Diversity In Rehab
Krystina Murray ❘
Treatment centers have included a variety of treatments to cater to all types of people. Read about factors impacting diversity trends with specific groups.
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Hayley: Hi, this is Hayley, and you’re listening to “Straight Talk with The Doc,” a podcast that takes a real look at addiction, mental health, and treatment. I’m here today with our content director, Jeff and of course, Dr. Bhatt. How are you guys doing today?
Dr. Bhatt: I’m doing well, thank you.
Jeff: I’m doing well too, Hayley, thanks.
Hayley: So I wanted to give our listeners some background on you, Dr. Bhatt. Some credentials, why you got into addiction medicine, in the first place. Can you start by telling us your title?
Dr. Bhatt: Sure, Hayley, thanks. I’m the medical director here at AddictionCenter.com, and I serve as a consultant to help ensure that the scientific data of the content is up to current information as it regards to addiction and mental health.
Hayley: Could you explain what your credentials mean?
Dr. Bhatt: Sure. My background, I’m trained as a medical doctor, M.D., and I trained in traditional medicine in medical school, and I further specialized in psychiatry. When I was going through psychiatry, I felt like to understand the total human being, you first had to master normal and abnormal childhood development to understand the adult, so I went on and specialized in childhood adolescence psychiatry also. And along that path I ended up becoming a diplomatic American board of psychiatry and neurology, so I’m board certified in both adult and child/ adolescent psychiatry. Furthermore, we saw so many patients in emergency rooms that were suffering from co-occurring health issues and addiction issues, so I started specializing a lot in that interface, and I ended up focusing on running multiple inpatient detox units and board certified by the Addiction medicine as a specialist in that.
Hayley: Okay perfect. Can you take us back and tell us what made you first interested in addiction medicine.
Dr. Bhatt: Well I have to think. I look back at a few things. It’s pretty complex I think for me. Looking back upon my own life, I see coming as a young child, I emigrated from English in the United States in the 70s and at that time, somebody of my background,–I’m Indian, with a British accent, who came to the United States and grew up in South Florida. Not everybody saw an Indian kid speaking in such a way.
So I was often the victim of people bullying and I think they were prejudicial and stigmatizing of the way you acted and behaved. And obviously I went through- I was resilient and became friends and went through normal adolescence, but that resonated with me. Acceptance And understanding by people towards others. So fast forward in the 90s, I was working a lot in the assisted living facility, where a lot of the patients were suffering from co-occurring mental health issues and substance abuse problems and I felt bad for them because people were jumping to conclusions.They were misjudging them and characterizing them inappropriately and inaccurately. So I always wanted to go into medical school, I love medicine, and I love science, and I was actually gonna pursue surgery.
But during the course of my experiences, practicing medicine and being in the emergency room and seeing how people were intoxicated and drunk, or people who came in with mental illness, it’s sad to say but I saw them being treated, also badly and people were jumping to conclusions, or nobody wants to talk to them, or here’s that drunk guy. And for me, I felt that I needed to make a change in this, I needed to make a change for people who are the victims of stigma and prejudice and people who are not treated fairly.
So for me, I changed direction and went into the mental health and addiction field because I wanted to make a difference. If I didn’t I felt that I was succumbing to the same stigma and prejudice that other people had with mental health and substance abuse issues, so I wanted to tackle it head on.
Hayley: I wanna ask about your professional background, but also compound that with the changes that you have tried to make (and what you’ve accomplished in your work).
Dr. Bhatt: Jumping off from that previous question is that, the changes I wanted to see is that I didn’t want to be like everyone else in the practice of medicine. I believe psychiatry is pretty subjective although we’ve tried to make it objective by following a set of rules in a book called the DSM. There is a personal interpretation by each practitioner so I think that can be taken advantage of. Because when people come to you with mental illness, who might be suffering with schizophrenia, depression or psychosis, they might not be in the right state of mind or they’re under duress.
You can’t hold the practitioner accountable. For me, I felt like I saw people taking advantage of that by not being as accurate and as accountable as they should’ve been as practitioners and so for me, I basically see a patient and treat them the same way I did with that same level of aggressivity and tenacity that I did from when I first started because that complacency issue of people being seen and taken at face value of previous diagnosis, or just not further challenging an addicted individual’s background.
So somebody comes in drunk and they’re depressed, not taken at face value that isn’t one or the other, but looking further. My personal approach was basically making a comprehensive, collaborative evaluation, and starting from scratch for everybody. Really for me, typing to make a change was creating systems in hospitals in treatment centers, in my own private practice where everybody is given a comprehensive, start to finish, long evaluation that takes multiple cross-sections in life and doesn’t just take a previous diagnosis at face value. I want to challenge them all and make sure they are getting the best possible opinion and care.
Hayley: Could you tell me about your work with inpatient, outpatient, and detox units and what you did there?
Dr. Bhatt: Well in my past, I’ve worked in various level of care so, after I finished my fellowship in child and adolescent psychiatry, I started taking on emergency crisis roles and in the hospital, when people are in their most acute phases, in distress, through underlying primary mental illness or through secondary substances of abuse, they came to us. They could be suicidal, psychotic, intoxicated, in withdrawal ,and I’ve been the medical director of those emergency services. And I’ve also run hospital based inpatient units, both for acute psychiatric manifestations, and substance abuse withdrawal detoxification units, and I’ve served as the medical director of those over time, and I had probably transitioned back about 10 years 12 years ago from that hospital-based world to sub-acute facilities, so I was more in the private sector.
I left the hospital-based world and went more to rehabilitation services, where I could have a little more control of the system and help address the patient through multiple levels of care. So from detox through maybe residential treatment, to a partial hospitalization and help them over a longer period of time which I could not do while I was in inpatient, which is kinda limited to just dealing with patients. For a few days I wanted to be a little bit more involved over a longer period of time.
Hayley: Right. So would you help patients with formulating a treatment plan long-term for them?
Dr. Bhatt: Yeah I think the foundation of helping people is to have some sort of goal. I mean a lot of times patients come and they have to succumb, and I use that word because they’re kind of given an ambiguous “Hey, just be in treatment, here’s the care” and not challenge it or be involved. Part of being a patient is to have the right to be involved in the treatment that you are participating in, and you are involved in that treatment plan.
So as a physician, I think it’s important that we give that opportunity to patients. So yes, I was involved with a treatment plan first establishing what’s going on with them, what’s happening in their life, taking on the goals that they have, and then formulating a diagnosis, an assessment, incorporating other members of a treatment team–social workers, a therapist, their family members, other doctors, and get through different levels of care, depending on the symptoms and the situation that they’re presenting, and help them with achieving those goals.
Hayley: So I know you touched on this a little bit earlier, but can you tell me about your philosophy on treating patients?
Dr. Bhatt: It’s really trying to be as accurate as possible. My philosophy isn’t just taking something at face value, just question and make sure that somebody’s getting an accurate second opinion if they’re coming in with a pre-existing diagnosis. Do they really have it? And I think that’s the difficulty here, in the current state of America is that, due to different pressures, bureaucratic, insurance, hospital, personal and what’s going on in the country right now, we’re just so pressed for time. And with psychiatry and addiction, we have no real objective testing and we have pharmacogenomic–genetics–I’m sorry and we can do certain labs. But our basic diagnostic workup is interviewing and testing people.
That’s the mainstay of how we diagnose and treat is speaking of that. And so for me, that’s being compromised a lot of times, because people are trying to put psychiatry as an abstract concept in a more concrete world where it doesn’t work by drawing blood by making a diagnosis or taking an x-ray or a cat scan. You have to speak with the individual. So for me, my philosophy is making sure you don’t compromise the diagnostic clinical interview, making sure you are not misdiagnosing anybody by just taking their previous misdiagnosis at face value.
A lot of times this can bear about where things start to happen where somebody was seen intoxicated on crack was diagnosed with bipolar, and then they leave the emergency room, don’t go to any follow up and end up being treated for bipolar for years, while concurrently using cocaine, and using all these meds and this stuff, and they believe it. Maybe they do have an underlying illness, but for me, it is performing an accurate and comprehensive psychiatric evaluation, giving them appropriate time and collaboration to do a comprehensive assessment, and not take a previous diagnosis at face value.
Hayley: So what are some aspects of addiction and mental health treatment that you believe can be improved upon?
Dr. Bhatt: Well I think we kinda segued into that with that I said. I really think that it really is the assessment process, without sounding so critical. I think the practitioners and health care people, workers in American under the tremendous duress and distress that is going on with the pandemic, we still, this is pre-existed before the pandemic. We need to be accountable. We need to be sure we are providing the best care and especially to our individuals suffering with homelessness and addiction is to not take the previous diagnosis just at face value. This is not a copy, paste and history taking just be self-report.
There’s often and many times, the ned to get collaborative and corroborate information to ensure you’re getting symptoms elicited that were existing both while on substances and not on substances and to ensure you’re spending that proper time evaluating them as accurately as possible. I really think that’s kind of the part I think without getting too long in this explanation is that needs to be corrected the most at the practitioner level.
Hayley: Is there anything that I didn’t ask you that you feel our listeners should know?
Dr. Bhatt: I think you’ve touched based on a lot of things regarding me and my background. Ultimately at the end of the day, we want to get the messaging out and our resources out for people that are seeking help for substance use disorders and mental health issues. And if they can find that information at AddictionCenter.com, we want to be that resource for them.
Hayley: Well, Dr. Bhatt, thank you for sharing some of your history with us. It’s wonderful to know we have people like you in the field of addiction medicine who really care about making a difference. Thank you to our listeners that tuned into today. We hope to have you next time on “Straight Talk with Dr. Bhatt.”
Dr. Ashish Bhatt
Addiction Center’s Medical Content Director, Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.