The psychiatrist isn't so scary. Episode 8

Monika Rachtan
I invite you to listen to the podcast. Patient first. Good morning, I welcome you very warmly to the podcast. Patient first, and today my guest, but above all your guest, is Slawomir Murawiec, MD. The doctor is a specialist in psychiatry. He has been treating patients for thirty years now. He is also the co-developer of therapeutic ornithology. But we'll take it easy today, we're not going to talk about birds, but about the intricacies of the patient-doctor relationship. A warm welcome to you, doctor.

Slawomir Murawiec
Good morning.

Monika Rachtan
Doctor. In a moment I am going to ask the doctor really a lot of questions about the work and life of doctors, but especially psychiatrists. And it seems to me that this is a very interesting subject not only for me, but above all for that part of society which does not have direct access to psychiatrists, e.g. does not have them in the family, and creates for itself some different images of what the life of a doctor looks like, what the life of a psychiatrist looks like. We in Poland, however, have such a tendency to create such stories and out of these stories later arise certain problems or certain expectations that patients have towards, towards these doctors. And the patient-doctor relationship is not always what it should be. And maybe I should start with young doctors and those who decide to study medicine. They choose a direction. They think that. And once they get to that hospital ward, they will immediately take care of patients, they will help them. But that's not always the case, and some of them run away on their third degree alone, because they say they don't see much point in working with patients.

Monika Rachtan
Is this pathway for a medical candidate really that convoluted and difficult?

Slawomir Murawiec
It seems to me that it is, but I am glad that you started by putting it this way. Because on the one hand, when we talk about doctors and we talk about psychiatrists, we are talking about a certain, let's say reality, the reality of our work or the reality of the needs of our patients, the treatment, the system and so on and so forth. And on the other hand, to a large extent we are talking about imaginary. And so if we were to start talking about psychiatric doctors we're talking about the fact that very many people have some ideas, they have ideas about doctors, they have ideas about what these doctors should do and what they shouldn't do, how they should behave. And they have ideas, of course, about psychiatrists. Why and how these psychiatrists should behave, or if, or just act. And what is a certain danger, it seems to me, when talking about such complex subjects, is to judge too quickly, that is, well, he said this, but it should be completely different. But after all, everyone knows that doctors should be like this, or do this, and psychiatrists should do this and that.

Slawomir Murawiec
And at this point we kind of block this possibility of understanding, and we use our own ideas, this is the first part of your speech, when you said that if someone doesn't have this doctor somewhere close, in the family, they can't talk to him, or even they can, because also members, members of my family also have wild ideas about doctors and what doctors can supposedly do, for example that all doctors more or less know each other in Poland. A phone call is enough to get things done.

Monika Rachtan
it is after all. Of course it is, that this doctor comes to the hospital. And why didn't this doctor call his colleague could help me and treat me, he just gave me this referral.

Slawomir Murawiec
So true.

Slawomir Murawiec
Therefore, we are talking about a large field that is saturated on the one hand with some reality, on the other hand with expectations, imaginations, fantasies and so on and so on anxiety, well, because it is an important sphere. Health yes, mental health or health in general sometimes devalues. Well, the psychiatrist There's a famous joke that they differ from patients in that they leave work at fifteen. There are quite a few different areas like that, which would have to be cleared up a bit, just at the beginning. And now these young doctors are also a nice example, because they come in having certain ideas, having ideas perhaps partly brought up from home, if they have seen at home that someone is a doctor. But, but if. Well, they have all sorts of ideas, and these ideas are probably the most common. However, I would say idealistic ones, i.e. to heal, to help, to do something. And these ideas can come from, for example, the fact that someone in the family has been ill and is getting a bit of treatment, going into this medicine to help.

Monika Rachtan
Or he has not received help and says I will be the one.

Slawomir Murawiec
Exactly right, or that is how I will be the better doctor. Therefore, this motivation seems to me to be mainly such a, well, very valuable motivation, that is, such a pro-social motivation. For the good of the people and so on. And then there is often a clash with reality. Professional burnout appears not only in doctors with many years of experience, but also in students, because various elements of this reality do not correspond to their ideas, expectations or needs. And I am not saying that this is on the part of these young people, it is often an absolute clash with reality, which does not correspond precisely to how it would be more optimal or whether it would be better. And as a result, when we start talking about the relationship between the doctor patient, the psychiatrist, the patient, medicine patients, we start to enter a field that is incredibly difficult, as they say now a sensitive subject, a sensitive subject, because it is saturated with such a mass of all kinds of perceptions, fears, hopes, needs, and on the other hand realities, limitations, that in principle we enter a very such a slippery area, where?

Slawomir Murawiec
And here I would urge our listeners to do something that seems to be very absent these days, namely to understand, not to judge. That is, not to, but they should, because this is what doctors hear in Poland all the time, but they should just try to understand both. And here, of course, the needs of patients are very important and. But also to understand doctors, to understand the conditions in which they work. And only then are we able to talk to them in a meaningful way.

Monika Rachtan
Doctor, and I'll come back to these perceptions, because it seems to me that half of society at least would say that young people go into medicine for money. Even though we said that they go to help, everybody thinks of doctors as people who do things for money, because they do private hospital admissions, here, there, they have so much of this work. And everyone, however, maybe not everyone, but some people may perceive the doctor in exactly that way.

Slawomir Murawiec
I would see it differently. I would see that if I wanted to make money, I would go to a slightly different university, one that was more finance or marketing. Well generally more towards the business side of things and that would then be clear and clean. On the other hand, it seems that a lot of people go into medicine precisely either wanting to help or wanting to give meaning to life. Yes, because it is, however, a certain chance to make a meaningful life, to help others. In any case, for these sorts of reasons, this money that is attributed to us as doctors, compare it with other professions that are so demanding. It's also the kind of inequality we very often feel: if someone earns money, makes a living, they're an enterprising person and generally cool, and if a doctor has any money at all, it's suspicious.

Monika Rachtan
But also, doctor, that moment when a doctor. It's how much he or she has to go through to get to that point, to be able to earn decent money. It is a very long road. Let's remember that it doesn't take as long as, say, someone graduates with a marketing degree in their third year of university, they can already go to work, they can already think about buying a flat, whereas a doctor usually has to work 10 12 years on 24-hour on-call duties to be able to think about such a decent life at all.

Slawomir Murawiec
And this is a problem that I, as you said, have been working with for 30 years. Whereas the beginning of my work was from job to job, well now probably many young people have the same thing, the same way, which is from one job to another. We hear about doctors dying, from overwork. Every now and then a colleague unfortunately falls from this overwork. Going from on-call to on-call. Therefore, the costs are really disproportionate to this effort. That is to say, we put in a great deal of effort after working a great many either full-time or part-time jobs, often after nights, because these are on-call duties. Whereas, again, I'm talking about these perceptions, This attitude is like you're going to make it, you're going to be a nice entrepreneur, woman, but as if you're a doctor, that's a bit much.

Monika Rachtan
Meaning.

Slawomir Murawiec
Suspicious, isn't it?

Monika Rachtan
And I understand.

Slawomir Murawiec
That it.

Monika Rachtan
As much as that? Yes, it is.

Slawomir Murawiec
Again, in these attitudes, which we are talking about a little here, there is already a different qualification, a different way of thinking, often very ambivalent. Again, to put it in a somewhat simplistic way, I would say that if a doctor is poor, he is a bad doctor, and if he is rich, he takes bribes.

Monika Rachtan
The poor reader doesn't come to it. Well, yes.

Slawomir Murawiec
And we basically have such a bit of a no-win situation then.

Monika Rachtan
And did the doctor decide to specialise in psychiatry?

Slawomir Murawiec
For me it started already at university, I can say, and probably for me, as I identify, such a breakthrough was Kępiński's book. Antoni Kępiński, such an icon of Polish psychiatry. It was anxiety, as far as I remember. Well I was probably about twenty years old there and I read that book. And suddenly I understood, I recognised, I saw that there was some kind of key to understanding people, to understanding people's behaviour. So with me it went through that. Through this kind of channel of understanding, that there are tools for this in psychiatry, which I discovered thanks to Kępiński. To understand myself, to understand people, and so I became interested in psychiatry as the field that uses these tools to the fullest. And I think.

Slawomir Murawiec
That it somehow comes in handy or works in my work, I mean it comes in handy in this work precisely in the sense that when I talk to patients, very often this understanding, understanding their situation, understanding the dramas they are in, can be just useful for them. I'll say again a little bit in terms of what we were saying earlier that a lot of people find it difficult to make that connection, which is, for example, I'm not sleeping, it's very bad, and there's a restructuring at work. And I don't know why I'm not sleeping and I'm in anxiety. And really, really people don't make that connection. Really people don't make that connection and sometimes understanding their situation. Obviously I've chosen such a simple example here, but really people sometimes don't make that connection. It just seems to them that they should continue to be so fit, so high c fit, and here it's not clear why they are no longer so fit. And that's exactly what they should be, and especially at a time of restructuring. So I think a big part of my work is just building such bridges of understanding, well also this line of therapy that they trained in, in this so-called view therapy, based on understanding, also starts from the same premise, that if you understand, understand what's happening to you, understand yourself, well then it's even therapeutic at that point.

Slawomir Murawiec
That is, he is able to change the course of life in this way. Therefore, this thread of understanding is not only individually useful for him in his work, but is also present in certain courses of action.

Monika Rachtan
Doctor, and whether after those years of study. Because there must have been many, and after those 30 years of practice. The doctor feels that he already understands and knows everything about the human brain.

Slawomir Murawiec
Well, that's exactly what it doesn't. And that's cool. I think it prevents professional burnout. Because I don't know. Probably every field of medicine is infinite. In the sense that there are new perspectives all the time. And I hear that being at neurology conferences, that there's a breakthrough in general and it's great. Do cardiologists also talk about innovative methods, So probably in every field this is happening. But psychiatry also provides that. I mean there's not a point where I already know everything, that I already know nothing new, it's just that basically on the one hand psychiatry is developing all the time, on the other hand basically patients can always surprise us. Surely, therefore, each individual patient is also a slightly different world and a different possibility of understanding. And also times are changing and psycho-pathology is changing. So there is no need to explain. When we have a pandemic, new types of problems or disorders appear, but the changes in civilisation generate other attitudes of people and other problems. Therefore, in principle, I would say it is difficult to get bored, because something new is emerging all the time.

Monika Rachtan
Doctor, and let me ask you a little bit more about this kind of private life of a psychiatrist. When, for example, you go to a private meeting, you're in new company and someone finds out that you're a psychiatrist, do any of these strange behaviours occur?

Slawomir Murawiec
And now I think a little less, But in general I identify quite a few situations in my life where, when I said I was a psychiatrist, it was a bit hollow. The funniest one was in Masuria when I was sitting at such a long bench. I leave it to the imagination of the listeners and listeners as to what it is like to sit at a long bench in Masuria. On the other hand, I told the first person that she was a psychiatrist. She passed on, so the next person leaned over the bench to look at me and then told the next person to hide, passed on to the next one and so on. That's the kind of head she was leaning over to see what this psychiatrist looked like. So there is indeed this reacting.

Monika Rachtan
And what these reactions are due to with an expert's eye.

Slawomir Murawiec
Well, and here we have a return to the subject again, which is imaginations, right? That is to say, these perceptions are often such that, well, the psychiatrist will just take a look and already know that he will diagnose, qualify and screen. First of all, maybe he will screen for the very appearance of the person. And this is again a fantasy. I mean I have to have some material to diagnose. The patient has to tell me something, I have to know something about him from him, from his family. I don't have an X-ray in my eyes. I am probably more or more sensitive to all sorts of signals, whether I have a deeper understanding of them. On the other hand. Well, also look, I will already know what kind of problem someone has, then no, because then the whole diagnostics would be unnecessary. Such diagnostics already there to test or something would be what for? In connection with this, many people have ideas about psychiatrists that are lined with uncertainty, lined with some fear, anxiety, and that the psychiatrist will somehow see, discover, at a glance.

Monika Rachtan
But when it is the case that the doctor has a few glimpses of situations, behaviour, the strange, the peculiar, does it occur to the doctor to analyse these people in total privacy.

Slawomir Murawiec
And if someone doesn't disclose some kind of, so to speak, statement or behaviour that makes me do it, well, I don't. So in ordinary situations I approach people in the same way, on a social basis. It's probably the case that if someone says something very surprising or draws my attention, or behaves in a way that makes me think, I use my knowledge, my tools to understand the situation. It doesn't necessarily have to be to that person's detriment, does it? Well, because then I can also modify my behaviour or in some way understand the rationale behind this kind of statement or behaviour of the person in question. So I would say that there is probably nothing to fear. Unless, of course, we say something so bizarre that the psychiatrist is forced to think Aha, but what does he actually mean? Or what does he actually mean to her? And beyond? Relax.

Monika Rachtan
When I think of the work of, for example, an allergologist who wants to diagnose asthma in his patient, he has a special tool for this, e.g. spirometry. And well, he performs the test and makes the diagnosis. The doctor is all about the tools that are used to diagnose. At least he has most of them in his head. Well, because it is the interview and based on this interview the doctor's experience. Mr Doctor makes this diagnosis. These are the doctor's eyes that observe the patient during the visit. And I wonder if it is possible in private life to somehow switch off , this analysing. The doctor said he could, but I, for example, was thinking about those doctors who think to themselves, choose a speciality. Psychiatry is maybe not for me, because I'll be using these tools all the time though, I'll be agonising over what it's like.

Slawomir Murawiec
It is unofficial, it is not in the psychiatric classification. Third year medical syndrome. I don't know if it's still there in the third year, when the clinical subjects start, it's the young people, the students who recognise all these things out of themselves one by one. So it's like in cardiology it's cardiac disease to gastrology and they're already seeing a gastrointestinal problem in themselves and so on and so forth. Then it moves on, then it moves on to something more realistic I think. When you get to know the whole pool, well you're already a bit more inclined to recognise what you actually have out of that whole pool. So this ability to suggest is somewhere in medicine. Well, when we learn something, we start to identify it, discover it in ourselves. Whereas I wouldn't see it as a phenomenon that psychiatrists would necessarily have to diagnose everyone somehow here. I think it would rather be again in terms of those notions I mentioned, that the psychiatrist has to, that he just looks and heads there all the time. And these are such fearful notions about psychiatrists, and especially if he sits there and keeps quiet, well, he's bound to have some very advanced interpretations of the person there, and you can talk to psychiatrists normally.

Slawomir Murawiec
Like I said, until we do something that really makes that psychiatrist think, but also think, and again that's probably not a bad thing, Well, because psychiatrists mostly have, I think, a higher tolerance, which is that you really need something already. They've seen so much, they've heard all sorts of stories and that you really need something that extra for a psychiatrist to recognise that there's a theme there. On the other hand, this tendency to judge or such negative valuing in the general population, not psychiatrists, I think is even greater than, that is, that a psychiatrist will not notice as inappropriate a behaviour that will already be negatively valued by other people.

Monika Rachtan
I understand, doctor, you spoke about these images and I think that many of us have an image of such an ideal doctor who will sit down, listen, look at the patient with such a fresh eye, take care of his case. If necessary, he will call a colleague from Rzeszów. Do many Poles have such an ideal vision of a doctor? What should he look like? I don't mean in terms of his private life, but in terms of how he should behave in the office.

Slawomir Murawiec
I think it is. And again I wouldn't say that's a bad thing. Yes, as long as these ideas are not excessive, because in fact some expectations that the doctor will find time, mental space, attention to diagnose, think if there is a problem and so on, are very realistic, but they are often too high in relation to what is possible, for example, due to various organisational constraints, and sometimes they are too high, taking into account what appears, for example, in the media. However, they are often too high in relation to what is possible, for example, due to various organisational constraints, and sometimes they are too high, taking into account what appears, for example, in the media, what appears in films devoted to doctors, where these doctors basically only think at night about their patients, cases, and so on and so forth. And therefore how, when one has watched, so to speak, all sorts of images and takes them in, one identifies that this is the way it should be. I'm not going to name them here, I didn't watch them there anyway, so I don't remember too well. So well, then these images can be unrealistic and they then.

Slawomir Murawiec
they collide. They then collide, that it should be like this and it is completely different. Or it's a bit different from the expectations that the patient has in his head here. So I would say yes, I understand, right, But you would also have to stick to a certain reality, certain conditions. And these perceptions are very often fuelled precisely by the media, for example by various images. What should it be like? Here, confronting reality, but precisely learning to be real, would seem to me to be quite important. On the other hand, well, indeed, images can be terrible. I remember talking to a friend of mine, she's a psychologist and I'm a bit interested in these birds and she told me about a friend of hers, who was furiously indignant that I'd become involved with these birds. Holy indignation.

Monika Rachtan
Why?

Slawomir Murawiec
Because a doctor is supposed to be in the clinic all the time, just working and there. And if he goes to a park or a forest somewhere, well that's basically a crime already.

Monika Rachtan
I can imagine how, with such a demanding job, you could not have passions, interests. After all, when one has to go to the gym, another has to go shooting. A third watches birds, a fourth paints. It is normal for the state to have a passion because.

Slawomir Murawiec
This applies to everyone except doctors. A doctor should, a doctor must doctor this and these notions. And that's what I mean when I say through you spoke the realistic part, that a person must also rest. And it is the part that speaks through the different perceptions, in my opinion the unrealistic part, that he must always, in every place and should.

Monika Rachtan
Doctor I'm going to side with those patients who are afraid of doctors because I did a little survey like this and I asked patients if if they, when, or if they go to the doctor, they prepare a list on a piece of paper of the problems that they want to talk to the doctor about. And generally that's a good thing because a lot of doctors are now recommending when we say, we communicate to patients write it down. And these patients write down there 5 questions for the doctor. Well, and we find that when they come to the appointment, out of those 5 questions they ask about two 3 maximum. And I asked why they don't ask all the questions. They mostly answered that by the second or third question they felt that the doctor was already nervous, that they were asking so much, that he wasn't answering them in the way they would have imagined or expected. Well, and that they feel generally unwell in this practice. So this doctor is bad because he doesn't have time for them anymore. And I thought to myself that they should treat this as a service that they deserve and that if they want to ask these 5 questions, they should allow themselves to do so and not look at this doctor so emotionally, Yes.

Slawomir Murawiec
They should be able to ask those 5 questions, even 10. The way I would answer the question is that if I, for example, have that one hour per single patient as a psychiatrist, then 5 questions is not a problem for me, then I and 10 is not a problem either. I will try to answer that too if I know. On the other hand, if there is very little time, a few minutes. I have heard of situations not in primary care, but of a few dozen eighty patients. One afternoon. How can I answer 80 times 5 questions in a few hours? It is not possible. And for me, the answer here is if that doctor has the time, the space, the mental space, that is simply not busy with something else, thinking about documentation, about some requirements, about checking something there, whether they are going to get attached, and something there, he or she will just have the time and the mental space for the patient. These 5 questions should not be a problem at this point, as they are not for me. On the other hand, if time, resources, limits are at a premium, then they can indeed be a problem.

Slawomir Murawiec
On the other hand, it is absolutely necessary for the patient to write down or ask these 5 questions, or to ask the next 5 questions which arise afterwards, as the doctor has answered the first 5, because this will then serve the treatment, it will serve the therapy. If these questions are not asked, the results of the treatment will be much worse in fact, because the patient is left with doubts, e.g. about the medication, the treatment, etc., which will affect the therapeutic process. This will affect the therapeutic process. So it is a drama if there is not just room for 5 questions plus a few more.

Monika Rachtan
Can a doctor also experience professional burnout and therefore be less focused on the patient's problems?

Slawomir Murawiec
The one you're talking about like that for example, right? Because it's a straight path to professional burnout. Because if we follow, we follow as a doctor such a path that it still interests me and the patients. Some patients talk about things that I already know a little bit. After 30 years, yes, but some of them are always talking about things that I haven't heard in my life. Even though I've been working 30 years. So there is always that element of motivation, curiosity, interest, a certain vividness, experiences and so on. And that will be the prevention of burnout, plus the conditions in which you work, the organisational conditions, the appreciation by your superiors, plus the financial issues, plus the issues concerning the overall atmosphere around the job. If with this, we somehow embrace it plus the interests we have already discussed. On top of that, this burnout has a chance of not happening. If we do the same work routinely for years, then unfortunately such attitudes towards patients that should not be the case, resulting precisely from burnout, distancing ourselves, such burnout. You talk about this kind of cynical attitude, right? That is, distancing, not taking over.

Slawomir Murawiec
The various comments that patients then cite in the media that the doctor said something there, then they are more likely to appear. But it's again like with anything. The lady said it was a certain service, just like.

Slawomir Murawiec
Service. It's like with any service provider, if the service provider is happy, well paid, it's not overloaded.

Monika Rachtan
Well, yes, it provides a service.

Slawomir Murawiec
It provides such a high level of service, just as there is too much stress, little pay, the boss shouts, and basically the salon is about to close.

Monika Rachtan
Well, that is a very good comparison, that we should not treat this doctor as some kind of extraordinary profession. I just think more that this is a man who is doing his job, he comes to the hospital for some hours, he would like to be there for 8, usually there 10, but he goes home. He's got a dog that needs to be walked, he's got a wife he'd like to go to the cinema with. He has children to pick up from school, nursery. He leads a normal life and he also has some problems that, for example, he comes to work with, just like a secretary, a teacher, any other profession. And sitting in front of the patient, or when the patient is sitting by the patient, there may also be such a domestic problem in his mind for a while, because you can't get away from that.

Slawomir Murawiec
That's what we're talking about, it's quite difficult for that, because it's true what you're saying, but on the other hand it is in a way an extraordinary profession, because yes it saves lives, sometimes it saves people's lives in connection with that, and that, and that's true, that is for some extraordinary things sometimes, which many doctors succeed in doing, probably cardiologists, but psychiatrists too. Psychiatry is also a life-saving field. If we think about the prospect of suicide, surely it is very often life-changing, isn't it? Therefore, it is, on the one hand, extraordinary and, on the other hand, burdened by the very day-to-day reality you mentioned. And it's probably no coincidence that various companies that offer employment abroad say we'll arrange things for you, right? So that he, she, the doctor doesn't have to, doesn't have to think about it, to relieve the burden of what no longer belongs, as it were, directly to the doctor's work. Assists of various kinds? Yes. That is, so that the doctor can focus on what belongs to him, which is a unique, certain possibility, and not just do the core work that someone else could just as well or better do for him.

Monika Rachtan
And do doctors suffer from mental disorders?

Slawomir Murawiec
Of course they do. Well, yes, already going by the thread you raised, they are just as much part of the general population. Therefore, they will suffer from these mental disorders, which are the result of simple statistics. That is to say, as in the population something occurs, well in the doctors the same, probably with some similar frequency plus will be the case. They will suffer from those mental disorders which Do mental problems that result from working conditions, e.g. overload, overwork, sometimes low levels of satisfaction, if the work cannot give satisfaction, Therefore, yes, and here both depression and anxiety disorders have a full chance to appear also in doctors. And also, as I said, resulting from simple, ordinary statistics, more severe mental disorders in the same way, but this does not absolutely disqualify from work.

Monika Rachtan
Doctor, I ask this because I would like to show our listeners that mental disorders are. Problems that simply involve the brain, which is an organ just like the liver, the stomach. It is there, it functions, and then something can go wrong. And then it needs a doctor's help. It seems to me that when someone says they have a mental disorder, that is a reason for various further things to be said. When someone says they have a cardiac disorder, people tend to feel sorry for them and talk about them being poor, sick. Why is this the case and how do we tame this problem?

Slawomir Murawiec
As you said, when we have mental disorders, it is such a canvas for all sorts of sayings. So it's not from today that people with mental problems, mental disorders are somehow stigmatised, they were more rejected from society. Now I think that at least in big cities this social education has gone quite far and already. Saying at least in a big city I have depression is not so much a stigma. But there is a long history of stigmatising people with mental disorders, dismissing them with misunderstanding and burdening them with various fantasies, just like psychiatrists. I said before that a psychiatrist is just an X-ray in the eyes, so here that a person with a mental disorder will not control their behaviour, will be aggressive, may do something wrong and so on and so forth. And this is immediately attached precisely in the assessment sometimes of relatives, sometimes such a broad social assessment precisely to the fact that someone presents some symptoms, features of a mental disorder. And then again we come to the fact that there is a realistic part and a part of various kinds of imagination. I would also say that a psychiatrist is the same kind of doctor as other specialists, such as a cardiologist, gastrointestinal surgeon, etc., who are also doctors of medicine.

Slawomir Murawiec
Although I work in a different specialty, but I graduated from the same university as my colleagues who chose other areas of medicine. It's the same route of treatment, not cure, just education at the beginning of course, then you get specialised. The brain can indeed become ill. The conditions we live in can also influence. Of course, so that we don't understand it strictly biologically. It's just that the brain suddenly gets sick here and the conditions we live in also have an impact on the occurrence of mental problems and depression, anxiety disorders and many other eating disorders alike. Consequently, problems arise and therefore one would have to go to a specialist, just as one goes to any other specialist doctor in other medical fields. This visit, too, is essentially based on the same pattern, that is, taking a history, yes to questions and then proposing some kind of management or diagnosis. Problems arise, as we said earlier, from certain perceptions about doctors or psychiatrists. It is the same here that they arise in turn from different perceptions. To the sayings about people with mental disorders, do you need treatment?

Slawomir Murawiec
We have effective treatment methods at our disposal. There is nothing to fear here.

Monika Rachtan
Why is the Doctor's Office the point that opens the path, the shortest path to get a diagnosis and a diagnosis? Why isn't it the Internet, where we are now very fond of treating ourselves? Why isn't it, for example, the quacks, but this very doctor's office?

Slawomir Murawiec
However, because I feel that, yes, we as doctors are bound by quite strict rules, so it is quite realistically the doctor who is entitled to make a diagnosis and propose treatment. But it is also the case in modern medicine that it is no longer possible to make up and propose to patients that I am bound by classifications, guidelines, recommendations, recommendations of societies and so on. Recommendations of the Polish Psychiatric Association as to the treatment of a given group of mental disorders. I have to fit in with that. And if somehow some treatment or medicine is used outside the indications, I have to explain it to the patient. And secondly, however, I must have some scientific evidence for it, write it out.

Monika Rachtan
In the medical records, because it is also like this.

Slawomir Murawiec
And I must have some literature on it, That is to say, someone must have described it, It has not yet entered into the recommendation, but there is already reliable literature on it. Therefore, then possibly on. I can't think of anything to say about it. It is, however, a piece of sound knowledge and sound patient management. But then again we come to the social part and perceptions. And when the social part, the media imagination, builds on all sorts of superstitions, beliefs and fantasies, imaginations about doctors, then some people start to be afraid. This is why we, as an environment, or the Supreme Chamber of Physicians, organised such a meeting just after a film by a celebrity on antidepressants, that it is necessary to convey reliable knowledge. However, on the Internet, anyone can write anything.

Monika Rachtan
This is true.

Slawomir Murawiec
Celebrities have their own ideas about treatment. Sometimes. Sometimes they stick to reality. For example, many celebrities participate in social campaigns. And that is wonderful. And that is just to be appreciated. The faces of depression show celebrities saying cure depression. But some have these ideas a bit. Well, absurd. Yes, especially I don't know if I can say that. When someone lives four thousand years, they may have their ideas, but they have nothing to do with reality. Therefore, let's not look to celebrities for this help, unless they are sort of serving a good cause as part of a social campaign. On the other hand, certain people in Poland are entitled to treatment and diagnosis, and it is there that we can find reliable help.

Monika Rachtan
Doctor, and I will also ask if the primary care doctor is the doctor we can go to with such a problem? Is this a good address, but additionally a story like this. I am a resident of a small town, 20,000 people live in our town. My primary care doctor is about my age. I have two others to choose from, but generally we all know each other because the kids go to the same school. The lady registrar will see the prescription that this doctor gives me and, even though there are codes now, she will see in the history what medicine I was given. And I think to myself, these women or men, these people are just scared. Of this evaluation. They are afraid of this stigmatisation again.

Slawomir Murawiec
Yes, yes. Exactly as you said in your conclusion. That is to say, until we create a situation in which mental health problems, to name the most common ones, namely depression, anxiety disorders, sleep disorders, somatisation disorders, are just like any other problem. Well, we will be afraid to go into such a situation, exposing ourselves to this potential element of assessment. I would consider two elements here. The first is that of the PCP. It absolutely can treat many PCPs are interested in diagnosing and treating mental disorders. They do it effectively, they do it professionally and they are as much as possible entitled to write prescriptions. So that's one thing. The other thing is a certain kind of normalisation or transition to a phase where, well ok, he has depression, yes before he didn't have it, now he does. If he's cured, he won't have it and we can go on living in the same community. Well, and the third thing that occurs to me here, though, is a certain specificity of smaller towns, where social control is very high, it seems to me, and that just. Well, in other words, there would have to be some social changes here, not ones that would allow this element of evaluation or control to be less strongly expressed.

Monika Rachtan
And is it not the case that for many years, patients and doctors have been put on two sides of the barricade, especially by the media, but also, I think, by politicians? So, for example, there would be a strike of doctors or nurses and they would talk about it in the media, and the next moment they would show footage of a patient saying that they were being treated badly, that these doctors were not looking after them, that it was the nurses, they were so busy in that ward. And it seems to me that this relationship is spoiled not only by the patients and the doctors themselves, but by this kind of whole picture. And yet it's like we should probably be on the same team after all.

Slawomir Murawiec
Absolutely. Doctors and patients, patients are on the same team, they are on the same side. I absolutely agree with you that this is how it should be, because if it is good for all the participants in the system, the stakeholders, as I think is the technical term, then everyone will be happy. However, in a situation where there are various funding shortfalls, or in other words where funding for the health care system is often too low, and has been too low for years, we are not talking about a year, two years, or five years, but we are talking about the principle that for as long as I can remember, which is 30 years now, it has always been too low. And every time someone drew attention to it, whether it was specialist doctors or then residents, well it was some person who undoubtedly. I think that they really were treated in an inappropriate way and some of them didn't get proper help, so God forbid that they should get it, but they served the purpose of preserving this deficit system a little bit, and if they did, then they protested, well, we shouldn't give them more money.

Slawomir Murawiec
These are not more resources for doctors, they are more resources for the system and indirectly for the patient.

Monika Rachtan
First and foremost for patients. The patient realises that when, for example, a hospital receives more money, then at last the patient will not get that one slice with butter and cheese for breakfast, but will get a full meal. These are measures which, however, de facto reach these patients.

Slawomir Murawiec
So it is. On the other hand, when there is a deficit of funds, it starts. The social engineering operations begin. I remember the residents' protest, the last white town, so spacious, was ended by the death of an elderly gentleman. Again, my deepest sympathies to you and the family. I do not want to say anything bad here, God forbid, about this gentleman. Perhaps he did not get the help he should have. But what was the result of this death? This is how the protests ended. In connection with this? Well, it's not always worth letting yourself be used for different purposes. Which don't really serve the people. Because if the presidents had succeeded, all patients across the country would probably have been much better off.

Monika Rachtan
I will use a final example, which I would like to use as a bit of a summary of our conversation, to show that when it is bad for the patient and bad for the doctor, what is bad for us, the system. Imagine a situation like this: I am a patient, I have a fever, I report to my primary care physician. It's sixteen o'clock, I look in, I see that there are 10 people sitting in the corridor. I know that the doctor only accepts until eighteen o'clock, so I already know that I probably won't get this advice from the doctor. But I approach the lady registrar and ask her if there is a chance, because apparently you don't see that many patients, so the quickest way, if you need help, is to go to the ED. You'll be there for a while, they'll give you your medication. You will already be, you will be better tomorrow. Generally speaking, you wanted to do well. After all, she did not want me not to receive this advice. As a patient who listens to the doctor's advice, I went to that ED. I sat there for three hours. Well, I am a little angry with the lady registrar, because I could have spent those three hours at home under the duvet with a fever.

Monika Rachtan
So he opens the door for me. The doctor asks me what's wrong, I tell him I'm coughing, I have a fever. And the doctor is obviously angry with me and just tells me, dear lady, but we are saving lives here and you come in with a fever. So he prescribes me medication, but in the end he sends me back to the primary care centre to be counseled the next day. And so, looking at the situation, nobody wanted it badly, right? And yet everyone is unhappy.

Slawomir Murawiec
And that's what we're talking about in the second part of our conversation today, which is the system of truth, which is a system that if it works like this, which is to say in a situation of permanent availability deficit, well, there will be situations where basically. Well the patient is not getting the right help. The first doctor, the primary care doctor, is overloaded, because he has such a full waiting room, or he accepts as much as he can, because he can't do any more. This doctor who is on the Sora is also right. And I hear and see accounts of astonished doctors who say that a patient came to me in the middle of the night with an ailment or a request for a prescription, and when asked when he had run out of medication, he said yes, three months ago, but tonight at 12 o'clock he felt the urge to return to treatment, which also evokes emotional reactions. A system where there would be space, there would be care. I am thinking like you. I'm not listening about other areas of medicine, because this one, this one I know a little less from the inside, I know as maybe more of a user.

Slawomir Murawiec
On the other hand, I think of the pilot programme of the Centre for Mental Health, which is a psychiatry that covers part of the Polish population. Not all of it, unfortunately, but it already covers several million people. And the assumption there is that there is a coordination point, that you can apply, that you get some kind of assignment, so to speak, to an appropriate specialist within 72 hours, that the system covers outpatient clinics, a day ward, potentially a hospital, so various forms of care, including a community treatment team. And that if you could organise the truth in such a way that this help is relatively fast, realistically, quickly and includes such forms that the patient needs, that would be nice and with benefit. I don't know how to do it in other areas of medicine, because I don't know about it. But, but the assumptions of such a reform and such mental health centres seem to me quite nonsensical here.

Monika Rachtan
Doctor, I guess at the end of our conversation I can't help but wish our patients that the system would change, but also wish them that maybe they wouldn't imagine all sorts of things from psychiatrists, but that they would take a realistic look at the situation.

Slawomir Murawiec
So that you look and learn, so that you don't come and already know better what, what, how And that doctor should only, to learn and adapt to what the situation is. And also to understand that the interests, if I may say so, of doctors and patients, are common. The interest of doctors is to provide good quality care. The interest of patients is exactly the same. Therefore, there is a community, a community of goals. Let us stick together. Exactly.

Monika Rachtan
Thank you very much, Doctor for our conversation today.

Slawomir Murawiec
I thank you very much and hope for the benefit of society.

Monika Rachtan
We hope that we have improved the relationship between patients and doctors, or at least that patients will benefit from our material today and think a little about what they could change in themselves to make this relationship better.

Slawomir Murawiec
Thank you very much.

Monika Rachtan
Thank you very much.