by Dr. Nadia Daly, PGY-3
At this year’s CPA Annual Conference, I had the privilege of interviewing David Goldbloom, MD, Senior Medical Advisor at the Centre for Addiction and Mental Health in Toronto, Professor of Psychiatry at the University of Toronto, former Chair of the Mental Health Commission of Canada, and last but not least, cherished mentor and role model to many of us.
Here is what he has to say about his new book “How Can I Help?”, about what discourages him in our field of psychiatry and about what he wishes he knew when he was a resident. We conclude with some fun facts about his personal life.
Your new book “How Can I Help: A Week in my Life as a Psychiatrist”, which you co-authored with Dr. Pier Bryden, came out earlier this year. What is it about and what were your intentions in writing it?
It’s about a week in my personal and professional life. Because I have done a wide variety of things in my professional life, from teaching to ECT to emergency work, this was a chance of showing the variety of things we psychiatrists do.
The intention was to combat the misunderstanding and the stigma around both people with a variety of mental illnesses and the psychiatrists who treat them. I feel that part of our job is to illuminate mental illnesses for everybody because nobody is exempt from these problems.
What are some of the responses you have received in regard to this book?
One of the most gratifying responses has been from residents who tell me, “I bought this book to give to my parents so they would understand what it is that I do”. Most residents have the experience that their parents are profoundly disappointed that after all those years of medical training, their child has chosen to go into psychiatry. Hopefully this book helps explain to confused parents of psychiatry residents what their child is doing – and maybe even why.
Two neurology professors of mine have written to me that the book explains psychiatry to them better than they understood it before. They also felt that this was a book not so much about psychiatry in particular as it was about being a doctor in general. And they felt that students in all the specialties should read a book like this. I would be delighted if they would, but I don’t have any illusions that that is going to happen.
Finally, patients and their family members have written to me about how much this captures their experience. There is an entire chapter devoted to ECT, our single most unspoken, stigmatized, vilified intervention, which also happens to be our single most effective intervention in psychiatry. A lot of people who have had ECT wrote to say thank you for positively portraying this treatment.
Top three reasons residents should read your book?
First of all, patients and their families might be reading it, so it’s good to know what they know. Second of all, I hope it will be encouraging to think about the variety of things you can do as psychiatrists and the rewards of the job. Lastly, I hope it would encourage every resident to be an advocate for mental health.
What discourages you most in our field and how do you deal with that?
I get discouraged when I see treatments over-sold. This can be anything from “CBT for everyone” to “Seroquel for everyone”. Ironically, while the number of diagnoses tends to increase, treatments tend to distill down to CBT or an atypical antipsychotic. It’s a narrowing that isn’t helpful.
I’m discouraged with the extent to which families still feel shut out from treatment.
I’m discouraged by the psychiatrists who are not engaged in any way with the larger health system, whether it’s with primary care, clinics, or hospitals. I wrote about this with Drs. Joel Paris and Paul Kurdyak last year in an article called “Moving out of the Office”.
I’m also discouraged by the failure of our health care system to recognize the need to modernize and increase funding for mental health services. I devoted some time to that through my work at the Mental Health Commission of Canada, but we are still lagging behind other countries in this regard.
But all of this gets offset in a heartbeat by seeing patients get better.
If you can enter a time machine and meet with Dr. David Goldbloom the psychiatry resident, what would you tell him? In other words, what advice do you have for training psychiatrists?
Don’t regard the personal history section of your interview as a painful, hurried exercise to try to establish points to hang your diagnostic formulation on—“the absent father”, “the cruel overbearing mother”, “the adolescent trauma”—on which you will come up with some facile explanation of why the person is the way they are. The idea that anyone’s life can be summed up in ten minutes is insulting. The personal history section is about looking for recurring patterns of identity, behaviour and interaction. (In case you have not noticed, humans are numbingly repetitive creatures).
Get comfortable talking about uncomfortable things. I find a lot of my residents have a hard time talking to patients about the “dirty details” of sexual life, especially if the patient is more than five years older than the resident, as if they make an assumption that sex no longer matters. And here we are, handing out drugs that significantly compromise sexual function and sexual pleasure. If we don’t ask about it, the signal to patients is don’t bring it up.
What are some of the ways you cope with stress?
I play piano. Some people have a scotch at the end of a stressful day. If I come home and have a lot on my mind, I play piano. But then I found out that having a scotch while playing the piano, tant mieux!
I also play squash first thing in the morning, 3-4 times a week. I have been playing squash for more than forty years. It is the best game ever, because after 40 minutes, you have had an unbelievable workout, there is not as much aggression left in your body, and you’re pumped for the day.
In one word, what drives you?
If you can be any animal, which one would it be and why?
I would be a dog. It would be for boundless energy, loyalty, continuous hunger for affection, and a great sense of play.
India with my wife. I will give you a recipe for the perfect holiday: regardless of whether you’re going away for a weekend or a week, with your partner or a friend, become unavailable. Shut down your data. You will be that much more engaged with the person you are traveling with, and guess what – you won’t miss anything.
This interview has been condensed and edited.