Vilius Ogenskas is a psychiatrist currently working at Jonava primary health care center and Lotus Medica Clinic. In the start of his career Vilius worked in the psychiatric ward of Marios Hospital and nursing home in Rukla. He’s a member of the American Psychiatric Association. He obtained his medical degree from The Lithuanian University of Health Sciences and completed his adult psychiatry training at the Psychiatry Clinic of The Hospital of Lithuanian University of Health Sciences Kauno Klinikos. He is a member and facilitator of the "Gentys" men's psychological growth platform, also he’s a content creator and consultant in an online platform “Kalba mamos”, dedicated to women's mental health care during pregnancy, postpartum, and for women who want to raise children. He writes a blog at www.ogenskas.lt dedicated to public mental health and stigma. His main areas of interest are adaptation disorders, anxiety disorders, mood disorders, and neurodevelopmental disorders in adults.
How would you describe communication as a professional skill of a psychiatrist?
The word communication means interaction, the exchange of knowledge and ideas. For humans, as representatives of their species, communication has always been an essential skill for survival. Medicine is one of those ancient professions where communication as a skill plays a significant part in its work results. The importance of communication in the psychiatry field can’t be overestimated in several different levels: patient-psychiatrist, public communication and communication among colleagues.
What major challenges in communication do you see at the patient-specialist level?
It is always a danger of narrowing the scope of our work to only listening to patient’s basic symptoms, diagnosing them based on criteria and giving them medical advice. The traditional paternalistic model of medicine, where the patient follows the doctor's orders and is then expected to recover, is still quite prevalent in psychiatric settings. In this model, if the patient doesn't get better, it's the patient's fault for the doctor, and the patient blames the professional.
Is it your personal professional experience, too?
One of the challenges I myself faced when I started working independently was in discussing treatment outcomes. I noticed that I would often feel anger when patients couldn't recover as much as I wanted them to. In my thoughts, I would blame them for not sticking to the regimen or doing something wrong. It was quite frustrating for me until it changed after I started asking my patients how they would know when they're better. This helped me a lot in establishing and building a strong therapeutic relationship. By aligning expectations, discussing all possible treatment outcomes and options, we can achieve significantly better subjective results. Because sometimes the doctor's imagination of what a person recovering from depression looks like clashes with the person's own view. Sometimes even small achievements, like waking up easily in the morning, could be a life-changing event and provide satisfaction. And sometimes it's only hope that brings a person back to a full life, as they see it. So, transitioning from a paternalistic to an equal relationship with the patient was one of the biggest steps in my work, leading to significantly better results.
What do you think are particularities of the psychiatrists’ communication with patients' families?
I think it is essential to align expectations with the patient's family and loved ones to avoid misunderstandings, too. A good example is people with dementia and their families. Often, after a long period of treatment, the patient's relatives come and complain that the patient's health is not improving, that the patient continues to forget things, get lost, and cannot take care of themselves. This is a critical moment where communication skills are indispensable. The patient's family often imagines that by diagnosing dementia and starting treatment, this person will quickly return to their youthful self, and caregiving will no longer be necessary. So, small changes can be discussed – is the person smiling more often? Are they more responsive to their surroundings? Are they eating more or sleeping better? And by explaining that this is the best that can be achieved and adding that the treatment is aimed at slowing down the progression of dementia, we can achieve decent results. Then, the patient's family can take the first steps towards acceptance, acknowledging that it is a chronic condition and that the patient will never be the same as before. They stop having expectations of restoring productivity, and they get less angry at the patient and themselves. Sometimes, all it takes is to say, "It's not your fault." And that's it. A little empathy, and that's enough.
What about communication among colleagues?
The transmission of medical information among specialists is a very important quality marker in healthcare. Let me share a story: a man who had recovered very well from depression suddenly started deteriorating rapidly. And it seems like nothing has changed. We both sit there scratching our heads – what to do? And only during an informal but open conversation did we discover the cause – a very common side effect of an acne medication he started taking a month ago is depression. I had to contact a dermatologist and discuss the necessity of treatment and alternatives, because even though he no longer had acne, the man couldn't work and was even thinking about suicide again. So, the lack of communication could have cost this man his life.
What other aspects of communication in specialist-to-specialist level do you find important?
I think that several other aspects are crucial for effective and efficient communication, one of them is feedback. Specialists should be open to receiving and providing feedback. This helps in refining ideas and solutions and ensures that the communication is a collaborative process. Another, sometimes lost, aspect of communication is ethics. Ethical considerations are paramount in specialist-to-specialist communication, particularly in fields where the consequences of decisions can be profound. Specialists must adhere to ethical standards, ensuring honesty, transparency, and respect for the rights and confidentiality of individuals involved. Also, what we learned in our residency is relevance. Specialists need to filter and prioritise information to ensure that what they communicate is relevant to the recipient's needs or the current situation. Providing too much information can be overwhelming and counterproductive. For example, people who suffer from psychosomatic symptoms sometimes can be overlooked by surgeons or other specialists, because they have a psychiatric diagnosis. If you have psychosomatic chest pain, it doesn’t mean you can’t have a heart attack.
Besides your clinical practice, you are running a blog where you share stories from work and personal life, as well as comment on various events related to mental health. I see that the ideas and stories you share find resonance in Lithuanian society, they are shared in social media, and it means that it is needed. How did you come to that idea?
Earlier I used to write posts on Facebook or create stories for relevant events. But the thing with Facebook is, that your posts easily disappear in the avalanche of news and stories are up only for 24 hours and they don’t have residual value. The blog, on the other hand, is always there and you can easily find all the texts in one place. Social media platforms provide a way to reach a broader audience and connect with people who may be interested in mental health topics. Sharing blog posts and engaging with the community on social media can help increase visibility.
In this way, I try to bring mental health closer to everyone, to contribute to improvement of society’s mental health through psycho-education and stigma reduction. My aim is to create a supportive online community where people can openly discuss their mental health concerns, seek advice, and offer encouragement to one another.
I believe that understanding what happens in our brains, why we have certain impulses to act is part of the healing process. Each person is unique, but common trends and problems we face are similar. Only the circumstances differ.
What would be your message-to-go to our colleagues?
I believe that communication as a skill is one of the most valuable things a person can have. It's just a pity that sometimes we forget how powerful words can be, how much we can hurt with thoughtless remarks, and what healing power a comforting comment said at the right time and place can have. Therefore, I invite everyone to think very consciously about the message we send when communicating with others. I believe that compassion and empathy are the values on which our daily communication should be based, both as professionals and as human beings. □