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Focus on Keith Garcia, MD, PhD

Keith Garcia, MD, PhD is assistant professor of psychiatry and director of the Wohl Psychiatric Clinic. His areas of interest include adult and geriatric psychiatry.

Dr. Garcia sees patients at the Wohl Clinic, 4950 Children’s Place, St. Louis, MO, 63110.

TO MAKE AN APPOINTMENT, PLEASE CALL 314 362-1222.

What happened in the course of schooling to make you choose psychiatry as your specialty?

My undergraduate training was in neuroscience. When I started medical school I was interested in human behavior and the parts of the brain that make us different from other animals. I was drawn to psychiatry because it seemed like it was the applied science of cognitive neuroscience. But when I actually did my rotations, I discovered that the kinds of skills that are used as a psychiatrist are very different from the skills that are used to be a neuroscientist. It’s absolutely fascinating.


What brought you to Washington University?

Washington University has a great neuroscience program and is a pioneer institution for functional imaging. I did a great deal of research in medical school and had a very specific research interest to pursue when I came here for my residency. I found that there is not a lot of time during residency to do any kind of basic science research -- but it didn’t matter to me because I fell in love with the clinical work.

Because I loved the clinical work so much, I stayed on as clinical faculty when I finished my residency. Actually, I discovered that when I’m doing research, I really miss the clinical work, but when I’m doing clinical work, I don’t necessarily miss the basic science research. I really enjoy being around people.

The department has been so supportive about accommodating me when my career moved in a different direction. It was on a fluke that I came up here to do research, and ended up loving something else completely different (seeing patients).
Dr. Garcia shows off his culinary skills


Which aspect of your practice is most interesting?

I really enjoy my patients -- I like talking to them and hearing their stories – not just about their illnesses, but how their lives are impacted by their symptoms. It’s interesting because everybody’s story is different.

I also see a lot of older patients. I enjoy interacting with them because they have a lifetime of history, a wealth of experience and stories to tell.

Earning a patient’s trust and respect and helping them feel better is the most rewarding part of my job.

Do you have any success stories that come to mind?

The easy patients are the ones with dramatic changes – they are very sick when they first come in. But then I am able to identify and take care of the medical problem that is causing their psychiatric symptoms. They go back to being their old selves and it is very rewarding.

However, the success stories that come to mind are the difficult patients. I struggle with them for months and work with them to teach them how to cope with their symptoms while they wait for medications to be effective. Those are the people that tend to really appreciate the care I give them.

Where are you from?

I was born in Houston, Texas. I went to undergraduate at Rice University in Houston, and I did an MD, PhD program at the University of Texas at Houston – that took nine years. When I turned 30, I decided it was time to leave Houston and live somewhere else.

I love Texas, and the food is great there. But now having lived in St. Louis for awhile, when I go back to Houston, I think, boy how do people live here? It’s so hard to get around.
 
Things are so spread out in Houston, it would take me 30 minutes to drive to work -- even though I only lived three miles away. I could have made it there just as fast walking, but because it was so hot outside, I needed to be in air conditioned car otherwise I would be too sweaty for the rest of the day.
 
St. Louis is like a bunch of little cities glued together. I feel like we live in this little community that has access to everything a big city has. I’m pretty happy to be here
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Is there a particular award or achievement that is most gratifying?

I’ve been named one of the St. Louis Best Doctors (this will be the third year in a row). Doctors grade physicians in the area and are asked who they would send one of their own family members to. It’s a nice award because it is recognition from my peers. I’m pretty proud of that.

Are there new developments in your field that you are excited about?

I’m very excited about a new device that we’ve been doing research with – called repetitive transcranial magnetic stimulation (RTMS). RTMS is a device that uses a powerful magnet that is turned on and off very rapidly. It stimulates the brain to treat psychiatric illnesses such as depression.

It’s essentially painless -- there are very few side-effects and it’s really an effective treatment for major depressive disorder. Maybe even a little more effective than medications. We’ve been working with this device to treat depression, but there are also a number of other applications that are being considered -- including tinnitus (ringing in the ears) and irritable bowel syndrome. It’s a budding technology and the breadth of use remains to be explored.

How does RTMS work?

Basically, the patient sits in an easy chair. The magnet is the size of both two fists put together, it is placed against the scalp and then is turned on and off very rapidly. If you remember your high school physics -- whenever a magnet is turned on and off, an electrical field is induced underneath it. Since the brain is an electrical tissue, brain cells can be stimulated that way. We can restore abnormal activity in the brain to its normal state – either by stimulating high frequencies or low frequencies. The science that helps us understand where activity is abnormal in the brain, during illnesses like depression or tinnitus, is helping us focus the treatment on the correct area of the brain so we can restore that activity to normal.

RTMS was recently approved by the FDA for the treatment of major depression. It’s particularly useful in patients who don’t want to take medicine, or for some reason, can’t take medicine. We’ve just completed a pilot study in postpartum depression. A lot of women don’t want to take medication because they’re breast feeding or they’re worried about the side-effects of medicines. It’s a shame to let someone suffer from depression during a time in her life when she has a new baby and is supposed to be really happy.

What is the best advice you’ve ever received?

When I was in graduate school, I had a friend who was an engineer, who was also just a very clever guy. I had to modify this piece of electronics (that was very expensive) for a study I was doing. I figured out what I needed to do in order to make this thing work, but was worried that I might break it if I opened it up and started mucking around with the insides. So I built models of what I wanted to do, hemmed and hawed over it. This friend said, “Look you’re not going to get anywhere in life if you’re worried about breaking things. You have to go in and try it. If it doesn’t work out the way you want it, then you have to figure it out and you prepare yourself as best you can, but if you break something, ‘oh well’, you have to pick up the pieces and move on.”

That’s a tremendously insightful piece of advice that goes beyond just fixing a little piece of equipment in the lab. It applies to everything -- anything you do, you can change your mind or your plan later. You can’t be worried about breaking or messing something up – otherwise you’ll never take a step forward.

If you weren’t a doctor, what would you be doing?

I would be a talk show host. I would love to have David Letterman’s job -- that would be the best job in the world. He basically does what I do – gets people to talk about themselves -- but he’s on television and makes huge amounts of money doing it.
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Copyright 2009 Washington University School of Medicine
Copyright 2009 Washington University School of Medicine