Thursday, February 23, 2012

A Letter to Potential Shrink Bloggers

So Shrink Rap has been up and running for a little while now, in April it will be 6 years.  Podcasts, twitter feeds, collateral blogs, a book, and by some small miracle, we've managed to do this, talk fairly openly about our work, and still (please, please, cross your fingers, knock on wood, and throw a shaker of salt over the dog's head) we've not gotten ourselves in trouble.  Our employers and chairmen and friends and relations know that we blog, and while we may have made a few cyber enemies along the way, it's mostly  been a really good experience.  We think there should be more shrinks out there blogging.  

Can I pretend I'm old and wise make a few suggestions for the younger ones in the Shrinky crowd who might be thinking about blogging? 

Dear Young Shrink (a resident or fellow, or early career psychiatrist, perhaps)--

So you think you want a blog.  

When we started blogging, we were all experienced psychiatrists.  I'll speak only for myself, but my experience of the practice of psychiatry has been a positive one: I like treating patients and most seem to get better.  People are often glad to see me and to tell me what's going on in their lives, and I am glad to see them.  I don't mind listening to people complain and I don't get tired of hearing their problems.

 When we started blogging, we learned about a whole other side of psychiatry through some of our commenters.  There are people who are angry with their psychiatrists, with the effects of the medications they'd taken, and who have felt injured and wounded by the treatments they'd received.  It can be a vocal and angry world, and while I've found it to be very educational and enlightening, and sometimes painful, I'm personally glad that I viewed psychiatry as a collaboration with generally good outcomes before I learned about this land where the psychiatrist and patient are adversaries.  I'm not sure it's the world we want our new initiates being inducted into-- it's like an agar plate to grow cynicism.

Having said that,  if you still want a blog, let me give you a few pointers.

It's not your diary, it's on the internet.  It's fine to use a pseudonym, but write every word with the assumption that your mother, your patients, your residency director, your next employer, and any malpractice lawyer representing a plaintiff might find it.  Or in the case of our blog---you may later decide to write a book.  There is no anonymity on the internet.  As the impulsive big mouth in our group, I decided it was safer for me to use my real name and not ever let myself forget that what I say is "out there."   If you wonder if you should post something, you probably shouldn't.  (Or you should ask your respected co-bloggers for their opinions).

Don't blog about your patients.
Don't blog about your patients. 
It was worth saying twice.

Even in the most ideal of worlds, some patients are difficult and there are bad days.  If you need a release for your own angry feelings, consider therapy, a good friend in your program, or a journal in Word (or another word processing program of your choice) that does not get openly posted to the internet.  Part of being a doctor means that you lose your right to vent in certain ways because no one wants to hear that doctors might not like their patients, and everyone (even me) hears these things and thinks "Does my doctor feel that way about me?"

There are moments when cynicism, sarcasm, and the totally politically incorrect world of Say-what-every's-thinking-but-never-wants-to-admit do work.  Samuel Shem's book, House of God, is one example and House, the current TV show about an opiate addicted hospitalist who spits venom at everyone, are examples, but then again, I Hate House.  I don't know why those examples worked, but maybe because House of God was so anti-Marcus Welby, and House is too ridiculous for anyone to take seriously.    They are both exaggerations.  If you try it on a blog, I think you'll get blasted, and be one more example of heartless psychiatrists who don't care about their patients, and that helps no one.

Put on a suit of armor before you start.  Learn to duck quickly.  Consider comment moderation.  Take a break, if needed, and stop if it's not going well.

Be considerate of the fact that people who are suffering from psychiatric symptoms may be reading your blog and try not to make their pain worse. 

And don't blog about your patients.  

Okay, we have time for a few questions.