Works with patients diagnosed by others as 'treatment resistant'
By Arthur Lightbourn
When Philip Botkiss was a child, he suffered from allergies and often got sick.
His parents had lost one 18-month-old child before Botkiss was born and were in constant fear of losing another child.
"So, you can imagine," Botkiss said, "every time I got sick, I was right to the doctor because my parents ... really never got over that loss."
He and his parents became frequent visitors to the local pediatrician up the street in their Maryland suburb of Washington, D.C.
"He was always a source of comfort for me and my family," Botkiss recalled. "He was always very calm, always knew what was going on and would always reassure my parents ... As a result, I had a positive introduction to what medicine was about."
He came to regard his pediatrician as a role model and wanted to be like him. He wanted to help and comfort people.
And that's exactly what he has been doing, not as a pediatrician or the cancer researcher that he had once considered becoming, but as an "in the trenches" psychiatrist, working both with children and adults here in San Diego for the past 20 years.
Botkiss, 50, a local resident and father of three, is a clinical psychiatrist at Sharp Mesa Vista Hospital, the largest free-standing psychiatric facility in San Diego where he treats mostly adults. Botkiss is also clinical director of a day treatment program for adolescents, 12 through 17.
"I'm treating patients who are what is called 'treatment resistant,' who have failed medications and other therapies so they come here to the hospital because they are still very sick and need more help," he said.
In addition, Botkiss, who also runs a private practice on High Bluff Drive in the Del Mar Heights area, frequently appears on TV as a local expert on psychiatry. He is called upon to comment on issues ranging from the treatment of registered sex offenders and tragedies such as school shootings to Tiger Woods, veterans suffering from post-traumatic stress and the latest advances in psychiatry.
Botkiss specializes in the treatment of mood disorders, such as depression and bipolar disorder, using medications and brain stimulation technologies, specifically electroconvulsive therapy (ECT), which is still used in modern psychiatry to treat severe and life-threatening depression.
"Our facility probably does the most ECT of any facility in California," he said. "To most lay people of our generation, they think of ECT as being like that administered in [the 1975 film] 'One Flew Over the Cuckoo's Nest.' The reality is that modern day ECT is administered in a much different manner. Patients are under anesthesia so there's no pain, no discomfort."
The downside to ECT, he said, is that patients often experience temporary short-term memory loss.
"And that can be, as expected, particularly troublesome, depending on the degree. The good news is that over time that should clear, but it could take a period of weeks to months, and in the meantime that can affect a person's ability to function from a cognitive standpoint."
Patients undergoing ECT sessions are restricted from driving.
Recently, Botkiss became the first private practitioner in San Diego to offer patients another therapeutic option for clinical depression called Transcranial Magnetic Stimulation (TMS), a non-invasive treatment, approved 18 months ago by the FDA, that sends magnetic pulses into the mood-regulating part of the brain.
TMS is painless, requires no anesthetic, can be done in a doctor's office, causes no memory loss and has no driving restrictions.
However, he said, "at this point TMS has not been shown to be as effective as ECT ... for severe and life-threatening depression. So there are certain patients where you want to try ECT first."
Because TMS is a new procedure, it is not yet covered under government insured services and by only limited private insurance.
Asked how he personally copes every day working with patients who are in various stages of depression, he said, "My way of approaching this is I'm here to help. And the best way I can help is to be able to make a diagnosis and based on that to develop a treatment plan for my patient. So I'm not focusing as much on the content that someone may share with me, as much as on the process [to help]. And that's very gratifying.
"Of course," he said, "for a psychiatrist the most negative outcome is [when a patient commits] suicide. I think any psychiatrist who works with enough patients will have some suicides in their career and I have as well. I think you have to approach patient care with the understanding that that will sometimes happen, no matter what you do, despite your best efforts ...
"But what I try to do is not only assess the level of suicide ideation, but to also instill some hope and optimism when I meet with patients. And I think I have a good style in doing that because I am upbeat, I like to emphasize the positives ... So I've learned in my career, always offer your patients something, never say, there's nothing else we can do..."