What does it really take to be a good psychiatrist? One of the competences needed in this line of work is the ability to collaborate. There are specializations in medicine where you can concentrate solemnly on your patient`s specific pathology and work independently. Psychiatry is not one of those specialities due to the nature of the pathologies addressed.
To really help and understand the patient you have to know what is going on in the patient's life. All somatic aspects play a huge role in the way we experience life. There are bidirectional relationships between so many somatic and psychiatric diseases. As a psychiatrist it is impossible to be an expert in different internal medicine disciplines, so a good collaboration with those specialists is essential. Due to the aging population, we are all working more and more with patients that are considered multi-morbid. In order to stabilize patients' mental health, we have to make sure they have been motivated and educated in treating their concomitant diseases. By failing to do so we are in a fast track for mental disease relapse. Nowadays the collaboration between different doctors seems even more essential because of the constant evolvement of specialities. As treatment plans and diagnostics become more complex, we tend to fail in looking the whole picture. Most specialist doctors seem to examine the patient through their “speciality goggles” and often fail to recognize other major pathologies that excessively impact that patient's life. To put it bluntly, by treating the broken finger we must also see that the finger was perhaps broken due to a major fall which was caused by a cardiac arrhythmia or a severe neurological disorder affecting balance or perhaps auditory hallucinations that the patient was running from. We need those multidisciplinary discussions to understand what we could be missing to establish a correct diagnosis and a treatment plan. In my experience collaboration is the way to excellence. The GPs can only observe and treat the patients well enough if they are supported by the specialist doctors with treatment recommendations and care plans.
Besides the need to work with other doctors we need to collaborate with other types of specialists like social workers, clinical psychologists and mental health nurses in order to do our job well. We might start to use artificial intelligence and decision support technologies, but none of that can validate your gut feeling about the diagnoses. In so many occasions I have sat with my teams' clinical psychologists in meetings and discussed what kind of diagnostic hunch or feeling they have after interacting with the patient. In those discussions we listen to each other, brainstorm together, reflect about patient encounters and come up with joint hypothesis to aim for correct diagnosis and better treatment. Often the patient's behaviour, verbal cues and complaints are different or even opposite in different situations, but by talking about our different experiences with the patient, we notice aspects that we haven’t noticed before. Working together with those specialists you also get a support system to pull you through the hard cases and a sense of unity towards a common goal.
Another aspect of quality psychiatric care is the collaboration with patients' family and loved ones. Disease recognition and care continuity is often fostered through supportive families. The closest people to the patient also need information, explanation and psychoeducation to support their loved one in their recovery.
People only really learn and feel connected through others, through meaningful relationships. Good collaboration with patients, their families and colleagues is one of the remedies to prevent burnout. Without collaboration a specialist could be like a horse with eye blinders running in a tunnel towards the wrong goals. The wisest people have the skills to listen, the ability to question their convictions and courage to change them when needed. Knowledge comes with asking questions and collaborating, not assuming and knowing. We are wiser through collaboration and our patients are better off.
What kind of doctors are loved by the patients? Is the academic knowledge enough to be a good doctor or do we need to have also good communication and collaboration skills? I aim for the latter part, although the former part is of utmost importance. Patients need to feel heard and understood and treated with empathy and respect, only this way the patient-doctor relationship fosters a good treatment pathway.
What kind of personality traits does a good collaborator need? Emotional intelligence, interpersonal skills and also an adequate self-esteem seem to be one of the key factors. We can promote good communication and collaboration through organizational trainings and acknowledge people that demonstrate excellence in those areas, for example choosing a colleague of the year etc. Estonian national psychiatric organization in collaboration with the national health board established quality care indicators that emphasize the need for multidisciplinary treatment teams and regular supervision. In that sense these indicators also value collaborator competence. □