Swapna 0:05
Hi, and welcome again to Myth, Magic,Medicine. This season is all about immigrant doctors coming to the US. And my guest today is Swapna. Yep. Swapna is all the way from Mumbai and found herself unexpectedly in the US. So, the Swapna, please tell us about yourself.
Hi, and welcome again to miss magic medicine. This season is all about immigrant doctors coming to the US. And my guest today is Swapna. Yep. Swapna is all the way from Mumbai and found yourself unexpectedly in the US. So, the Swapna, please tell us about yourself.
Swapna 0:23
Oh, no, absolutely. Thank you. First of all, for the opportunity, Denise, I mean, for me, this is really a great platform to talk about my experience, both as a doctor and as a person, a human being, because coming from another country and trained in medicine in another country, and then redoing everything, especially reworking all the cultural aspects. That's a humongous game. But I am so blessed today after practicing 20, 25 years of Psychiatry here. And couple years in India, maybe 1 &1/2 years,
Denise 0:55
Actually, if I could just interrupt the flow for a moment, psychiatry must have been one of the more difficult ones because culture is everything. It is, go back, go back to your flow. I'm sorry, I didn't mean...
Swapna 1:10
So what you're so right, because that's what I was gonna actually sort of focus on the difference of how it was for me to practice psychiatry back then, mind you of talking about the 90s I'm dating myself here. But still, when when I started psychiatry, I mean, there was a lot of objection or even, you know, a lot of surprise from my co-medical students, but also my dad, who was the general practitioner, I was hoping that I would do some traditional pathways, OBGYN or pediatrician because there was something that entailed medicine there, psychiatry was such an taboo subject or came up with so much stigma. They weren't even sure how I would practice in India, what I would really do, as if there was no depression, psychosis, mania, none of that existed in that very Uber Indian culture, wherein you will never talk about such things, even as a doctor even as a physician. So this, for me was my impetus, because I'm always challenging myself. And I wanted to throw myself in a field where really, there was no help. And I really felt that when I had practiced there and here I feel like there's such a vast difference. One of the things that, you know, was very interesting for me, it was that we used to get from a lot of religious places, because in India at that point in time, again, in the 90s. Now I know with rapid urbanization, global growth, everything is different. But at that point in time, a lot of the time families brought their loved ones who are afflicted with, according to them demons, or hosts, or whatnot, because they were hearing voices, that we would actually get calls from these places. I used to work in a government hospital in India, as a resident, and we would take referrals from them, and then start patients on antipsychotics and watch them get better. So it was a uniquely frail system, nothing that I would ever see here. But that was the one of the biggest differences that people were marginalized. This was basically a fringe population that really had to be locked away. You don't have to look at them. There was no concept of the fact that mental illness exists. You know, ubiquitously. I mean, we lived in a powerful world, where it was just denied that 1% rate of schizophrenia would never occur.
Denise 3:34
do you think that was because people have not seen successful treatments? Well, so it's sort of self perpetuated?
Swapna 3:43
Absolutely. So couple things, I think, in Southeast Asian populations, and I think this goes to a lot of countries where there is cultural, a taboo in a way that you cannot speak about your feelings in a, how you're doing, what is depression, you know, what is feeling sad. And a lot of the time the complaints process through somatic complaints, such as people who talk about having nausea, vomiting, or uneasiness. And this was repeated studies, they found that this was actually predominantly related to a psychiatric issue a stress in their family.
Denise 4:22
So this was an acceptable embodiment of this distress?
Swapna 4:25
Absolutely. You couldn't say that you were depressed, you couldn't say that you have not feeling a certain way. But you could say that you have extreme abdominal pain or you have headache, there are a lot of culture bound neurotic syndromes. For example, I mean, you know, I think there is something called Koro that exists then there is running amok in different cultures in a name that is kind of like, embedded in mysticism. There's a lot of neuroses that is seen in Somatoform disorders. So um, in schizophrenia, for instance, you know, it was observed that there is a certain uniformity in the way schizophrenia presents, right, globally, but there are clearly distinct cultural differences. But there is a reason for this, this is because it was interpreted as what was then thought to be related to the Divine or related to possibly the devil. There is a term called Jin in certain Muslim regions, this is sort of like the influence of that. So, a lot of people interpreted it that way, so that that was acceptable culturally to talk about it. There's many times when people would say, Oh, I'm depressed, people would say, what is that just "spruce up", you know, just kind of "buck up."
Denise 5:42
And that's, that's unfortunately prevalent in many cultures that that attitude, who, if it's all in your head, it can't be that important. That is, one of the banes of my life is, I belong to the Royal Society of Medicine in the UK, which is an international organization, really, but they have a section on hypnosis, which is my thing. But it's called hypnosis and psychosomatic medicine. And everybody is insulted when you say something is psychosomatic. But we talk all the time about the mind body connection, as if these are not the same two things!
Swapna 6:15
It is, and somehow I feel like this is this, this, for me was an eye opener that even in the US, as you said, culturally, they exist everywhere. Mind and body are so distinct, even at this practice medicine here. Today, it's almost like we get referrals from other doctors, and there is a little certain amount of this is not I can something I can deal with. Okay, that this person, you know, they use the term crazy, very flippantly, or this person is acting crazy. I mean, and I think that it is so insulting in so many ways, to the, you know, intricacies of what a human being is, I mean, how can you not expect somebody who's going through cancer, to not have an emotional response to that? Yeah. So why don't we treat? You know, or why don't we teach our medical students or residents to be more empathic to look at it as a whole connection?
Denise 7:09
I almost feel like this is like, Okay, this is gonna be part two, because we really wanted to talk to you about all of this, but, but I would love to know a little bit more chronologically when you came to this, you, you so you, you defied your family's expected pathway for a start, and when you did psychiatry, and you did a residency program, there is
Swapna 7:31
actually a year and then, you know, I got actually married and arranged marriage, but that didn't work. But then when I came here, I decided that I you will use this opportunity.
Denise 7:42
So you came here because the arranged marriage that I had, again, I again, I stress because I do interview, a fair number of Indians, arranged marriage doesn't mean forced marriage.
Swapna 7:53
No, no, no, it wasn't forced.
Denise 7:56
But as will happen with many versions of marriage, this one didn't work out but it was the reason that you came to the US it wasn't on your radar?
Swapna 8:06
I mean, you know, I always did think that since my interest was in psychiatry, maybe my future lay abroad, not necessarily US, I think I was looking at UK at that point in time, a lot of my colleagues would go into UK, but then, you know, life happened, and I came here. And then I decided to use this as an opportunity to pursue it was really difficult, because to do all the USMLE exams,
Denise 8:30
and so long after training,
Swapna 8:33
So long after training, I had to retrain, and then retrain culturally, to know how to address patients who are from here, and be aware about my own cultural experiences, my own cultural, you know, barriers and aware of my transferences counter transparences. So I felt like the residency in US was a very interesting, and a very growth, kind of like, the growth that I saw personally in me, was immense, I realized that so many myths and so many concepts that I had about culture, about society, the way I was raised, and then I now see here and the exact opposite of it in a very good way. And also diversity that I saw here, really led
Denise 9:22
us from here, there is no American Oh, yes, there is there is a predominant American culture, but there's all these subsets. Yeah, because it's such a melting pot of places. So where you are now practicing the Seattle area,
Swapna 9:36
yeah.
Denise 9:37
So right now, I mean, how many cultural groups do you think you can quickly figure out how you have to change your practice?
Swapna 9:46
Right. So yeah, so it is interesting that so you have to change your practice based upon where your patients, you know, roots are from? Absolutely. So if I have a patient who is from India, there is that familiarity. There is that understanding. And you know, there are certain nuances that are caught on both sides. But let's say I have a patient from Eastern Europe, and it's a little bit, I have to like immerse myself in what that upbringing was like I met there's language barrier, and sometimes there is cultural barrier. But ultimately, you know, what is really important, the human experience, it's the same. trauma is trauma, illness is illness, and humans are humans. And that transcends all cultural barriers, you may express it differently. It may be psychosomatic, in the sense Somatoform disorders, in some cultures, it may be, you know, a full blown sort of manic episode in another culture, but whatever that is, the experience of the human being remains the same. And I also feel the other thing, there is an advancement in treatment now, across globally. And as I speak, I'm pretty sure my colleagues in India are pretty much practicing TMS, and ketamine and you know, doing all the novel treatments, and there's such a growth in the mindset of understanding what psychiatry is, especially due to the pandemic, I think that threw the spotlight on mental health, like I had never seen before.
Denise 11:13
And well, the up-tick- just the identification of depressed adolescents is just phenomenal. I mean, it wasn't, it wasn't exactly a not a problem to start with. But it's a really big problem now.
Swapna 11:27
It is a huge problem. Right now, the youth are suffering. I mean, there is immense need for child psychiatrists. And there's immense need for therapists, counselors, people who we need for psychological evaluations, this, this pandemic just threw, you know, these kids under the bus, unfortunately, there was due to no fault of them, the isolation that happened. And we do know right now that loneliness is one of the biggest triggers biggest factor for suicide, for increased incidences of depression, anxiety. And culturally, that's also very relevant. Because sometimes there can be stigma for people who are living here, because of their family's conceptions and understanding about it. And we also see a lot of kids suffer because of the gender identity. And we also see that is culturally a little bit, you know, difficult to, like wrap your hands around because of parents are from. So there's so much growth, I think that needs to be done. And so many programs that I think should be there, there should be more investment in mental health. I mean, I know that that's where the government is also going. But still, I do feel that it's not enough.
Denise 12:38
And you've also got so many little charitable organizations that pop up, but there's, but there's not a lot of oversight of that. So you're not sure what treatments are being offered and what therapies and
Swapna 12:50
I think you've nailed it, there's not a lot of oversight in the sense that I think right now, people are just struggling through one day at a time. And I say clinicians also, because I know a lot of clinicians who got burnt out during the pandemic, I mean, it was not possible to keep up with the trauma that they were hearing they were absorbing, and at the same time, having to kind of like maintain their semblance of like self. And so I think it was just a very difficult time for everybody. But we do see now that the incidence of depression, anxiety, rates of suicide are very high. And there is a need for crisis centers and counseling, and kind of really looking at this in a very pragmatic way. I do see the stigma is slowly disappearing. So that is a huge change that I have seen. Yes, in the pandemic.
Denise 13:40
I mean, even my childhood in the UK in the 50s and 60s, people had "breakdowns" [whispered] They went to the hospital for a little while, and nobody talked about it. If you said you were depressed, I mean, the trouble is that, like the word crazy, depressed is a word that should be used for a specific cause, but it tends to be I'm a little bit sad all the way to I want to throw myself off a bridge. I mean, it is not nuanced when we speak, but but in the UK, at least, if you told somebody that you were told to buck up, or you were given vitamin B 12. because that clearly was going to help and even if it does, yes, it certainly can. And there's because it's mind body, right? But but it's there's not one, it's not one size fits all. It's also everything is multifactorial,
Swapna 14:40
Everything, everything you know, and I think that it's such a, I would say like a complex puzzle, right? There's so many factors, your social factors, your upbringing, how your resilience is, what does mental health and mental health sort of how does it influence you? You know, what is your understanding of that? Do you know how to get help. Do you know what kind of help you should get?
Denise 15:03
This is the problem because we're putting the onus on the patient to figure out what kind of specialist they need. That's hard for us. So
Swapna 15:11
that is, and I was saying it almost in a way to kind of go into my next segue is that that onus should really shift from them to us to clinicians, who are going to step in and help them. And of course, primary care, you know, would be the first hub, because that's where, but they are also,
Speaker 1 15:29
they're also stretched very, very thin, and seven minute, clinical settings are not, you know, aren't going to tell you the deepest, darkest secrets of, you know, I'm going to talk to you about my stomach. But I'm not going to talk to you about why.
Swapna 15:44
That's why I think, you know, right now, I think consultation models work a lot better , a psychiatrist might be integrated, but has sort of the oversight of how to develop the model, how to bring in the right resources for the right patient. So I think that if, and it's happening right now, there's the collaborative care models, you know, co located clinics. So there is sort of like the consult model. But there is this, the Udub model, which was actually developed at U W - University of Washington. It's called AIMS. And it really the aim of AIMS is actually to make sure that there is more exposure for psychiatry in primary care, so that patients can get the help where they need or where they come to receive it. A lot of the times, this is where they will come and say they may have nausea or some sort of Gi illness that is not going anywhere. And there are lots of like screening tools now that we do,PSQ-39 GAD-7, the mood cue a lot of questionnaires can trigger that, okay, this might be a patient who would benefit from seeing a psychiatrist. But mind you, none of this is really perfect. I mean, there are so many
Denise 16:53
Also, you're still going to run up against the patient who, you know, we're not talking about somebody who's schizophrenic, we're talking about people who've got mood disorders, that are going to be resistant, the first thing they they're hearing 'psychiatrist', they're hearing 'Oh, You're crazy. You're just crazy. Go away'. And, and that's takes some finessing, you know, how would you if you have a psychiatrist or a psychologist within your clinic setting. Yeah, probably easier. Whereas if you say, I want you to go and make a separate appointment to go to see this person over here.
Swapna 17:28
Yeah, that is very hard. You know, so actually, I like now I currently work in an integrated setting, you know, at the company called Crossover ,in the Microsoft location. And there are challenges right now in the sense of like, how we should develop this program, but this is the basis of it to have a psychiatrist there. But, you know, I am actually soon in September, I'm joining a startup. It's called OptionsMD, and I'm really going to look into people who are the exact, you know, group that we talked about people who really don't have resources, are struggling to find help for their treatment resistant depression. The really looking into ways to innovatively help them, match them with the advanced technologies that we have right now with ketamine, TMS, or, also to look into ways to, you know, do some research and see what kind of medications really might work best for a subset of population. So, I'm excited. I joined as the lead psychiatrist in September there.
Denise 18:37
We missed out a whole chunk of how you got from India to here. I mean, we know you, you came, you know, presumably by plane that's how most people get. Nobody gets to have the lovely scenic sea voyage where jetlag doesn't happen
Swapna 18:51
I didn't I didn't get into like a ship for 10 days. No.
Denise 18:55
But so you came here you were, where were you first? Where did you
Swapna 18:59
first I was in California. Yeah, I was there. And then after that, you know, when my marriage didn't work out, then I went to India for a while, but decided to study for my USMLE. So my brother at the time had migrated to Canada. And I ended up staying with him. Sometimes I had a cousin in New Jersey. So I was kind of like, couchsurfing person. But my main goal was to clear my exams, which I did. That took me about a year, but I was very lucky that I, I actually got my results. And I decided to cover all residencies because I thought, well, sometimes there is post match-up, luckily.
Denise 19:43
Were you off-cycle or do you just wait for the next
Swapna 19:47
Oh no, it was actually on cycle. I was going to apply for the year after. So I had applications and ERAS applications, and I was looking at it and someone told me that, hey, it's May, and I know it's kind of late and probably and not really 100% gonna get in, but there are things called, you know, residency clearinghouses, they call residencies and see they have an opening, - there's is a list that's published on the internet. And that time, I mean, it was difficult to get those lists because I'm talking about 1999. But somehow I got lucky. And I was able to call a program and that was in New York, my dream city, I always wanted to work there.
Denise 20:27
I was personally thrilled to find out were you trained? I know, because we trained at the same hospital decades apart, but we trained in the same hospital,
Swapna 20:37
St. Luke's Roosevelt, and my God, I'm so indebted to, you know, the program and our great program director, Dr. Scott masters. And it was it is affiliated as you, you know, we talked about University of Columbia at that point. Now, it's affiliated to Icahn School of Medicine. So it's different now. But that time, I mean, I love the campus on, you know, like 112 street and just walking there and having my lunch there. And I think that, you know, in New York, I got to see a cultural melting pot. Yeah. So that also shaped my training, I think in a great way. It's really, really,
Denise 21:17
how important do you think it is? Obviously, for if I was seeing a psychotherapist, yeah, that it would be very important that that person have similar background to me, I think of albeit that they would have been born in America, what do you feel is important? A psychiatrist doesn't feel quite the same. Very few psychiatrists are doing standard therapy throughout,
Swapna 21:42
Right? You're right, you're absolutely right. And that is, again, a lot to do with how care is being dispensed and the shortage. Let's be very clear, there is a shortage of psychiatrists. Right now, we are sort of like the dying breed here, because a lot of us are retiring. And, you know, there is, I know, that are residencies and everything. But I think that they have projected that the shortage is going to be very acute, especially in 10 to 15 years down the road. So this is the reason why now we have to practice at the I would say at our you know, top level in the sense that we have to look at patients who are coming to us for complex psychopharm management. And unfortunately, we cannot, unless we're doing private practice, in a community setting or even in a clinic setting,it's becoming harder and harder to have your own psychotherapy practice. Again, the world is also changing quite a lot. There is not that immense interest in that in that psychoanalysis, I'm actually trained in a psychoanalytic environment. We were, we had supervisors, and I, again, cherish my training because I don't see that happening right now. I don't see that focus. I see a lot of it now change because of the digitalization, a lot of psychiatrists are growing into becoming digital leaders and sort of like incorporating technology through apps. And now No, let's not even talk about artificial intelligence, because that's another ballgame. To see that,
Denise 23:09
if I can, if I cann't understand somebody speaking to me in English, if I can misunderstand them think how well computers got to do, oh, my God, you're talking about nuance you have to listen between the words, right.
Swapna 23:22
And this is actually the chapter that I have written for AI in this book that is coming out for 15 of us 15 physicians from different specialties, wrote a chapter that's going to come out in August, I believe, and I say exactly the same thing. What are the ethics of AI, the nuances, how's the robot going to understand exactly what you want me to, I do feel that we can only do so much. I think we can have some work standardized through AI, where you can't really replace the physician, you can't replace the psychiatrists or that human touch the empathy. I mean, if a robot develops empathy, fine, I mean, you know, I hope I live to see the day or not I don't know yet. I haven't made up my mind whether I want to do that.
Denise 24:04
But about the proliferation of other therapy, like myself hypnosis, which I don't do therapy, therapy within hypnosis, but it is it's therapeutic hypnosis. i What about your family and family, marriage, marriage and family? Counselors addiction? Yeah, all of those things fits within that.
Swapna 24:27
I definitely does fit into this. I mean, it may not be sort of like, again, and we're schooled in a certain way, right. I mean, when we did a residency in psychiatry, I wouldn't sort of like be trained in hypnosis, maybe I should have been but this is not an area that was from a very kind of like a structured format of how we got our residency training or fellowship training. But you know, this is the thing that I feel like and I know there is a little bit of this dilemma that doctors are entering fields of coaching and all of that, but I find that why Watch. I mean, if there are people that are struggling, and if you as doctors, as physicians, as therapists, counselors are going to touch that aspect of human life and make it better, then why not? I mean, I know that the it's a bit controversial with some of my psych colleagues might say, Oh, well, we trained and everything.
Denise 25:23
And I guess, I think the concern, a legitimate concern is, is somebody less qualified, going to give them just enough help, just not really diagnose the problem, and just keep a lid on it, keep a lid on it, keep a lid on
Swapna 25:35
it. That's the thing, that's the thing. And it really would depend, right. And I would say that, at least, I would hope that if somebody sees people and feels like, this is something that is beyond me, you know, like something that really I would like a trained therapist who has gone through a PhD or who has, you know, finished their psychiatry residency, and need that kind of help. And they will probably refer to that higher level of care. But right now, also, we have, you know, we just have such shortage that we have lot of like, mid levels helping us out, you know, we, unless I mean, of course, they should understand the scope of how they are practicing. Because that is a complete different training than what psychiatrists do or MDS do. So I feel like everybody has a place in how they practice. But I do feel that if we want to build like a really integrated, ethical way of practicing, I think we should accept what our scope is, what is the limit of it. And we should be very clear with ourselves, and sort of with the board in general like that, this is what we can admit, this is what we cannot do. This is where we need the expertise. That is my thinking. But again, I know that there is a lot of people with different kinds of pros and cons, there tends
Denise 26:43
to be a bit of competitiveness, there is a
Swapna 26:47
bit of like this exactly. So I'm sort of I follow the middle ground. But I do agree that scope of practice to define that is very important. And then ultimately, that is do no harm to the patient, right? So I would operate that. And let's see that if I was not enough qualified to be a psychiatrist or whatnot, I would probably understand that this is what I could help my patient with. But this is somewhere I feel this patient benefit
Denise 27:12
problem, of course, is when somebody identifies that, and then they can't get the patient and appointment for X number of weeks to months.
Swapna 27:20
I know, then it's agony. This is the agony and this is why I'm saying that there is no real answers here. And this is why we need all sorts of clinicians who are stepping up right now to help because as I said that psychiatrists in general, they have been stretched thin. I mean, it is not a field that is sustainable anymore. A lot of my colleagues have retired, gone into small mini cash only private practices. And I think that
Denise 27:45
as a response to financial issues with the way that we're reimbursed, or as a as a way of controlling their own burnout
Denise 29:00
change and some of the apps are very good. But I do worry that people are self diagnosing and following those instead of seeing somebody to get a actual diagnosis or initial help.
Swapna 29:10
. Absolutely. I think these apps these sort of like, you know, kind of things they help in maintenance. But initially, you need to see a professional to get a good treatment plan to understand to have some some oversight in what's happening. And then you may have the help of these apps or AI or these, you know, V bots or chat apps are what they have to continue the maintenance, but I do feel that there is use so that's why I say that nothing is all bad or all good. I think everything has a meaning. Everything has a place in this complicated structure of what our healthcare has been become as long as we understand the scope of that particular intervention. And we know how to sort of like raise the bar and say okay, this is where I need you to go to XYZ
Denise 29:58
and and just because this is a about immigrant doctors. And I think because I'm an immigrant too. I think we just need to remember how how much value there is in bringing people in from different trainings. Do you think that your training in India and your practice in India affected the way other people in your program appreciated? Did you have additional stuff you were able to bring in?
Swapna 30:25
You know, I think that's such an interesting question. So my program was a melting pot itself. I was from India, I had another resident from Nepal. One was from Yugoslavia, I think Romania, so people from all walks of life. And I felt like that melting pot itself, helped each of us develop as clinicians, and kind of each other's I said, sounding boards. We used to have a group, you know, which was sort of like our, kind of like a group therapy, where we talked about our patients, we brought like an interesting patient, and we discussed the patient. And what I really learned was the unique experiences of each of my other colleagues and how they would look at the case. And that made me grow so much, because my, maybe my focus was sort of trained in one way, as you know, we have some sort of sometimes sometimes a tunnel vision. But this broadened it. And so I would say that, in India, I practiced very differently. First of all, I practiced mostly my language, because a lot of our patients who were very poor, and, you know, didn't speak English. And so there were different ways to kind of talk in this and, and I learned a lot in the, in the growth with that. Whereas in the US, I had to sort of really, you know, change myself a bit, too. You have so
Denise 31:52
many languages available in the US, too. When I when I was at St. Luke's Yeah, more than 50% of the time, I was using Spanish. Now, that was helpful because I speak Spanish. Yeah, many as we did many other residents, there were residents from Puerto Rico. But the people who were from Ghana, it was harder for them, because they had I mean, by the second year, they were pretty good Spanish, you
Swapna 32:15
know, you're right. And I think we did like of course of medical Spanish, because New York again, you know, for us, especially in on the Harlem side, we absolutely had to know
Denise 32:23
but you've you've also got French, you've got Haitian French, which is different. Oh, you've got Romanian, you've got you've got everybody from everywhere. And can you speak a little bit to that, when you're when you are working with somebody who's not from your culture, but not even from your linguistic background? You can get confused between English English and American English.
Swapna 32:44
Completely, completely. Oh, my God, tomato tomahto. Right. But yeah, I mean, I have to say that, that time we really struggled, because right now there's so many of these language services. And you know, it's really available. But we used to wait for interpreters. Yeah. But then
Denise 33:01
interpretation and translation are so different. And Google, Google make some interesting misses. Have you ever read the subtitles to a language that you understand that you watch the English and that's not what they said,
Swapna 33:14
100% 100%, I was just watching like a series on Netflix, which was in Punjabi, which is another format of you know, I don't understand the language that well, but I do know enough to know the translation in English was completely off. So that does happen. And so I think that there is limitation to what happens, but you know, even with just the spoken words, I think the cultural relevance of those words, because it can be misinterpreted, the way you say things in certain languages can be completely misinterpreted. A joke can become an insult in another language. So it is it was very difficult, I would say when I had patients who didn't speak the language who didn't speak English, or even like my little limited medical Spanish that I could understand, but then, as you explained, you know, some people who were from Ghana or spoke a language that I was on completely not familiar with, it was it was very, very difficult and also when they came in a psychiatric crisis. Yeah, I think as as a doctor, I mean, I think I mean, I might have shed a few tears in my, you know, sort of like once you finish your work, and it was it was hard. I mean, you know, this person was in crisis and we just had to kind of do what we had to do. And there was nobody who could really explain to this person i What was very funny this
Denise 34:30
is this isn't a language problem, but I may cut this out but I had a client in Sorry, I've trained myself say client instead of patient because now I'm just a hypnotist. But when I was still a doctor doctoring, I was in a remote area of the country, I shan't say where and I had somebody who was having a major psychotic break. precipitated by the imminent arrival of one of her relatives for Thanksgiving, it it just threw her out completely. And I had to wait for the crisis team, thankfully, it was a very small ER. And I had the time just to sit and talk to her and like, keep her okay. And what she was saying to me was very, very typical, a lot of sexual imagery, a lot of tinfoil hat stuff, the CIA, of course, because they had put, they had implanted her with little machines. And so it's always what started this, I will definitely get this to rubbish machine to put in. But so I listened to this. And just I kept her steady until the crisis team got there, and they could admit her to a different facility. And the betrayal on her face when she realized she was getting admitted. And I wasn't just going to sit there and talk to her for three weeks was heartbreaking. When this woman, you have to go to hospital, honey, you're in pain. I mean, she was so clearly in pain. I then when I used to work nights, and I flipped on the TV, so I feel like you know, come down. And I'm listening to PBS. And it was Bill Moyers, I think. And it was, it was all about nano machines, and how you can put them into people's bodies and get feedback on like, Oh, my
Swapna 36:10
God told me to watch PBS. You know, what is this interesting? And yeah, I mean, this is so true. I mean, there are having such stories that I can say that sometimes culture, right TV current into things, and the patient's the way they'll absorb it. And then that would feed into their own psychosis that's brewing and the way it comes out. So yeah, I have a lot of stories like that. So
Denise 36:37
we agree that immigrants are very useful to America. However, there used to be a concept called the brain drain. Yes. Do you ever experience any feelings of distress other than the one sent to you by your grandparents and your parents? When they say "Come home!"? Do you? Do you ever wish that you could take what you've learned here? As
Swapna 36:57
always, I do. Actually, you know, I mean, I think you can't really take the country out of you. You've been in a country, you were raised there for 24 years, and I'm really proud of India, from where I am my heritage and everything. But at the same time, life does happen. You know, and I did create a life here. For me, my brother also migrated to Canada. And so we kind of became, we joke about it, you know, we were both born in India. He's a Canadian, and I'm a US citizen, you know, so, life took us in those paths. Luckily, we are only four hours away, border wise. So, so we can see each other. But I feel like now 20 years here, I sort of feel that my life is become you know, more. But then again, you would say really, because then I married a French guy. So yes, I'm married again. And I have a kid who is half French, and half Indian.
Denise 37:52
So that's why my husband ended up I ended up staying because I married somebody from the Dominican Republic, and the kids are American. And it's, you know, I kept away, go be American and Dominican in England, NO! It's just easier to stay in the third culture. That's exactly why I love America, but I love lots of places.
Swapna 38:11
It's my dream. And I think it's a dream. Also, he's from Nice in France. So when I retire, that's where we will go once my son is in college, you know, we do what we
Denise 38:19
do, and who knows where he'll go, he may go someplace else.
Swapna 38:23
But I will tell you something, talking about roots. My son is eight and he has some, you know, his classmates. Some of them are from India, originally, that parents are from India. And he says, Well, why haven't you taken me to India, we've been to France several times.
Denise 38:39
It takes a lot longer than get into France. But yeah,
Swapna 38:41
I told him. I said, like, then the pandemic happened, okay, I didn't do anything about it. I had plans, and you were all of four or five. And now you're eight - great - so let's go this year. That points to the stories that I am taking him, he is very excited in December to, you know, see where I am from, where did I go to school? What did I do? You know, how did I grew up in India, because kids have this concept about parents. They were just like born as parents. Yes, of course. Like I did about my parents, youwere just parents, you were never a child.
Denise 39:13
It's like with kids go to kindergarten. It's my teacher, she lives at the school. And even sometimes, a patient will you know, they got this they meet you supermarket and this shocked that you shop for food!
Swapna 39:27
That that's a very interesting thing as a psychiatrist because, you know, we have some
Denise 39:32
not supposed to acknowledge them. Yes, very difficult.
Swapna 39:35
And, you know, it's been kind of like, interesting, and I also talk about it a lot with my psych colleagues. Sometimes, I mean, you know, I'll just see what I know they've seen me and, you know, if they do very well just be back, but I do know that some patients really do not, you know, they will feel very distorted inside if I acknowledge them. So you really have to be very careful with that. My understanding of what they would feel and they wouldn't feel, but they would bring it in the session, you know, and some would apologize and say, I just didn't know how to react. And I would say no, no worries, you know, like you react the way you felt comfortable. There is no right or wrong here. You know, of course, it's very difficult. We live in a society, we wouldn't we might see somebody if you wanted to acknowledge Fair enough. And if you want me to acknowledge fair enough, but it's just like a quick "hi" or quick "hello" you just move on. Because, yeah, we we definitely maintain those boundaries very, very, as we should, you know, as we should.
Denise 40:34
Now, that makes it more difficult, though, if you're in a very small community. That is true. Which, you know, has led to some some issues with you do do charge colleagues do? Can you employ somebody you know, to work on your house, if you're the doctor? Well, if you need somebody to work on your house, and the next person is 100 miles away? Yes, I guess you do
Swapna 40:57
that. I think this is the cultural phenomenon, which I would like to talk about. My my father. He's a general practitioner. I mean, he's retired, or I hope he's retired because he still get calls from his patients. Yeah, and, you know, God bless him. He's really like, as you said, the town doctor, everybody knows him. Everybody knows of this doctor, Dr. Vaidya. So my last name is Vaidya, so he's Dr Vaidya. And, you know, his patients, we knew them. Some of them are fishmongers. My father was a very, I think he practiced community medicine really the way it should be practiced. He practiced, hehad his own practice. But he decided the terms of, you know, he would charge people based on how much he thought they could afford.
Denise 41:42
Is there a national system or provincial system or state?
Swapna 41:46
Not I mean, I'm not sure exactly how it works, because most of my doctor friends back home or in their own private practices, there is no law in India that you cannot own hospitals or practices as there is, a law, in America. So it's very different. But there is insurance has started creeping in now. And there are insurance companies coming into the, you know, of like getting that part of that stake in the business. But my father, at least at that point in time, and I know, my friends still who are doctors, they practice independently, they are consultants to hospitals, they get their own fees, they have their own patients, they decide their own hours. So yes, so in a way, sometimes I do look at their lives and think hmmm... you know, I mean, it's not easy. I mean, they keep telling me, it's, it's everything looks greener on the other side, also. But I like the autonomy that they have. I like the fact that they have that ability to, you know, expand themselves the way they want to or not, there's not a national health system as such, but there are government hospitals. So when I did my residency in KEM, that was a government hospital, it was completely free. at a given time, I used to see 200 patients, I'm not kidding, outpatient, or shift per shift 200 patients, we didn't have a lot of paper charts. Okay. Let's put that EHR in our, okay, we literally were doing care. It was crisis care. We had patients, there was used to be a line in the OPDs. Still remember, and we were seeing one after the other one after the other dispensing medications, you know, doing what we could, you know, sort of like we used to do also have a inpatient unit we did ECTs there. So we had to sort of prep the patients for ECTs the next day. It was very, very busy. But it was there was a lot of joy because I wasn't getting encumbered by you know, did I tick this? Did I tick that? Did I not tick? Oh my god, like, Did I not write this for the CMS measures? Which Yeah, I know, I know. I'm not I don't want to create a controversy. But I did practice in India, I would say in the 1990s Actually, I practiced from just exactly what I was supposed to do and not be encumbered by chapter. Yeah.
Denise 44:00
That's the difference. Yeah, that's a whole that's a whole nother series to talk about that you don't have EHRs
Swapna 44:04
even now, my friend is not EHR typing or anything. She's doing forgeries you know, she's helping patients just she's delivering kids. She's obviously her documentation is
Denise 44:16
what would help is a document somewhere from somebody.
Swapna 44:19
There's a document somewhere but I really highly doubt that she's writing down you know, these click click click and death by 1000 clicks that has to go somehow that has to be different that I feel like doctors have lost the joy of practicing. If I had to practice in a way that I could practice in India and just really not have to bother about the amount of work that I have to do later then maybe AI can help somebody can do my notes Yes, maybe
Denise 44:47
maybe I can have to figure out a way for it to be really useful you know, I've
Denise 44:52
got a I'm gonna edit everything before it goes out but so this hopefully it'll be over but the SAT_AFTRA just joined the righteous strike a couple of days ago before we're talking here, and their primary concern is the use of AI. Oh, taking away the jobs of writers and actors, because you can now through AI, you know, make a different person, but it looks a bit like Brad Pitt, but it isn't Brad Pitt,
Denise 45:20
you know. So, it when you consider that how much emotion and I mean, real actors, not the people who just stand there and say words, but real, real actors. That is that takes up talent and a huge amount of training. It really does. A lot of practice goes into that. So the idea that I would get the same experience from watching a computer do is just disturbs me, they are getting better. The computers are definitely getting better, ChatGPT is fun to talk to, it answers you as a person. But it can also say some really goofy things.
Swapna 45:56
Really, I think that's exactly what it is. I was watching actually, something you know, there was a tech kind of thing going on in somewhere in Switzerland, and there was a robot, and robot who's been designed that can also create human expressions. So one person asked this robot, do you think whatever the name of the robot was that, you know, AI is gonna take over, sort of humanity. And she literally gave aside I said, creepy. It was creepy that she could understand that robot was like, she gave a sarcastic side-eye. Like, like, how can you even ask me that question? And she gave a very sarcastic answer also. Oh, my God, they are taking over the world. That scared me. That creeped me out.
Denise 46:44
That's why you say please, and thank you to them, in case it does. It has been really lovely talking to you but we do have to close up and I think I'm going to invite you back for another season to do some other aspects that
Swapna 46:57
will do this.
Denise 46:59
Thank you so much. Thank
Swapna 47:00
you so much. Thank you again for the opportunity. You have a wonderful Sunday. Bye.
Denise 47:05
Thank you for joining us at Myth, Magic, Medicine. If you found this episode useful, you can apply for free CME credit through the link provided in the shownotes. If you're not a medical professional, please remember, while we're physicians, we're not your physicians, so please consult with your own healthcare professional if you think something you have heard might apply to you or a loved one. Until next time, bye bye
Transcribed by https://otter.ai
