Knowing you want to go into psych during med school

[touchpause13]

I'm one of those people who is in med school for the express purpose of doing psych. I was torn for a while about whether or not I wanted to get a PhD in clinical psych or go the MD/DO route and now I'm a first year at a DO school.

I feel stupid for saying this but it's so much more difficult than I thought it would be. I'm not just talking about the course work, I mean emotionally and culturally as well. I'm surrounded by mostly extremely science-minded folks who were taking immunology in undergrad while I was taking women's studies. I love my classmates and I have a lot of friends here, I just miss the humanities and the types of personalities that brings to an extent I wasn't expecting. We did have a behavioral medicine course at the beginning of the semester which has been my highlight so far, but that was the last time I really felt like I was in my element here. Most of it feels like the things I'm really good at are viewed as unimportant, while all the focus is on hard sciences.

For those of you who had early interests in psych, how was medical school for you? Any tips on staying engaged with the material? Sometimes I can't help but fail to see the reason for taking a lot of these courses, more of it feels like hoop jumping than I originally thought and I'm struggling to care about courses to the detriment of my grades. I'm passing and all, but I don't think I've ever gotten so many C's on exams in my life.

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[vistaril]

Oh sheeesh......so you signed up for medical school and are surprised/disappointed that you have to study a bunch of......medically relevant stuff?

You'll be able to do some electives 4th year such that your 4th year has a bunch of mental health related stuff, but the next 3 years are going to be almost all medical stuff and very little mental health stuff. You knew this going in(or should have). That's why it is called medical school and not mental health school.

 

[Maeloryne]

I'm in the same boat as you, except I'm still in undergrad! I'm excited for med school but hope I like the science part too, since I don't mind it now! Best of luck man

 

[touchpause13]

Oh sheeesh......so you signed up for medical school and are surprised/disappointed that you have to study a bunch of......medically relevant stuff?

You'll be able to do some electives 4th year such that your 4th year has a bunch of mental health related stuff, but the next 3 years are going to be almost all medical stuff and very little mental health stuff. You knew this going in(or should have). That's why it is called medical school and not mental health school.

Wow thanks V that's really helpful, I never would have been able to figure that out on my own I appreciate your encouraging words.

Listen I'm sure that there IS relevance of anatomy to psychiatry somehow and I just don't see the big picture yet, just wondering if there was anyone else who had similar thoughts as me and if so how they dealt with it

 

[Armadillos]

The first year of medschool is hoop jumping for pretty much everyone, very little of it is used in any physicians day to day practice. Thats not saying I dont think its important to learn that stuff at one point during medschool, but its not going to be what any doctors career focuses on.

Also instead of approaching it as the fact your missing the humanities, think of it as an opportunity to get exposure to a lot of skills and knowledge that will make you unique compared to the run of the mill therapist,counselor, social worker, etc. Also non-psychiatric medical skills/knowledge are going to be important to you throughout your training. Your going to do up to 6 months IM internship. Depending on the setup of facilities you train or practice in, you may actually be doing physical exams on some patients when they are admitted. In several residency programs at some point your going to be literally the only doctor in the psych hospital at night and you will need to have some general medical knowledge or else your going to be constantly sending pts to the ER for absurd stuff.

 

[wolfvgang22]

I'm one of those people who is in med school for the express purpose of doing psych. I was torn for a while about whether or not I wanted to get a PhD in clinical psych or go the MD/DO route and now I'm a first year at a DO school.

I feel stupid for saying this but it's so much more difficult than I thought it would be. I'm not just talking about the course work, I mean emotionally and culturally as well. I'm surrounded by mostly extremely science-minded folks who were taking immunology in undergrad while I was taking women's studies. I love my classmates and I have a lot of friends here, I just miss the humanities and the types of personalities that brings to an extent I wasn't expecting. We did have a behavioral medicine course at the beginning of the semester which has been my highlight so far, but that was the last time I really felt like I was in my element here. Most of it feels like the things I'm really good at are viewed as unimportant, while all the focus is on hard sciences.

For those of you who had early interests in psych, how was medical school for you? Any tips on staying engaged with the material? Sometimes I can't help but fail to see the reason for taking a lot of these courses, more of it feels like hoop jumping than I originally thought and I'm struggling to care about courses to the detriment of my grades. I'm passing and all, but I don't think I've ever gotten so many C's on exams in my life.

I was much like you. You aren't stupid. It is hard. A lot of the memorization seems like hoop jumping but turns out to be important later. Kind of like elementary school math.

I went to med school just to be a psychiatrist and hopefully be of some help to people with mental illness. I'm a humanities guy. I love to read, write, and study philosophy. Logic, as learned in philosophy, is very helpful for understanding concepts. However, I sort of suck at math, and was average at best at memorization prior to medical school. That first anatomy class was a big shock, as was the culture, just like you say.
How to stay engaged and succeed?

For me, fear is a great motivator: I survived because medical school debt is no joke, and it was make it or bust for me, and my kids who count on me.

Anger is also a great motivator: I didn't seek out competition in school, but it was sort of forced on me by others who brought it. At my school, even walking down the damn hall was some kind of race as to who could get to the class room first. We had some real jerks there. People who bragged about their Biochem degrees. I got angry at all the disrespect. So I worked harder. I came to love the look on the faces of these few people when I did better on exams with lots of extra hard work. Kicking ass is fun and does wonders for your self confidence. Don't get me wrong, I was never intentionally rude to anyone, or unhelpful. I just learned to love competition and the fruits of hard work. I made new friends who were the same way.

If you are intelligent enough to get into med school in the first place, all you really need is hard work and determination. You can do it. You will change and grow as a person if you take care in how you respond to adversity. You will blend your old culture and new culture together into something enriching for yourself and others.
Your patients will benefit from all the hard work.

 

[Mad Jack]

Wow thanks V that's really helpful, I never would have been able to figure that out on my own I appreciate your encouraging words.

Listen I'm sure that there IS relevance of anatomy to psychiatry somehow and I just don't see the big picture yet, just wondering if there was anyone else who had similar thoughts as me and if so how they dealt with it

I'm in your boat. The only thing that gets me through anatomy is thinking that maybe I'll decide psych isn't for me.

 

[OldPsychDoc]

I had a mentor who reminded me that in general, Years 1 & 2 are just learning the vocabulary, and 3 & 4 are about the H & P.

Think of it as immersing yourself in a new culture where you'll be living for the next 5 years. Some stuff makes sense, other stuff doesn't--but you'll enjoy it more if you learn as much as you can.

 

[notdeadyet]

OP- In residency, where psychiatry really starts, I think you might find you will fare better than all of your colleagues who are loving the wrote memorization of the first two years of hard sciences and medical school. Your training in the liberal arts will help you as a psychiatrist immensely. psychiatry really favors those who learn how to think rather than those who memorized what they were told.


Sent from my iPhone using Tapatalk

 

[Armadillos]

OP- In residency, where psychiatry really starts, I think you might find you will fare better than all of your colleagues who are loving the wrote memorization of the first two years of hard sciences and medical school. Your training in the liberal arts will help you as a psychiatrist immensely. psychiatry really favors those who learn how to think rather than those who memorized what they were told.


Sent from my iPhone using Tapatalk

It's funny how everyone comes to this stuff from different angles. I remember a residency interview I had with someone who I later found out is one of the most prominent and well known psychiatrists in the country. They were like "I'm glad you actually came from the hard sciences and your not just another one of us liberal arts psychiatrists, it will serve you well "

Goes to show there is something for everyone in psychiatry.

 

[Back 5]

The first year of medschool is hoop jumping for pretty much everyone, very little of it is used in any physicians day to day practice. Thats not saying I dont think its important to learn that stuff at one point during medschool, but its not going to be what any doctors career focuses on.

Hahahaha. So many MS1's (at my school) think first year is the be all end all. I've tried to explain that life beyond first year is not what they think it is, but they're of the opinion you won't be a good doctor unless you get an A in Micro/Biochem.

 

[Psych56]

Keep an open mind. You may not even end up going into psych when it's all said and done. Also, getting a strong foundation in medicine is crucial regardless of what field you choose. Yes, studying the biochemistry, immunology, etc. may be difficult but I promise you'll get to the "good stuff" sooner than you realize.

 

[jzrocker]

Please please please don't perpetuate this idea that psychiatry is not medicine. There's a difference between psychologists and psychiatrists, which seems to be everything you appear to dislike. Patients you will see are going to have a lot of problems that require a doctor, lots of comorbidities, lots of other medications, lots of medical issues that contribute significantly to their mental status. As an MD, you are expected to be able to recognize and treat metabolic disorder or know how to prescribe antibiotics or when to be concerned about neutropenia. Psychiatry is not just listening to people talk for 12 hours a day. It's great to love and hold on to humanities, but there's a reason why you have to go through medical school to become a psychiatrist.

 

[touchpause13]

Please please please don't perpetuate this idea that psychiatry is not medicine. There's a difference between psychologists and psychiatrists, which seems to be everything you appear to dislike. Patients you will see are going to have a lot of problems that require a doctor, lots of comorbidities, lots of other medications, lots of medical issues that contribute significantly to their mental status. As an MD, you are expected to be able to recognize and treat metabolic disorder or know how to prescribe antibiotics or when to be concerned about neutropenia. Psychiatry is not just listening to people talk for 12 hours a day. It's great to love and hold on to humanities, but there's a reason why you have to go through medical school to become a psychiatrist.

I'm not trying to say that psychiatry isn't medicine. I'm trying to say that 1st year sucks and I'm having a hard time connecting the stuff I'm learning to anything relevant. You don't have to lecture me on the difference between psychologists and psychiatrists lol - both my parents are psychologists I know the difference.

Altho the other day in histology we did talk about the effects of bulimia on tooth enamel which was super cool (well not for the patient obviously). Learning about co morbidities and actual diseases sounds awesome and I'm hoping that 2nd year will be better because it just all seems so much more interesting than what we are doing now. And I totally get the learning the alphabet before learning how to write a novel thing (forgot who said that) and that's a better way to think about it. I'm just frustrated.

 

[heyjack70]

Learning medicine is like creating a beautifully expensive mosaic with thousands of tiles. Each tile represents bits of knowledge. Early on, your creation looks haphazard and unfinished, with seemingly disconnected and irrelevant tiles placed at random. But as each year passes, the creation gets more recognizable, and eventually you've got a real piece of art. The trick is to not let those early tiles fall away as new ones are subsequently placed.

 

[NickNaylor]

I think everyone shares your perspective to varying degrees. As others said, try to power through it for now. @heyjack70's comments above are particularly apt. Things will start to click once you've seen them clinically; for me, I've found it much easier (and interesting) to go back and learn the basic science content after having a bit of clinical experience under my belt.

At some point you'll also develop the attitude of, "oh ****, someone is going to rely on me being able to provide competent care based on all that stuff I was taught." That's a pretty strong motivator.

 

[jzrocker]

I'm not trying to say that psychiatry isn't medicine. I'm trying to say that 1st year sucks and I'm having a hard time connecting the stuff I'm learning to anything relevant. You don't have to lecture me on the difference between psychologists and psychiatrists lol - both my parents are psychologists I know the difference.

Altho the other day in histology we did talk about the effects of bulimia on tooth enamel which was super cool (well not for the patient obviously). Learning about co morbidities and actual diseases sounds awesome and I'm hoping that 2nd year will be better because it just all seems so much more interesting than what we are doing now. And I totally get the learning the alphabet before learning how to write a novel thing (forgot who said that) and that's a better way to think about it. I'm just frustrated.

I see. I know someone who has decided on psych and just blows off the rest of his rotations, which is really disturbing to me. It's not right because the patient is not getting the doctor he/she deserves. I've found psychiatrist are either really good or really bad, but everyone thinks they are the best lol

Let's work hard to make psychiatry more respectable.

 

[splik]

Let's work hard to make psychiatry more respectable.

Yes let's. but pretending its real medicine isn't going to help that cause. It's all of the trying too hard to be a part of medicine and pretending to be more scientific that we are that makes psychiatry look bad. We do much better by playing to our strengths which include the ability to look beyond the biomedical to the sociocultural, psychological, ethical and legal aspects of care, to formulate problems from multiple perspectives, to situate problems in the context of narratives, and to privilege connections and relationships in our healing practices.

 

[slappy]

...and read minds.

 

[AlbinoHawk DO]

Yes let's. but pretending its real medicine isn't going to help that cause. It's all of the trying too hard to be a part of medicine and pretending to be more scientific that we are that makes psychiatry look bad. We do much better by playing to our strengths which include the ability to look beyond the biomedical to the sociocultural, psychological, ethical and legal aspects of care, to formulate problems from multiple perspectives, to situate problems in the context of narratives, and to privilege connections and relationships in our healing practices.

Medication and medication management is not medicine? Are you in psychiatry or psychology? You seem confused about your own role.

 

[NontradCA]

Medication and medication management is not medicine? Are you in psychiatry or psychology? You seem confused about your own role.

 

[NontradCA]

Fezcat, why are you even concerned about what your classmates backgrounds are? I only know of one person's undergrad major, and it's because he told the whole class douchestyle during the first day of a block. I tend to think that doing your best in med school would be better for patients no matter what specialty you choose. It's all about balance. If you're not being challenged, then how can you grow? I don't think the grades matter too much, honestly. I'm breezing through school right now, but also feel that I should be pushing myself a little more. I envy you, because I feel Im becoming apathetic, which can be dangerous.

<3

 

[slappy]

Medication and medication management is not medicine? Are you in psychiatry or psychology? You seem confused about your own role.

I think you may have missed the spirit of the post you'd quoted - it's something I agree with - that we shouldn't try to make psychiatry seem more scientific than it actually is. However, the problem is, not many (even within the field) really understand how scientific psychiatry actually is. A lot of the scales we use for diagnosis are as validated as the measurements (sodium levels in blood, say) that the "rest of the medicine" use for diagnosis. It's natural to equate "lab values" to "scientific" and "objective", compared to the scales we use, but anyone intelligent enough to compare the validities would not say the diagnostic methods in psychiatry are unscientific.

One could argue that the diagnoses used in psychiatry are largely arbitrary and artificial with no real link to the actual changes in the brain, but that's not what science is about. It's about working within the realm of what we know while continually trying to push the boundaries of what we can learn. If you're not satisfied with the current diagnostic system's correlation with actual brain processes, investigate them yourself and develop a better understanding for everyone.

There is more uncertainty with the treatment options in psychiatry compared to the rest of medicine, but that is largely due to the aforementioned gaps in knowledge of the psychopathology. It's also a reflection of the reality: relatively little money in psychopharmacology, and research in the area stagnating for decades now. I doubt things would change here unless breakthroughs are made in our understanding of the psychopathology. So, lets make it happen. I'm doing my part.

 

[touchpause13]

Fezcat, why are you even concerned about what your classmates backgrounds are? I only know of one person's undergrad major, and it's because he told the whole class douchestyle during the first day of a block. I tend to think that doing your best in med school would be better for patients no matter what specialty you choose. It's all about balance. If you're not being challenged, then how can you grow? I don't think the grades matter too much, honestly. I'm breezing through school right now, but also feel that I should be pushing myself a little more. I envy you, because I feel Im becoming apathetic, which can be dangerous.

<3

I don't even know. I really shouldn't be. It's just during the behavioral med class sooo many people were bitching about how they hated it/blew it off as pointless and how the professor was worthless because he wasn't a "real doctor" (he's a PhD - just like almost every other one of our professors ). Idk. Basically I've let stupid shet get to me much more than it used to.

You make good points of course.

<333

 

[Frazier]

...

 

[splik]

Medication and medication management is not medicine? Are you in psychiatry or psychology? You seem confused about your own role.

I wanted to chew you out and rant but clearly you don't really have much of a clue about what medicine is yet, being only a 1st year DO student. But you make the point quite clearly - wtf is "medication management"? Psychiatry is the only specialty that routinely uses this stupid term to describe its practices, presumably to try and remind people that like real doctors psychiatrists too can peddle drugs. It says it all really. I have never heard a neurologist use the term medication management to describe what they do. In other specialties they evaluate diagnose and treat patients. In psychiatry, there is "medication management" which all too often means flinging as many drugs at a patient for each symptom they have with little thought of a formulation of what is actually going and why. There are of course some excellent psychiatrists, but the field as a whole aspires to mediocrity (being generous) and yes its cheerleaders make it sound like we are the most advanced specialty and on the "cusp" of major breakthroughs. It must be a very long cusp or else we're precariously at the edge of a precipice because we've apparently been on "cusp" of these discoveries for over 25 years. The decade of the brain and the human genome project has been and gone and yet there have been no major advances in pharmacological treatment since the 1950s.

Psychiatry is a wonderful specialty and provides me with endless fascination but I cringe when our leaders use terms like "psychiatric medicine" or talk about these mythical advances in neurobiology or genomics that have revolutionized our field.

 

[AlbinoHawk DO]

MI

I wanted to chew you out and rant but clearly you don't really have much of a clue about what medicine is yet, being only a 1st year DO student. But you make the point quite clearly - wtf is "medication management"? Psychiatry is the only specialty that routinely uses this stupid term to describe its practices, presumably to try and remind people that like real doctors psychiatrists too can peddle drugs. It says it all really. I have never heard a neurologist use the term medication management to describe what they do. In other specialties they evaluate diagnose and treat patients. In psychiatry, there is "medication management" which all too often means flinging as many drugs at a patient for each symptom they have with little thought of a formulation of what is actually going and why. There are of course some excellent psychiatrists, but the field as a whole aspires to mediocrity (being generous) and yes its cheerleaders make it sound like we are the most advanced specialty and on the "cusp" of major breakthroughs. It must be a very long cusp or else we're precariously at the edge of a precipice because we've apparently been on "cusp" of these discoveries for over 25 years. The decade of the brain and the human genome project has been and gone and yet there have been no major advances in pharmacological treatment since the 1950s.

Psychiatry is a wonderful specialty and provides me with endless fascination but I cringe when our leaders use terms like "psychiatric medicine" or talk about these mythical advances in neurobiology or genomics that have revolutionized our field.

Ahh yes, the "you don't know anything because you're in year blah." I remember that one from being a premed too. You sure showed me though since 100% of people with your training level agree psychiatry isn't medicine.

So psychiatry is not real medicine because medication management isn't real, so what is it that all those PM&R and Pain Med docs do with their medication? Something medication management perhaps? Those other specialties do everything super science and everything.

No medications since this 50s? Yeah, that 1990s Zoloft and Prozac was never invented.

The only reason psychiatry could be mediocre is if it attracts people like you into it. Go do another residency if you don't like it.

 

[Frazier]

I wanted to chew you out and rant but clearly you don't really have much of a clue about what medicine is yet, being only a 1st year DO student. But you make the point quite clearly - wtf is "medication management"? Psychiatry is the only specialty that routinely uses this stupid term to describe its practices, presumably to try and remind people that like real doctors psychiatrists too can peddle drugs. It says it all really. I have never heard a neurologist use the term medication management to describe what they do. In other specialties they evaluate diagnose and treat patients. In psychiatry, there is "medication management" which all too often means flinging as many drugs at a patient for each symptom they have with little thought of a formulation of what is actually going and why. There are of course some excellent psychiatrists, but the field as a whole aspires to mediocrity (being generous) and yes its cheerleaders make it sound like we are the most advanced specialty and on the "cusp" of major breakthroughs. It must be a very long cusp or else we're precariously at the edge of a precipice because we've apparently been on "cusp" of these discoveries for over 25 years. The decade of the brain and the human genome project has been and gone and yet there have been no major advances in pharmacological treatment since the 1950s.

Psychiatry is a wonderful specialty and provides me with endless fascination but I cringe when our leaders use terms like "psychiatric medicine" or talk about these mythical advances in neurobiology or genomics that have revolutionized our field.

I get it was likely rhetorical -- but WiseGeek has a definition for everything:

http://www.wisegeek.org/what-is-medication-management.htm

 

[splik]

which proves my point, this is not a term used in the rest of medicine, hence why the definition there has nothing to do with anything physicians do (including psychiatrists actually, who mean something else when describing med management)

 

[erg923]

The only reason psychiatry could be mediocre is if it attracts people like you into it. Go do another residency if you don't like it.

I dont know what SDN you read, but the one I read clearly shows SPLIK to be one of the most, if not the most, critical, deep, and well read psychiatrist on this forum. His thoughts are the epitomy of someone who truely attempts to use vast medical knowlege in the exploration and treatment of vague psychic distress/disturbance and peronality pathology. Psychiatry is NOT just "medicine."

I agree "medication managment" is a dumb term with no actual meaning, not the least of which is that it leaves out what is actually being "managed."

 

[milesed]

My first semester was terribly hard for me. I loved the science though. I was used to X level of effort to get A's and suddenly had to put forth Y effort to get C or B's. I adjusted and had A's the next semester. You just have to realize it's grad school and the expectations are at a whole new level.

 

[NontradCA]

MI
Ahh yes, the "you don't know anything because you're in year blah." I remember that one from being a premed too. You sure showed me though since 100% of people with your training level agree psychiatry isn't medicine.

So psychiatry is not real medicine because medication management isn't real, so what is it that all those PM&R and Pain Med docs do with their medication? Something medication management perhaps? Those other specialties do everything super science and everything.

No medications since this 50s? Yeah, that 1990s Zoloft and Prozac was never invented.

The only reason psychiatry could be mediocre is if it attracts people like you into it. Go do another residency if you don't like it.

Cmon man, you're in the Psych forum as a first year student. You're talking about psych to a psychiatrist and being rude about it. Relax, because you'll make it bad for the rest of us med students who want info.

 

[Armadillos]

Couple things I feel compelled to mention-
First off, I dont think it means much to say stuff like "Psychiatry is NOT just "medicine."", thats obvious to anyone in medicine because no medical specialty is "just medicine". Some people seem to have a very strange definition of what the practice of medicine is and then are wondering why psychiatry doesn't meet that definition.

Even in fields you think of as being extremely technical, some of the most most important aspects of practicing in that field are things that some people would claim are "non-medical". It doesn't take much deep thinking for an oncologist to follow consensus guidelines for various cancers, but the "non-medical" aspects like breaking bad news, care giver fatigue, end of life planning, deciding to take a more palliative approach, etc. are arguably some of the most challenging situations in all of medicine and it would be silly to argue these interactions are not medical.

Second- I feel like many people are too pessimistic about the "science" of psychiatry because they don't appreciate the history of medicine in general. People have been dying of infections for thousands of years and doctors have been trying in vain to save them for thousands of years, and then we somewhat luckily develop antibiotics within the last 100 years. We didnt even know xrays existed until like 120 years ago and useful medical imaging is even younger than that. The human body is super complicated and the brain is arguably the most complicated part. I'm willing to be patient and accept gradual modest improvements in anticipation of more breakthroughs in the future, anyone who thinks psychiatric treatments are stuck where they are severely underestimates the ability of human ingenuity to recognize and harness unexpected discoveries.

Things were put into perspective for me a couple years ago when I was talking to my century old relative. He was excited to have a doctor in the family and then recounted how as a child he spent 3 months in a hospital bed with pneumonia and then complications of pneumonia because they had no antibiotics back then. Things take time, but historically its always been those who think we have plateaued who end up looking shortsighted.

 

[vistaril]

good discussion here. props to splik for a few excellent posts. As for the OP, I never said there was any relevance to what you are doing now in anatomy and psychiatry.

 

[smalltownpsych]

MI
Ahh yes, the "you don't know anything because you're in year blah." I remember that one from being a premed too. You sure showed me though since 100% of people with your training level agree psychiatry isn't medicine.

So psychiatry is not real medicine because medication management isn't real, so what is it that all those PM&R and Pain Med docs do with their medication? Something medication management perhaps? Those other specialties do everything super science and everything.

No medications since this 50s? Yeah, that 1990s Zoloft and Prozac was never invented.

The only reason psychiatry could be mediocre is if it attracts people like you into it. Go do another residency if you don't like it.

I think what he was saying is that your view of psychiatry is extremely limited, not that psychiatry is. Maybe you should look into the neurobiology of attachment and how brains interact with each other through relationships to determine neural functioning. Also, learn a little more about expectancies and placebo effects and demand characteristics because those all play a role in our treatment. If you don't think that psychological and socio-cultural factors plays a huge role in the treatment of most physical illnesses, then you might want to stay away from any type of medical specialty that involves human interaction.

 

[vistaril]

Second- I feel like many people are too pessimistic about the "science" of psychiatry because they don't appreciate the history of medicine in general. People have been dying of infections for thousands of years and doctors have been trying in vain to save them for thousands of years, and then we somewhat luckily develop antibiotics within the last 100 years. We didnt even know xrays existed until like 120 years ago and useful medical imaging is even younger than that. The human body is super complicated and the brain is arguably the most complicated part. I'm willing to be patient and accept gradual modest improvements in anticipation of more breakthroughs in the future, anyone who thinks psychiatric treatments are stuck where they are severely underestimates the ability of human ingenuity to recognize and harness unexpected discoveries.

Things were put into perspective for me a couple years ago when I was talking to my century old relative. He was excited to have a doctor in the family and then recounted how as a child he spent 3 months in a hospital bed with pneumonia and then complications of pneumonia because they had no antibiotics back then. Things take time, but historically its always been those who think we have plateaued who end up looking shortsighted.

I see this line of thinking a lot, and I'm aware that in 2245 or whatever we may know more about the brain than we do now(whether or not that knowledge will be good for psychiatry is another question). Im also aware that my career(and most everyone else in this forum) will not last centuries, so using tales of 18th century medicine to prove a point isn't really relevant to me.

I just find the argument that 100 years ago internists didn't have antibiotics(and now they do) to be completely meaningless along these lines. My career isn't going to be 100 years- yours isn't either. And now internists do have antibiotics.

Im interested in whats going to happen in the next decade or two.

 

[Armadillos]

good discussion here. props to splik for a few excellent posts. As for the OP, I never said there was any relevance to what you are doing now in anatomy and psychiatry.

This is just because anything we do need to know now seems like complete common sense to us because of medical training. Psychiatry pretty clearly uses the least anatomy of any specialty, but even psychiatry uses some very basic anatomy.Its good to be able to do a physical exam in instances when its warranted (obviously much rarer in outpatient). When your inpatient complains of abdominal discomfort its good to know some anatomy. When doing ECT its nice to know landmarks of the head/skull. When doing TMS its good to know the location of the motor cortex and the prefrontal cortex.

But probably most importantly knowing clinical applications of anatomy lets psychiatrists more fully appreciate a patient's overall circumstances because physicians can understand a patients medical and surgical history significantly better than a non-physician. Its nice to know there may be a few extra questions you want to ask when you have a single patient in her 30s and you see BSO in the internists surgical hx (or maybe a different pt had 4 D/C's spaced over her 20s).

Or a different not very forthcoming or not very educated pt might tell the MSW, "I had a little growth in my liver, but the doctors fixed it last month", the MSW says "O thats good" and moves along. But a physician asks "So how did they fix it?" and then the patient describes a TACE and the physician instantly knows this is a completely different situation that the MSW completely missed.

 

[Armadillos]

I see this line of thinking a lot, and I'm aware that in 2245 or whatever we may know more about the brain than we do now(whether or not that knowledge will be good for psychiatry is another question). Im also aware that my career(and most everyone else in this forum) will not last centuries, so using tales of 18th century medicine to prove a point isn't really relevant to me.

I just find the argument that 100 years ago internists didn't have antibiotics(and now they do) to be completely meaningless along these lines. My career isn't going to be 100 years- yours isn't either. And now internists do have antibiotics.

Im interested in whats going to happen in the next decade or two.

Well for some of us the fact that we could help contribute to the discovery/development of psychiatry's "antibiotic", be it a psychotherapy/medication/electromagnetic procedure/population level intervention/social intervention/etc. is extremely exciting.

 

[smalltownpsych]

But probably most importantly knowing clinical applications of anatomy lets psychiatrists more fully appreciate a patient's overall circumstances because physicians can understand a patients medical and surgical history significantly better than a non-physician. Its nice to know there may be a few extra questions you want to ask when you have a single patient in her 30s and you see BSO in the internists surgical hx (or maybe a different pt had 4 D/C's spaced over her 20s).

As a non-physician who believes that knowledge of the medical is essential, what should I be thinking with these cases? Don't know what BSO is so am a bit lost there, for the D/Cs would that be for miscarriages?

 

[Armadillos]

As a non-physician who believes that knowledge of the medical is essential, what should I be thinking with these cases? Don't know what BSO is so am a bit lost there, for the D/Cs would that be for miscarriages?

Yeah the D/C's would be miscarriages. BSO would mean she had her ovaries removed, likely because of cancer or really terrible cysts, but more importantly now she is not going to have children by "traditional means" (Please nobody nitpick the bso example from a gyn surgery perspective, you all know what im getting at). The TACE patient has hepatocellular carcinoma (which he most likely got b/c of a psychiatrily relevant risk factor) and could very well be dead in 6 months.

Also before anyone get bent out of shape, Im not saying non-physicians cant and dont learn this stuff. Its just that psychiatrists have a broad medical understanding as their foundation and we all know "physical" and "mental" illness go hand in hand. (I personally think the distinction isnt very useful, but everyone else seems to disagree so I give in to social norms for now)

 

[vistaril]

This is just because anything we do need to know now seems like complete common sense to us because of medical training. Psychiatry pretty clearly uses the least anatomy of any specialty, but even psychiatry uses some very basic anatomy.

If you extend things to this extreme level(some of the examples cited), you could pretty much carry it even one step further- a hairdresser could use anatomy to make sure not to cut into the skull itself when styling hair? right?

 

[vistaril]

Well for some of us the fact that we could help contribute to the discovery/development of psychiatry's "antibiotic", be it a psychotherapy/medication/electromagnetic procedure/population level intervention/social intervention/etc. is extremely exciting.

again not to be intentionally insensitive, but I seriously doubt we have any Alexander Flemings in here. And that's ok- I'm certainly ok with knowing that I will never be that sort of innovator, and I suspect most of the others in here are too.

 

[smalltownpsych]

If you extend things to this extreme level(some of the examples cited), you could pretty much carry it even one step further- a hairdresser could use anatomy to make sure not to cut into the skull itself when styling hair? right?

They also need to know where the hair is located. Kind of a ridiculous comparison. i feel that I am a better psychologist because of my knowledge of basic anatomy and function especially the endocrine and nervous systems, but I have a pretty good understanding of a lot of other aspects of functioning, as well. Obviously, most people that went to med school are going to have more knowledge of this than those who don't, I fail to see your point.

 

[Armadillos]

If you extend things to this extreme level(some of the examples cited), you could pretty much carry it even one step further- a hairdresser could use anatomy to make sure not to cut into the skull itself when styling hair? right?

I mean you could reduce to absurdity, thats your choice.

 

[SmallBird]

again not to be intentionally insensitive, but I seriously doubt we have any Alexander Flemings in here. And that's ok- I'm certainly ok with knowing that I will never be that sort of innovator, and I suspect most of the others in here are too.

To your point, sometimes it is also very difficult to stomach the exorbitant amount of money spent on work that seems like it may lead to new interventions in 2245 when we are already aware of several, evidence based interventions for which there is little funding - like supportive housing and family based work for patients with significant mental illness. It seems as if there is prioritization of things that are fascinating over things that seem likely to have clear and present impact. Similarly, as a psychiatry resident one could invest a substantial amount of time learning neuroscience in the hopes that one day this knowledge may be essential to important patient care, but it is possible that one might be very old before that happens.

 

[vistaril]

I mean you could reduce to absurdity, thats your choice.

imo it had already been reduced to absurdity.

You mention a GI example where anatomy would be useful- the problem with that example is that a direct link is not there. Is it useful for a psychiatrist to know some basics of a GI exam? Perhaps(that's another point we could argue), but then to extend it ONE STEP FURTHER and argue that you need an anatomy course to know some basics about a basic GI exam? You can obviously learn a basic GI exam(that would be plenty good enough for psychs) without knowing much about anatomy(at least what you would need to know the relevants of the exam)

If this is the way one thinks about things, one literally could use virtually EVERY SINGLE SUBJECT some way in literally EVERY FIELD

 

[Armadillos]

To your point, sometimes it is also very difficult to stomach the exorbitant amount of money spent on work that seems like it may lead to new interventions in 2245 when we are already aware of several, evidence based interventions for which there is little funding - like supportive housing and family based work for patients with significant mental illness. It seems as if there is prioritization of things that are fascinating over things that seem likely to have clear and present impact. Similarly, as a psychiatry resident one could invest a substantial amount of time learning neuroscience in the hopes that one day this knowledge may be essential to important patient care, but it is possible that one might be very old before that happens.

I agree completely, its all a balance. If society had told inventors to stop wasting money on ridiculous flying machines that will never serve any useful purpose, then it would be a real shame not to have airplanes. On the other hand, if they stopped making cars and instead spent all the money on innovating flying machines, thats no recipe for success either.

 

[Armadillos]

imo it had already been reduced to absurdity.

You mention a GI example where anatomy would be useful- the problem with that example is that a direct link is not there. Is it useful for a psychiatrist to know some basics of a GI exam? Perhaps(that's another point we could argue), but then to extend it ONE STEP FURTHER and argue that you need an anatomy course to know some basics about a basic GI exam? You can obviously learn a basic GI exam(that would be plenty good enough for psychs) without knowing much about anatomy(at least what you would need to know the relevants of the exam)

If this is the way one thinks about things, one literally could use virtually EVERY SINGLE SUBJECT some way in literally EVERY FIELD

You think its been reduced to absurdity because your a doctor

 

[Armadillos]

Also to be clear I'm not saying every psychiatrist needs the entirety of MS1 anatomy to practice, that isn't really true of any physician. Medical education is horribly inefficient in some respects, no arguments from me. But I do think there is value in teaching everyone some of everything before we choose what to do with our lives. If we were going to efficiency, much better for all highschool kids to take some test and then start training them to be plumbers/engineers/accountants/surgeons/radiologists from day one.

 

[smalltownpsych]

Also to be clear I'm not saying every psychiatrist needs the entirety of MS1 anatomy to practice, that isn't really true of any physician. Medical education is horribly inefficient in some respects, no arguments from me. But I do think there is value in teaching everyone some of everything before we choose what to do with our lives. If we were going to efficiency, much better for all highschool kids to take some test and then start training them to be plumbers/engineers/accountants/surgeons/radiologists from day one.

Besides don't we all forget half of what you are taught anyway? Hopefully, the other docs remember the half that we forgot. It's why we have a policy here of two in and two out. Both the med and the psych have to agree on admit and discharge. Although it can be frustrating with some of the docs who think that we should keep psych patients until they are not crazy anymore, it generally works out well.