Op-Med is a collection of original articles contributed by Doximity members.
Name: Aparna Iyer, MD
Education: Albany Medical Center, St. George’s University School of Medicine
Areas of Expertise: Psychiatry
Current Position: Adjunct Assistant Professor, Psychiatry, University of Texas Southwestern Medical College
1. Why did you choose psychiatry?
Simply put, there seemed to be a goodness of fit between my personality and what the field of psychiatry had to offer for my career. I really sought out the field in which I felt I could help create the most deep and meaningful change in my patients, and psychiatry feels like it. I also really enjoy the long-term relationships I have with many of my patients, which allows me to witness growth over time.
2. What area of psychiatry is changing most rapidly?
I think that perinatal psychiatry is probably changing most rapidly, which is why it is such an exciting field to be a part of. The medical society is increasingly recognizing some of the unique mental health challenges that occur in the perinatal timeframe, and we are better equipped than ever before to address some of these issues.
3. What is the last journal article or piece of research that significantly changed your practice?
The ‘SMILES’ trial paper was a great article that really moved my practice along and helped to validate the non-medication and lifestyle approaches that I had been speaking about with my patients in addressing their depressive symptoms. This trial explored the beneficial impact of major dietary changes in a population of people with depressive symptoms.
4. What is the biggest obstacle for women in psychiatry?
I think balancing the demands of being a psychiatrist with the choice to have children is probably the biggest obstacle I’ve faced so far. A provider’s pregnancy can stir up quite a lot for patients. And it can be tricky to figure out how to maintain the continuity of the relationship with patients who see you regularly for their treatment, particularly when planning for an extended maternity leave. The relationship between a patient and psychiatrist is a very important and privileged one based on trust, so it’s not always easy for patients to transition to another interim provider, even for a brief time.
5. What is a common misconception that other clinicians have about psychiatry?
There seems to be a misconception that clinicians should only refer to psychiatrists when a patient is severely symptomatic or ill. This does not have to be the case. Psychiatry is a rapidly evolving field, and we have multiple techniques (even ones that do not include psychotropic medications) that can help patients reach their wellness goals long before they reach a point of severe symptomatology.
6. What’s the best advice you’ve ever received?
My program director used to advise me that, whenever asking a question to a patient, the driving force behind the question should always rest in the betterment of the patient’s health, never in just the curiosity of the clinician.
7. What has been your most gratifying moment of being a clinician?
The most gratifying moment for me was when I recognized a patient had been misdiagnosed, which was important because it completely changed his course of treatment. Up until that point, he had seen several psychiatrists and had struggled with multiple repeat hospitalizations and difficulty functioning in his life due to severity of his symptoms. At that point, we completely altered our approach, and he has not been hospitalized since and is doing incredibly well.
8. If you weren’t in this specialty, what specialty would you do? If you weren’t a clinician what would you do?
Due to my interest in women’s health, if I were to choose another specialty, I would have chosen to be an obstetrician. If I weren’t a physician, I would have chosen to be a professional photographer — mostly due to my curiosity about other people and interest in capturing their essences.
9. How do you motivate patients to do what’s best for their health?
I first focus on establishing a strong level of trust and communication with my patients. This helps because if I feel like I need to challenge them or question them in any way, they need to understand that I am doing it truly out of the best intentions for their well-being. I also can identify that many of us may feel ambivalent about change, even if we can logically see that the change would be positive for us. I try to normalize and directly address this ambivalence.
10. What is the biggest challenge or obstacle in psychiatry?
The biggest challenge is the misconception of what exactly we do, which leads to difficulty in initially establishing a doctor-patient relationship. There are a lot of misconceptions about psychiatry and psychiatrists that I think make it difficult for patients to make that initial appointment. For example, people are often under the misconception that seeking an initial psychiatry appointment automatically means they will be medicated or involuntarily hospitalized. I wish that the public could have a more accurate view of what it means to seek outpatient psychiatric care.
My favorites are the articles, particularly the ones specific to women in medicine, and the ability to create virtual connections with my colleagues.