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A Piece of My Mind
October 27, 2015

A Piece of My Mind—Actually

Author Affiliations
  • 1Departments of Family Medicine and Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, Pennsylvania

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2015;314(16):1693-1694. doi:10.1001/jama.2015.8429

I finally gave Tom (not his real name) a piece of my mind, but it’s not what you think. I didn’t “dump on him,” in the colloquial use of the phrase. Rather, I provided his mind with a part of my mind that I hoped would be therapeutic. For better or worse, this happens in every clinical encounter and should be recognized to be as intrinsic to clinical practice as gathering the history of the present illness—where it usually begins.

Background: During my psychiatry residency, I moonlighted by covering the practices of several primary care physicians. I now have a dual academic appointment in the departments of psychiatry and family medicine and teach primary care physicians how to conduct short-term psychotherapy. Tom’s primary care physician had asked me to treat his pathological mourning for his cat, and Tom agreed to see me once a week in a room with a one-way mirror that would permit family medicine residents and students to view our interaction. By the eighth week, we both agreed that Tom had achieved a satisfactory outcome, and he continued to see his primary care physician for his usual medical problems.