Medical student considering psychiatry with questions

[musek]

I am a medical student strongly considering psychiatry as a future career. If there are any psychiatrists here that can add their 2 cents that would be greatly appreciated!

When I was a pre-clinical, I always thought I would practice internal medicine or family medicine.

Clinicals hit. For a few weeks, I was on inpatient psych wards and I enjoyed the experience. Saw some schizophrenics that improved and it was amazing/rewarding to see their transformation. Sure, some of them were aggressive, but I would just walk away if things started to escalate. The bipolar I patients in their manic phase were also fascinating. I worked well with the residents and attending on my team, and my evaluations at the end were the best I had ever received from any other rotation. My own mental and physical health was the best it had ever been on this rotation, I actually enjoyed coming in everyday, and the hours were lighter. I also saw outpatient psychiatry for 1 week, and most of the cases I saw were depression, bipolar, and a few schizophrenia sprinkled in there.

Currently, I am halfway on my internal medicine, and I am not really sure if I am enjoying the experience. The hours are especially rough, I’m getting pimped everyday and I don’t know the answers 70% of the time which makes me feel absolutely miserable. The material is so vastly broad in internal medicine, I don’t know anything and I don’t have enough time to study. I go in earlier than everyone else everyday because I have no idea what is going on with my patients and have to think for a long time while looking up information. The residents look pretty stressed out, and basically ignore me while they place their orders, which was completely different from psych where we worked as a team together. Bottom line: I don’t enjoy inpatient IM very much. I think the people I work with may contribute to a large part, but I also don’t get enough sleep and feel stressed every day when I’m in the hospital.

I haven’t had family medicine yet, so I can’t judge that.

I am now strongly considering psychiatry at this point as future career, I would do outpatient psychiatry mostly. The only qualms I have right now is about safety as a psychiatrist. I’ve had one attending say that he was stalked by a patient before, and another one tell me that when he was in private practice, one patient came into his office with a gun one day and threatened to shoot him.

How often do these things occur? Have they occurred to you? Do you ever feel like your life or your family’s life is in danger? If you are an outpatient psychiatrist, how sick are your patients in terms of their mental health? What would you consider the pros and cons of being psychiatrist to be?

Thank you for reading.

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[MacDonaldTriad]

You sound like about 90% of the MS-IIIs who decide to go into psych. I haven't personally felt unsafe, but things can happen. These are generally widely talked about. I would point out that ER docs and some other specialties have similar safety concerns at times. Safety is important, but even with procedures and policies, your best protection is keeping your wits about you and assessing the situation.

 

[northernpsy]

Psychiatry IS a great specialty. Some of the positives I see in psych:
-Getting to know patients as people and learning about their lives can be really interesting
-I jokingly think of Psychiatry as "the poor man's dermatology" (by which I mean it has a great lifestyle, yet is also not terribly competitive like most lifestyle specialties - it's very feasible to work part time or just do a 40 hour week with no call if you choose to, though you can also work more if you want to make more money)
-There is an extreme shortage of psychiatrists, so you can find a job just about anywhere in the country easily and in MOST areas you have a lot of leverage to negotiate for what you want since the job needs you more than you need them.
-Because of the shortage of psychiatrists, there are a lot of mediocre or crappy psychiatrists just skating by on the minimum of effort. If you really try and you're GOOD at what you do, you can really make a difference and help people get decent care when they otherwise wouldn't.

However, that being said...I strongly suspect that most of the reason why you're feeling overwhelmed and clueless on IM is because you're a brand new 3rd year who is just barely starting on rotations. If you honestly enjoy the nature of the work in internal medicine, don't feel like you have to do psych just because you are scared that you can't keep up with the information in internal medicine. You can adapt and learn. It gets easier as you get more experienced and learn tricks to become more efficient.
So, if you truly thought psychiatry was interesting and fun, cool, welcome aboard. Just don't feel like you have to flee to psychiatry because you can't hack it in IM (or FM). Do what you honestly enjoy and you'll pick up the skills you need.

As far as safety goes, docs in ANY specialty can end up with stalkers. All of us are basically working in a "public eye" job so we should all try to take steps to guard our privacy such as making sure you do what you can to make it hard to find your home address. I personally try my best to avoid making any info about my family publicly accessible (for example, I keep my Facebook locked down and I don't talk about my family on the physician bio page that the hospital I work for made me write for their website )

However, even though I do sometimes work with some pretty sick people on inpatient, so far I haven't felt unsafe in residency or now as an attending. Nobody has threatened me or tried to take a swing at me. I think some of the important aspects to staying safe are:
-Always be aware of your surroundings
-Never let a patient get between you and your escape route
-If you can sense a patient is getting riled up then back off and let them calm down rather than trying to push forward with a line of questioning that's upsetting them
-Learn to contain your own emotions, so you can treat patients in a calm, professional and respectful way even if they're trying to get a reaction out of you

 

[clausewitz2]

So far I have had one patient become aggressive with me on my two and a half months in a busy psych ER. The person in question charged me, grabbed the clipboard out of my hands, and smashed it against a wall. They believed that this would win them admission. I stepped back a few paces and offered them the same PRN I had offered them moments before for "helping you calm down". They sat back down and accepted it.
A lot of aggressive behavior from people who are not obviously riled up us instrumental, so I agree with the above that not giving people the reaction they are trying to elicit or providing an obvious means to achieve their end is hugely helpful in reducing the chances you get attacked for real.

At the same time, we had one person for a while on one of our more chronic units who specialized in suckerpunching residents whenever anyone started talking about discharge, so there's that.