1. An Experienced Psychiatrist's Departing Pearls
Charles Hart Enzer, M.D.
Rechov Emek Refaim #24 Apartment 1 German Colony, Jerusalem
Israel
  WebSite:  homepages.uc.edu/~enzerch
Child - Adolescent - Adult - Family – Psychiatry
An Experienced Psychiatrist's Departing Pearls
Objectives:
The Role of the Patient
The Role of the Physician
“Easily, I Can View the Patient as Non-Compliant.
My Challenge: How I Must Change First”

2. An Experienced Psychiatrist's Departing Pearls
Disclosures
No Potential Conflicts of Interest to Report
Senior Attending
Good Samaritan Hosital
Practiced Psychiatry for 90,000+ Hours
Board Certified General Psychiatrist
Board Certified Child and Adolescent Psychiatrist
Past Board Examiner
Volunteer Associate Professor of Psychiatry
University of Cincinnati Medical Center
Suicide Rate of Zero
All Patients with Schizophrenia Competitively Employed
Most with a License to Practice a Health Profession

3. Interruptions vs Contributions
An Experienced Psychiatrist's Departing Pearls
Interruptions vs Contributions
Questions Are Contributions
Criticisms Are Contributions
Comments Are Contributions
Who Is Wise: Who Learns from Every Person
Sayings of the Fathers, Chapter 4, Verse 1
איזה הוא חכם -- הלמד מכל אדם

4. Rule Out Suicidality in 15 Seconds
Enter Text here… ..

5. Indirect Questions Make it Easier, Safer to Say Everything
General Principles for Effective Interviewing:
Avoid Asking Direct Questions
Indirect Questions Ease Talking about Sensitive Matters -- Safer
Universalize
“Many People ”
“People Who Have – Name the Disorder/Complaint ”
Use a Time Reference
“I Wonder When was the First Time You Recall ”
“I Wonder When was the Last Time You Recall ”

6. 1. Assess Recency of Suicidal Urges
For Generalized Screening:
People with [Disease/Complaint] from Time to Time, Think about Suicide
I Wonder When Was the Last Time You Thought "I'd be Better off out of the Picture, Dead – about Suicide“ Or
I Don’t Know When Was the Last Time You Thought "I'd be Better off out of the Picture, Dead – about Suicide"
 If Positive, Review the Remaining Two Questions of the 45 Minute Evaluation of Suicidality at:

7. Key to Evaluating Suicidality is Getting the Chief Complaint I Don’t Know How You Get the Chief Complaint
Enter answer text...

8. How We Get the Chief Complaint is Informed by Our Understanding of the Term Chief Listening to How You Get the Chief Complaint, Leaves Me Wondering: Your Definition of Chief
Enter answer text...

9. I Wonder What You See as the Function or Role of the Chief Complaint
Enter answer text...

10. The Value of The First words the Patient Says:
Chief Means:
Most Important
Main
Principal
Crucial
Essential
Note Well:
The Value of The First words the Patient Says:
May Be Clinically Limiting
May Be Clinically Distracting

11. The Chief Complaint How We Get It
Tells Patients Our Concern about the Whole Person
Tells Patients whether We are Listening
Leaves Patients Feeling:
I am not Being Doctored
I am Being Doctored

12. Chief Complaint = Essential
There are Three Components to a Chief Complaint
Reasons
Deciding
Temporal = Now
I Wonder What Are Your Reasons for Deciding Now is the Time to Seek Medical Care

13. 58% of Psychiatric Patients Have Physical Illnesses Undiagnosed
27% of the Physical Disorders of Psychiatric Patients Produced Symptoms Related Directly to the “Psychiatric Symptoms”
Psychiatrists and Psychiatric Institutions Missed the Physical Disorders in about 50% of Patients
Non Psychiatric Physicians Miss Physical Diagnoses in about 30% of Patients They Refer for Psychiatric Treatment
Koranyi EK. Physical health and illness in a psychiatric outpatient department population. Can Psychiatr Assoc J. 1972;17(2):Suppl 2:SS109.
Koranyi EK, Potoczny WM. Physical illnesses underlying psychiatric symptoms. Psychother Psychosom. 1992;58(3-4):

14. Diagnoses Do Not Classify People
Diagnoses Classify Merely Disorders/Diseases

15. How to Earn Distrust
See My Website

16. I Earn Trust by: Suspending Moral Judgment
Judgmentalness Aborts Compassion
Maintaining a Zone of Safety
Examining Comprehensively
Informing about the Findings
Making Recommendations
Only When Indicated, Providing Specific Treatments

17. The Basics of Doctoring
Be Curious
Be Thorough
Enjoy Caring for the Patient