Sunday, November 17, 2013

The Wizard: Psychopharmacology Magic?

One of the most memorable psychiatrists that I worked with as a trainee is someone I think of as The Wizard. He specialized in treating some the most difficult behavioral manifestations of autism and other genetic conditions like Fragile X syndrome. He had a magical ability to calm even the most agitated children and adolescents and seemed to inspire reverence and awe in their parents, who kept voting him to the top of various "Best Doctor" lists.

What most amazed me about The Wizard was his Zen-like serenity. Regardless of how much noise the patient was making or how many toys went flying around the room, he would be like the calm eye of the storm, holding still while everything else moved around him. His gaze was remarkable, intense yet warm and soft, like a bright candle. He would focus intently on whoever he was talking to, making that person feel important and special. His voice was smooth and soothing, almost soporific; perfect for those in emotional distress.

He took no notes during the appointments. His dictated progress notes were usually just a couple of paragraphs long, without pesky details like what medications the patient was taking and what medication changes were made during the visit. However, he did not have to remember those things. During the visit, he would shine his bright gaze upon the parents and say, "So tell me, what did we decide to do with the medications last time?" And the parents always provided the details. Maybe they knew that they would be quizzed this way, so they prepared so as to not be embarrassed. More likely, I think the parents were pleased that this eminent psychiatrist trusted them enough to empower them in this way.

The Wizard was an expert psychopharmacologist, often prescribing medications that I've seen no other psychiatrist prescribe. Things that may have had success in case studies, but no positive clinical trials (and maybe even some negative ones). Yet for him, he was able to get results using those medications. Perhaps he was lucky, or with his experience he was able to intuit the right medication for a certain patient. However, I firmly believe that just being in his presence was one of the major therapeutic interventions that he provided for his patients and their parents.

I attempt to channel him during every patient encounter. But try as I may, I can't help but continue taking notes while talking to patients and then writing overly detailed progress notes.