP, it's expected to have setbacks. It's expected when there's a stressful period, you know, death of a loved one, hard loss of a job or something”

“if they're better, I say, hey, by the way, don't be surprised if things get worse again in the future. That's life. But at this point, you've picked yourself up out of this and you know what to do next time”

“with bipolar, you're teaching about the long game. I think he had a quote. I think he said I got it from a mentor of you're not trying to treat the symptoms. You're trying to stop the cycling”

“about 50% of people would come back and go, yeah, that really didn't do anything. The other 50% came back and said, these are amazing. When I wear these things, I fall asleep an hour earlier”

“Even on an overcast day, the blue wavelength still gets through. The ideal thing is go outside and do something active in the morning. The Western solution is buy a light box and stay on your computer”

“If they think about a leather car seat, it's been sitting out in the sun, they never oil it, it's going to get all crackly and crusty and broken. And that's what the brain looks like without the proper oils”

“at the end of the day, as clinicians, we're supposed to help the patient not be right and smart and say things that research is backed”

“During the first appointment, I interrupt, I jump around, I ask a lot of questions. I promise moving forward, I'm going to be better at listening”

“I appreciate that. At the same time, I want to use the time productively. I want to talk about the things that help me figure out what to do with medications for you”

“So just set the expectation with patients that whenever we're going to do some work together, whenever something needs to get filled out, whenever we're talking about side effects or whatever, we're going to do it in that 20 minute chunk”

“I'll have to insist this is still a medical relationship. The reason why we're meeting is for your good. I'm not just here to be friends. I'm your doctor too”

“I'm not feeling those feelings. And what I feel is care for your well-being as a patient. That's my job here. And that's always going to be my job as long as we're working together”

“I can't go to this thing because of my, you know, whatever, insert mental illness. It's a very, very, very dangerous, self-fulfilling prophecy”

“most of the time maybe 80 to 90 of the time the terminology is needlessly abstract uh to capture you know the information that is trying to be communicated”