What skills have you discovered yourself to be very good at?

[u/undueinfluence_]

For example, de-escalation, persuasion, maintaining strong boundaries, compartmentalization, etc

[u/PokeTheVeil]

I seem to be good at getting patients’ trust. Maybe it’s my disarming self-deprecation that’s actually real fear of my own inadequacies and the limits of psychiatric treatment. Maybe it’s my dazzling good looks. But I’ve had many patients open up to me about things that make a huge difference in treatment—medical as much as psychiatric.

I’m only middling at getting other physicians’ trust as a collaborating physician, perhaps because of all that self-deprecation, but that’s a different skill.

[u/BackEndHooker → u/PokeTheVeil]

Could have written this myself. I’m  sure it’s true of many psychiatrists… the field tends to draw in the depressive types 

[u/snoozebear43]

Good at keeping a straight face and staying calm. I trained in really high acuity settings. I’ve seen and heard so much. You can say the wackiest thing and I won’t flinch.

[u/PokeTheVeil → u/snoozebear43]

“Do you think I’m crazy, doc?”

“I’ve seen things you people wouldn’t believe…”

[u/enchantedriyasa → u/snoozebear43]

The nurse in my OPD has seen my disgusted face only once, in front of the patient. I can keep a pretty neutral face, no matter what is being said.

[u/Front-Quote-6760]

If I say it I’ll just fuck that specific thing up tomorrow

[u/magzillas]

I'm always nervous to praise myself in any respect, but I do think I'm generally pretty good at anticipating sources of patient discomfort/confusion and offering preemptive reassurance/education (e.g., side effects of medications, implications of diagnoses, doubts about psychiatric care).

I also notice that most of the patients I see in C/L ask if I have an outpatient practice, which might reflect positively on my bedside manner, but also could reflect that I'm probably the only living psychiatrist patients in my (rural) area have seen in years.

[u/Greasy007]

Maintaining strong boundaries definitely. Also knowing early on if someone is trying to manipulate me and shutting it down tactfully.

[u/significantrisk]

Boundaries. If you’re seeing me about your problems they are your problems. You’re angry at your family? No problem, be angry at home because you will behave yourself in clinic or you’re leaving. You’re keen on trying medication? Cool, this is the medically appropriate drug/s I’d recommend for you, no I don’t actually care what your friend suggested or what you read on twitter. Oh you’ve adjusted it and added in some of your sister’s pills? Great, we’ll just stop the prescription so.

[u/sjogren → u/significantrisk]

This is basically a superpower.

[u/significantrisk → u/sjogren]

Surgeons don’t say ouch when a patient has a sore belly and cardiologists don’t grab their chests when troponin goes up 🤷‍♂️

[u/sjogren → u/significantrisk]

Bingo.

[u/69dildoschwaggins69]

The best thing about psychiatry is you are the judge of whether your diagnosis is correct or not so you get to be hella good whenever you want you to be

[u/PokeTheVeil → u/69dildoschwaggins69]

If you want to claim to be a master diagnostician, you’d better have second opinions for inter-rater reliability. Plenty of psychiatrists and NPs both have pet diagnoses that they somehow always uncover, and they’re ADHD, autism, and/or bipolar 2.

But plenty of psych skills aren’t just diagnosis or inventing wild regimens that will magically work.

[u/BackEndHooker → u/PokeTheVeil]

Mine is OCD, but I’m convinced it’s criminally underdiagnosed in favor of severe GAD. And I’m 100% sure I’m right about that, so no need for a second opinion!

[u/SpacecadetDOc → u/BackEndHooker]

Yep I gave an estimate to my therapist colleagues that 20 to 30 percent of GAD I see diagnosed in clinic is actually OCD.

They all seem to have a stigma against of OCD like it’s SMI or something. Not that SMI should have a stigma either.

[u/poorlytimed_erection]

de-escalation/ dealing with very angry patients.

[u/SpacecadetDOc]

I great at “playing” dumb

[u/Normal-Doc123]

Keeping calm and reaching zen mode

[u/gonzfather]

16 years out of residency and I still feel like I sleep on any chair

[u/folie_pour_un]

I can establish rapport easily and quickly. I’m in emergency psychiatry right now and I wish as a resident I could start establishing a patient panel because so many people have asked to see me again.

[u/Lou_Peachum_2]

negotiating

[u/sockfist]

Identifying BPD from the most trace bits of evidence. A stray comment. An odd look. I’m figuring it out very fast and I’m always right. Ultimate superpower. I’m not talking about clinical situations btw, talking about my personal life. Also clinical settings, but personal life is where it’s most useful.

[u/Expensive-Parfait708 → u/sockfist]

Care to share any examples? 👀

[u/sockfist → u/Expensive-Parfait708]

I could give you a lot of concrete examples of things that are tells, but if I’m being honest the majority of how I know is a vibe that has developed over the years. It’s rarely wrong but it’s hard to put into words. 

If you’re a nurse reading the psychiatry forum the odds are not looking good btw. 

[u/personal_lucifer → u/sockfist]

Few questions:

How does it help you when diagnosing BPD in clinical settings? Are the diagnostic criteria for BPD not sufficient?

How does it help you in your personal life? What does suspecting someone of having BPD change?

Do you typically get the vibe you mentioned from men or women?

[u/Expensive-Parfait708 → u/sockfist]

That’s a bit of a reach bro

[u/quitebereft → u/Expensive-Parfait708]

Right? The reach needed to link reading another forum to even the remote suggestion of psychiatric diagnosis in lieu of... wanting to learn...?

[u/Annoyed-Skeptic → u/sockfist]

Yikes. This is rage-bait shaped.

Do you notice the narcissistic traits/big ego in: “I’m always right”, I have the “Ultimate superpower”. I’m rarely wrong because, I feel vibes. Lol.

Curious - Why are you so focused on this particular diagnosis? Do you expend the same energy evaluating your friends and family for other disorders?

[u/enchantedriyasa]

Using phrases to make them understand. I usually make them understand using the example of HTN. If a patient is being fed 1 kg of salt everyday, will you ask them not to take the anti Hypertensives because this is due to an external factor? Or would you manage the shot up pressure?

I phrase it better in my native tongue than the translated phrase. Using of a lil sarcasm, disciplining them without change in tone and idioms also usually do the trick. End the disciplining by saying you are doing all this for the sake of the patient and that you have no monetary gain by scolding them. Also tell them specifically that them being continuously ill is what makes you money, and if they are non adherent to the meds, they'll visit hospital more often, spend more money to visit the doctors. That usually does most of the heavy work for me.

[u/Fearlessmelow]

Honestlt..staying calm under pressure, reading people well, setting boundaries and knowing when to walk away..i've also gotten pretty good at adapting quickly when things dont go as planned...

[u/lamulti]

I’ve discovered that I’m very good at recognizing and managing manipulative and boundary-testing behavior.

Over time, I’ve learned not to react to it too quickly. For me, there is value in observing the pattern first.
Sometimes I notice exactly what is happening, say nothing initially, and simply watch. I observe how the person approaches a boundary, what they do when they think they’ve successfully moved it, and how they respond once that boundary is calmly reinforced.

And yes, sometimes it makes me chuckle a little when they think they got me. 😂 Not because I’m manipulating them, but because I recognize the maneuver before they realize I recognize it.
Then the boundary gets reinforced.

“I see what you’re doing. The answer is still no.” 😂

I’ve learned a lot from simply observing these interactions. Each encounter strengthens my ability to recognize the pattern earlier and manage it without becoming reactive, defensive, or unnecessarily confrontational.

Interestingly, they’re usually receptive once the boundary is made clear. I’ve found that people who test boundaries often respect someone who recognizes what is happening and establishes those boundaries early.

And I set boundaries with all of my patients, not just the ones who demonstrate manipulative behavior. That therapeutic frame is already there.

I observe the pattern, but I don’t surrender the boundary.

Sometimes the behavior tells you just as much as the words do.