What does a psychiatrist do all day?

6 a.m. The first thing I do when I get up these days is walk our dog, a year-old black lab named Whiskey, around our neighbourhood in Drummondville, Quebec. My wife Lynn Massé and I have lived and practised medicine in this small rural city a 90-minute drive east of Montreal for the past 30 years. Lynn retired as a family doctor here in 2019. But I’m still going strong as a psychiatrist, both in private practice and as a staff member at the Hôpital Sainte-Croix, a century-old facility in the heart of the city with nearly 200 short-term beds, including 20 in psychiatry. 7 a.m. I don’t drink coffee. I was never a big fan of the stuff anyway, but I gave it up completely 15 years ago because it made me feel anxious. However, I do enjoy a small breakfast like toast with peanut butter. Read: What does a pediatric palliative care physician do all day? 7:30 a.m. I leave home and make the 10-minute drive to my office in a family medical group clinic downtown. Once there I prepare my files for the 14 or 15 patients I’ll see for a half-hour or an hour each during the day. 8 a.m. I call my first patient from the waiting room outside my office, where a radio—not a TV—plays music. (The music helps to reduce people’s stress and ensures clinical conversations can’t be overheard.) Thanks to Hollywood and popular culture, there is a lot of stigma associated with psychiatry and mental health illnesses. But many conditions are quite common and they affect people from all walks of life. Depression, which is always major, is one of the most frequent pathologies I see and treat. Adjustment disorders—short-term emotional or behavioural disturbances like sadness, fear or anger brought on by stress or grief—are also common. Other frequent psychiatric pathologies include bipolar disorder, psychotic disorders like schizophrenia, personality disorders like narcissism or anti-social behaviour and anxiety disorders, which include several subcategories like PTSD and phobias that lead to intense, successive and persistent panic attacks that disrupt people’s daily lives. Thankfully many new treatment options have become available in recent years. New anti-depression drugs in particular are more effective and are better tolerated by patients who are more likely to continue taking their prescribed meds as a result. The same holds true for monthly injections to treat schizophrenia, where the number one reason patients stopped taking them was the intense side-effects. Most of my patients are referrals from family doctors who have tried to treat them with a couple of oral drug therapies like Prozac, Zoloft, Celexa or Effexor XR. I’ll usually first try a number of second-line drugs such as Abilify, Vraylar and divalproex. If those don’t work we can try a third line: electroconvulsive therapy. Also known as seismotherapy or electroshock therapy, it involves placing electrodes on each side of a patient’s skull and passing varying intensities of alternating electrical currents through their brain to provoke convulsive seizures that have therapeutic effects and benefits. ECT has been much refined since the 1950s and 60s, when it was widely considered a barbaric treatment that had no place in modern medicine. But patients now are put under general anesthesia and new ECT machines both control and target electrical currents to trigger brief seizures. The resulting changes in brain chemistry can put a quick end to some mental health symptoms in patients, including elderly people, especially those suffering from depression or melancholy and who don’t respond to meds. The success rate of ECT therapy is around 90%. That is very rare in medicine. The most important indicator however is making sure you give it to the right person. Noon Some days I eat in my office and read La Presse newspaper on my tablet. It helps me to relax and digest all the things I heard in my morning sessions. Other days I have lunch with my colleagues at the GMF Saint-François clinic, which has 14 doctors, including me. My wife Lynn worked here, and many of my colleagues are old friends. Family and friends have always played a central role in my life. I was born and raised in Chicoutimi, a four-hour drive north of Drummondville, in a family of nine kids (I was the second youngest). Our dad was a mechanic, our mom a housewife and I’m the first and only member of the family to be a doctor. I played hockey and baseball as a kid, but I switched to other sports like skiing and biking and golfing in the years after I went to the Université de Sherbrooke. I did an undergrad degree there in biochemistry (punctuated by a year-long trip in Asia and the Middle East with a girlfriend) and was planning on a career in fundamental genetic research. I landed a summer work placement in Strasbourg with the idea of coming back to do graduate studies in the field. But pure science is very isolated work, and I was worried that my social life would suffer as a scientist. So at the Mirabel airport on my way to France, I applied to both the Master’s program in science and the medical school at USherbrooke. In August, one of my brothers called me to tell me I’d been accepted in both programs. I decided to go into medicine and arrived three weeks late for the session. That’s when I met Lynn, who was one of my new classmates. After medical school I was thinking about becoming a surgeon. I did three residencies, including one in Cordoba, Spain, which was amazing. Those experiences made me realize however that I didn’t want to be dependent on surgical systems, which are complex and depend on many people, including doctors, medical staff and hospital administrators. I thought it would be hard for me to deal with. I also realized during my training that I hated doing physical exams. I found it frustrating trying to diagnose problems by touching. So I turned to psychiatry, which has an intellectual aspect that I love. Unlike any other medical field, it touches on many facets of human life, from anthropology and sociology to the physical and cultural. There’s also less technique involved. Instead, you work with concepts and people. And there’s an element of neuroanatomy to it, which fits with my biochemist training. After doing a residency in forensic psychiatry at Montreal’s L’Institut Philippe-Pinel, I came here to Drummondville in 1990 to do another. Lynn also had a chance to work in obstetrics and started her 28-year career here. At the time, the psychiatric department in Drummondville, which had opened in 1975 and was affiliated with USherbrooke, had only one psychiatrist and a handful of beds in an old nursing school next to the hospital. In addition to my fierce independent streak, I’m also a leader. I like to work with others and mobilize them around an idea or concept. I’ve always believed that people are resourceful and have lots to offer when they are properly motivated. I started working to build the department here by bringing in residents and students and adding human and community resources. In 1993, when I became department head, I also started teaching and giving conferences on my own time for local family doctors about psychiatric practices, drugs, therapies and theories. Since then the department has continued to grow. We’ve notably added several specialized clinics, including personality disorders, youth psychosis, outpatient services, day services, and psychiatric and social services through a first-line, CLSC-led mental healthcare team. We now have 11 psychiatrists and a modern unit with 25 acute-care beds for a city of 70,000 people and a rural region with twice that number. I stepped down as department head in 2007 to become medical director of the hospital, which has 135 doctors. But I gave that position up too in 2015 to focus on my clinical practice, which also includes regular hospital duties, acting as an expert witness in trials and hearings, supervising the CLSC team, and my private clinic. I was able to wear so many hats because we had built a great team that, while autonomous, could always reach me. Since 2019 I’ve lightened my workload even further. I only work three or four days a week and I don’t anymore do ER work or be on call. I’d like to keep doing this for a few more years at least. 1 p.m. I’m back seeing patients—or I’m doing work at the hospital or something related to expert testimony. 4 p.m. My work day’s over but my exercise time begins. In summer I hit the golf course most weekday afternoons and play nine holes on foot. On weekends, Lynn and I usually play with friends, many of them long-time colleagues. I’m a good golfer, with an 8 handicap, but for me golf is leisure, not a sport. It’s a great way to relax outdoors and lift my spirits after a day of listening to a lot of suffering. In winter I used to do yoga, but now I do pilates group workouts with Lynn. It’s great for flexibility and keeps me in shape for skiing at Mont St. Anne, where we have a chalet. 6 p.m. After walking Whiskey again I usually make supper. I love to cook and I watch a lot of cooking shows and like trying new things. 8 p.m. Lynn and I like to relax and watch TV or read. Lynn likes novels, but I prefer non-fiction articles on all things scientific, as well as on anthropology, archeology and history. I also read papers and articles on psychiatry, and keep up with my CME requirements. Lynn and I also stay in close touch with our three adult children and our two young grandkids. Being a grandparent is fantastic. 10 p.m. Time to put Whiskey outside for the last time today, then watch some news before heading to bed.—As told to Quebec City writer and longtime Medical Post correspondent Mark Cardwell

What does a psychiatrist do all day?

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