A psychiatrist presenting emotion [PODCAST]

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“Many families still prefer their providers to wear a mask. I have no way to know who carries what political or health views around their mask-wearing. Their masks were off, and mine was on. When I asked them for their preference of whether they feel comfortable with me wearing a mask or not, the parent’s response was: ‘Whatever you want. It doesn’t really matter.’

But it does matter. Doesn’t it? It matters if you feel comfortable and safe. It matters if I am an agent of viral infectivity. It matters if you want to be able to read my emotions as much as I need to read yours. It matters if your child has autism, is hearing impaired, or even if English is your second language. It matters if we want to ‘get back to normal.’

But for all the reasons listed above, I find that I don’t want to lift my mask just yet. Given a choice, I find myself behind the mask still.

At least, for now, this continues to give me the semblance of safety: to wear my heart on my sleeve and my emotion on my face. I will not feel guilty about this. I am just a psychiatrist presenting emotion. PPE for me.

Shivana Naidoo is a child psychiatrist.

She shares her story and discusses her KevinMD article, “PPE: psychiatrist presenting emotion.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Shivana Naidoo. She is a child psychiatrist. She wrote the KevinMD article “PPE: psychiatrist presenting emotion.” Shivana, welcome to the show.

Shivana Naidoo: Thank you so much. Thanks for having me.

Kevin Pho: So we’ll get into the article in a little bit, but first off, share your story and journey to where you are today.

Shivana Naidoo: So my name is Shivana Naidoo. I’m a child and adult psychiatrist. I was born in Minnesota. My parents moved there from Guyana, which is where they immigrated from, a small country in South America. And I moved to New York, where I spent most of my life. I did my training all in New York, and then after that, I moved to Arizona for my first job. I’ve been kind of back and forth, but we just got a house, and now we’re here in Arizona.

I’ve basically been working in all aspects of outpatient mental health care. In training, we do inpatient, we do ER, we do consults, so as a part of our residency, we kind of have all facets of psychiatric background in us. But really, I’ve chosen to be a soldier of mental health care in the outpatient world. So I’ve worked for private practice, I’ve worked for hospitals and an outpatient setting, and now I work for a very large nonprofit. My hope is that I can add to the hundreds of people working in mental health care to combat depression and anxiety.

My role at this point is really to educate people. I feel like my parents are teachers, and I think being a part of your podcast is one of those aspects of just really getting the word out there on how to get really good mental health care. So I’ve started a podcast called “Thinking It Through with Dr. Naidoo, Child Psychiatrist,” which you can find anywhere, and that’s really just to give education about how to maneuver this complex world, with insurance and without insurance, to really get the best mental health care for you and your child.

Kevin Pho: So you have a platform here on KevinMD. So tell me, what are some of the main messages that you want to convey from your perspective?

Shivana Naidoo: Oh, so I think that the number one thing is that you have to find the right fit for you. And this is going to be a journey, right? It’s not like just walking into a shop, into Walmart, and finding the product you want because everything is lined up. Really, it’s like walking into Walmart and everything is all over the place, and you have to kind of look around and keep your eyes peeled. That is unfortunate, but that is how the world is set up right now. But I do think that telehealth is going to really widen the option, to have greater access to clinicians and therapists and physicians who really are able to provide help for you.

But I think if you find your first fit with a doctor or a professional and it’s not a good fit, that’s OK. Keep trying, because we have to work on that alliance and on finding a good fit for you, to really help you in the best way possible. So I would stay encouraged, even if the first person you meet is not the best fit for you. I would remember that, in a world where we want a quick fix, just like every chronic medical condition, diabetes, hypertension, cancer, it’s a journey. So one pill may not fit all. One therapy may not fit all. We’ve got to try and see, which is why I think that alliance is so important.

And I think the last thing I would say is that it takes more than just one intervention to really help your health care. We need to be thinking not just about potentially medication or therapy, but also diet and exercise and relationships and mindset. So I think that COVID has really primed us to have these discussions. That’s one of the positive things I think has come out of COVID: to really bring mental health care and the need for that to the forefront, and how we can chip away at that every day. And I think one of the benefits of social media and having our platforms online is that it makes it accessible and free to everyone. If we know where to look and persist in looking, we can find those tools.

Kevin Pho: Now, especially in my area, it is very difficult to find outpatient behavioral health. So for those patients who may be listening to this, do you have any tips and tricks on how to find an outpatient behavioral health clinician?

Shivana Naidoo: Yes. So I have a podcast episode on “Thinking It Through with Dr. Naidoo” called “Connecting to Care,” and that entire episode is about connecting to care. The first thing you can always do is go through your insurance company, on the back of your card. You can call, and they should be able to give you three people who take your insurance, which is the most prohibitive thing, right? Being able to pay for care. So three people who can take your service and be within a certain vicinity, a geographic vicinity. There are lots of online opportunities that you can also find by looking at your local websites.

I also think that another option would be any academic health center that you’re close to, because academic health care centers have residents, and residents are in training, and they care, and they want to do a good job. And they have great referral sources. And academic centers tend to be associated with an ER and pediatrics. So as you know, as an ER doc, you are kind of the gatekeepers for everything. So I think if you have a good ER, an academic center, those are good ways to kind of be able to get your buy-in into a good mental health professional. And I think online, also, there are lots of great new platforms that are set up to be able to meet care where you’re at, in your own home. So I would continue to look through those resources.

Kevin Pho: All right, let’s transition into your KevinMD article. It was published back in April. It’s titled “PPE: psychiatrist presenting emotion.” Now, for those of you who get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Shivana Naidoo: Sure. So as a psychiatrist wearing a mask and seeing patients in person over the past two years, I’ve kind of thought a lot about the symbolism of what that means and how to express that. And for those who are not connected to mental health care, anyone who trains to be a mental health care professional, whether it’s a psychiatrist, a psychologist, a social worker, or a therapist of any level, is kind of trained to be able to keep this poker face, basically like a mask, right? That way, whatever the patient brings to you, they can continue to bring to you without having your reaction influence what they share, or feeling judged. That takes some time to develop, and for me, that was really hard, because I feel all the feels, right? So once I developed that poker face, it was interesting to then have to wear a mask, and then to be able to kind of share more of my authentic self.

So this article is really reflecting on the nuances of what it means to reflect your authentic self while being a psychiatrist, because so much of our training is to kind of hold yourself in, so that people can be themselves by holding yourself in. And I think that kind of dovetails into a little bit of an analogy between being a physician and sharing yourself on social media, because I think that also kind of puts yourself out there. But you want to be able to put yourself out there in a way that’s authentic to you but also protects your privacy. You want to cultivate a brand but also be authentic to who you are as a person. So I think that the mask has really been a great analogy to understand: Who do we really want to be? Who do we really want to show? And what do we want our patients to get from us?

And I think mental health care is really changing, because social media has put so many mental health care professionals out there, and people want to choose people they like, right? They want to get a read of you before they see you and start talking to you. So I think that’s something that’s really changed compared to when I started my training, because when I trained, we really didn’t put anything out there. But now I think you have to, if you want to be something and go somewhere and share your message.

Kevin Pho: Now, what kind of tips and advice do you have? Because most physicians, when they’re training, are trained to be proverbially stoic. How can one put themselves out there? How can one be authentic, especially on social media or even in the exam room? What kind of tips do you have for clinicians to be their authentic selves while straddling that line of professionalism?

Shivana Naidoo: So it’s challenging, I think, and I feel like I am still working through that. But I think that it’s important to share compassion and genuine emotion. Compared to my training, where nothing should shock you, I think that when you are shocked, when you do hear a story that touches you, holding their hand and saying, “Oh my God, I can’t believe you got through this. You’re incredible,” just sharing your true feelings in a supportive way, I think, really goes a long way with developing that alliance with the patient and having them trust you.

I think online, it’s been a challenge. I’m still learning, and I think that it’s great to have role models like you who are doing it and doing a great job. But I think being aware that whatever you put out there cannot come back is important, being aware that whatever you put out there is going to be a reflection of you, and you don’t know to whom, and being aware that we are an agent of change and positivity or negativity. So I think as physicians, as healers, as leaders, remembering to put yourself out there in a way that continues to foster growth and development and healing is something we should always remember.

Kevin Pho: Now, do you have a case study or an example of a success story where a clinician authentically put themselves out there? You can take that in any direction you want. And how did that positively affect their practice?

Shivana Naidoo: Off the top of my head, I’m not entirely sure. However, I do listen to SiriusXM, and I listen to Doctor Radio. On Doctor Radio, I have heard several doctors, on that version of radio, and it’s not quite podcasting, share a lot of their intimate stories about being physicians and how it touches people’s lives. There’s a particular portion called “Vital Signs,” where they talk about themselves being patients as doctors, and how that has helped them be better doctors, because they’ve learned from being a patient what that is like.

I think there are several stories of mental health professionals who have put themselves out there, having dealt with suicide, having dealt with depression and anxiety, having schizophrenia, and walking through that and becoming leaders in the field, to be able to help others get compassionate care and to give the best care possible. So I think that those of us, you know, every doctor can become a patient. And there’s a saying. As a trainee in New York, our psych ER is called a CPEP, or a comprehensive psychiatric evaluation program. So we would all say, “We’re all one foot in the CPEP.” All of us could become mentally unstable given the stressors, given a certain kind of amount and threshold of stressors.

So I think having that compassion, and knowing that we could all kind of be in a position to need help, helps us to see ourselves in our patients and helps the patients see that we care about them. And that’s really what it is. It’s having the patient see that we genuinely care about them despite the busy world that we have, and see that we want to do our best and that we’re going to try whatever way we can to do that.

Kevin Pho: We’re talking to Shivana Naidoo. She is a child psychiatrist. She wrote the KevinMD article “PPE: psychiatrist presenting emotion.” Shivana, over the past few weeks, there have been some tragic mass shootings across our country, and I’m interested in hearing your thoughts about that from the perspective of a child psychiatrist.

Shivana Naidoo: So, as a child psychiatrist, it’s been a really challenging few weeks, as a child psychiatrist and a parent. I also did another podcast episode on this recently, in response to the Robb Elementary School shooting, because it’s made me look at my patients a little bit differently, and my kids a little differently. When this happened, it was the tail end of the school year for my children. It happened on a Tuesday, but I still had to send my kids to school on Wednesday and Thursday, and I, like many, many parents, really struggled with doing that. And I know on the East Coast, they’re still doing that. They have another month of school left.

But I think for my patients, you know, I see so many kids, and I see a lot of these adolescent males who are now being kind of represented as a group to watch and look for. And I think that for a lot of these young men, we need to work harder at helping support them earlier on and helping them feel connected, not just to care, but to each other, to society, to friends, to school, and to themselves.

And I think this goes back to authenticity. I think that for a lot of our young people who are growing up in the era of social media, and putting not their authentic self out there but putting something else out there to get the likes, or to get approval, or to get attention, there’s a disconnect developing between who young people really are and are feeling on the inside and what they put out there. And I think that disconnect further isolates young people, which is what helps us know that we need to help in-person contact kind of restart, despite COVID, despite telehealth and its technology. We still need to have people holding hands and hugging and having face-to-face conversations.

In my podcast episode, I spoke about my expertise in assessing for suicide. My suicide assessment and questioning can take a good 30 minutes, to get a good handle on what those thoughts are and really help them think this through and think forward. But for homicidal ideation, we still have work to do. It is so, so rare that people who present for mental illness have homicidal thoughts. It does happen, but it’s rare. And I think that having these shootings persist makes me, as a psychiatrist for teenagers, and teenage young men in particular, be much more conscientious about spending the time to assess for those as well, and really trying to work at connecting young people to care and helping them feel valued.

And again, going back to that interaction between me and a young person: them feeling connected to me, right, them feeling that I’m listening to them, that I’m validating their concerns, that I’m here for them, is really important. And I think the idea is that we’re going to continue to work with them and follow them, even if they’re not ready. So many of these young, I’m going to say young boys in particular, who cause me some pause, don’t readily open up. I have my 60-minute assessment, and then I have another 30 minutes or 15 minutes, and sometimes we have to sit in silence. But I’m making small interventions, small statements, kind of trying to bring them out of their shell and trying to tell them things to let them know, “I want to hear your story. I want to hear what you have to say, and I value you and your life.”

Now, that’s kind of part of the power, I think, of being a mental health care professional: knowing that we have that ability to kind of reach in and give that inner hug that they need, if they’ll let us, and if not, to continue to see them until they will. But a lot has to change with mental health care. We have a really broken system, and it’s been really frustrating for me as a psychiatrist working in community mental health care, seeing all the gaps that we still have, despite all the resources that I have at my fingertips. I still feel like we can do more and need to do more in terms of mental health care.

And I think also, it’s about dispelling the myth, right, that school shooters all have mental health care issues. That may or may not be true, and I think the vast majority of mental health care patients do not have violent tendencies and do not hurt people. And it’s knowing that it’s more than mental health care that needs to be fixed to solve this problem. There are societal levels and political levels we need to involve, and that involves not just gun regulation but also families and restructuring families, having families spend more time with their children, having schools be more cautious and aware, and educating our children about what they can do to get help for themselves and for their peers if they need it.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Shivana Naidoo: So I think the take-home message for me would be that there is mental health care out there. It’s hard to get, but we’re there. There are good psychiatrists like me and good professionals who want to help your child and help your family. Keep looking for us.

I would also say that anytime you feel that your child might be in crisis, please call the hotlines. Please let us know. Please don’t ignore the warning signs for your child needing help. It’s always a good idea to have one of us take a look at your child beforehand versus waiting until they’re too far gone. We want to avoid hospitalizations, and we want to avoid crises, so be proactive and look out for us. You can always start with your schools. You can always start with your family, with a therapist first, and then come reach out to the level of psychiatrist if you need to.

And in terms of responding back to my article about PPE, I think, as a young psychiatrist, if anyone is out there, young psychiatrists, young professionals, know that the mask we have developed to become this professional can be lifted, and that you can become your authentic self and share a little bit of that to really build that alliance with patients. And then I think that they will appreciate that and need that, especially in these times.

Kevin Pho: Shivana, thank you so much for sharing your time and insight, and thanks again for being on the show.

Shivana Naidoo: Thank you so much, Kevin.

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