We encourage you to get help so we can judge you.

I spent three months on my surgical rotation. Surgeons are very busy people, and so they were always a little hurried with their patients; a little more brusque than I was comfortable with. What made me really uncomfortable was how they talked about anyone with psychiatric illness. Just an SSRI and some benzos listed in the chart, and inevitably one of the residents would comment on how the patient was "crazy" and that it explained everything. After that, they'd disregard much of what the patient had to say; afterall, if they were in pain or worried about going home after surgery, it was because they were nuts. Clearly.

Usually people reserve "crazy" for multiple antipsychotics and some mood stabilzers. I was particularly unnerved by the choice comments reserved for a teen suicide attempt. She jumped from her building. There were comments from surgical residents, nurses and techs alike. "If she had really wanted to kill herself, she should have..." Awesome. I'm sure our empathy for this girls comes through.

What made it even better was that during this time I was starting psych meds. I have a rather spectacular personal and family history of depression, and I had just spent a month in family medicine telling patients that "it's not good enough to feel just a little bit better. We want you to feel at your best." I thought I would take my own advice. I also remember telling patients how safe and effective the medications are, and how few side effects they have. I regretted that one... I couldn't sleep, felt nauseous and jittery, and had a tremor that everyone noticed. I couldn't talk to anyone about it, because I had already seen how they judged people.

Good old SSRIs. Do you realize how common those things are? How common depression is? Most of the patients I saw during my family medicine rotation were on some sort of antidepressant. Heck, most people I know have had some sort of psych issue at some point in their lives. I've often said that I think everyone should see a good therapist at least once. Do none of the surgeons have these problems? Do they seriously not know anyone who does? Is it better in other specialties? I remember joking about it a bit with residents on pediatrics, mostly because when you deal with adolescents, you can assume there's a psych component; the trick is figuring out exactly what it is. On family med, the doctor often sent me into the room with patients who needed adjustments on their psych meds; I figured it was because it takes an hour to talk them down, and he needed to keep seeing other patients if we were ever going home that night. I still hope that's why.

There was another patient I remember who crashed her car. She was hysterical, panicked that she had hurt someone. I tried to talk to her about her medical history. She was very careful, very suspicious. It was a long time before she would tell me she was in some sort of behavioral program, and the medications she was prescribed. It sounded like she had a touch of schizophrenia and was slowly putting her life back together. She kept saying "I'm a good girl", and reiterating that this was an accident. Her brakes went out. She was afraid no one believed her. I reassured her, and she was slowly more open with me, but still very suspicious of everyone else and very adamant that this be confidential. I felt terrible. Clearly, she had been through something like this before. In the end, an x-ray confirmed several breaks in her foot and ankle, consistant with full pressure on the brake pedal, transmitting the force of the impact into her leg.

I always wondered how often patients could tell what the surgeons assumed about them. And if so, how tempted they were to omit it completely. I did, but the medications I take was not crucial information for my relationship with the residents. I didn't have to tell anyone in order to keep taking them while I was at the hospital. Seeing this, I have to think they must know. It makes me feel awful. I'm on psychiatry next... I hope it's better.