D
deleted421268
I have always thought that Pysch seems to have interesting work and the hours/lifestyle are good, but am concerned about going crazy from all the patients you work with. What are the pros and cons of this interesting field?
- Joined
- Mar 15, 2007
- Messages
- 1,822
- Reaction score
- 2,116
My take (current MS-IV)...
Pros:
-Extremely interesting subject matter
-Interesting and unique patient presentations
-Potential to majorly benefit patients' lives
-Great lifestyle relative to many fields
-Pay is pretty good when you think about it
-Potential to start an outpatient practice with little overhead or work a salaried position nearly anywhere
-Residency is not super competitive (more likely to get desired program or location)
-Lots of exciting research opportunities
Cons:
-Less prestige (are you a 'real doctor?')
-Less 'hands-on' (almost no procedures, no cool physical exams like neuro)
-Little to no confirmatory labs or imaging for most disorders
-Less solid understanding of pathophysiology (what is depression? v what is hypertrophic cardiomyopathy?)
-Reimbursement rates strongly favor medication management over therapy
I can't speak to how patients affect you over time, but I think you can get a sense of how you handle different types of patient interactions during a month's rotation.
Pros:
-Extremely interesting subject matter
-Interesting and unique patient presentations
-Potential to majorly benefit patients' lives
-Great lifestyle relative to many fields
-Pay is pretty good when you think about it
-Potential to start an outpatient practice with little overhead or work a salaried position nearly anywhere
-Residency is not super competitive (more likely to get desired program or location)
-Lots of exciting research opportunities
Cons:
-Less prestige (are you a 'real doctor?')
-Less 'hands-on' (almost no procedures, no cool physical exams like neuro)
-Little to no confirmatory labs or imaging for most disorders
-Less solid understanding of pathophysiology (what is depression? v what is hypertrophic cardiomyopathy?)
-Reimbursement rates strongly favor medication management over therapy
I can't speak to how patients affect you over time, but I think you can get a sense of how you handle different types of patient interactions during a month's rotation.
- Joined
- Oct 16, 2001
- Messages
- 2,871
- Reaction score
- 996
"Going crazy" is less of an issue than burnout is.
Wise clinicians develop appropriate emotional coping skills throughout their training. I always emphasize the idea of detached compassion - feel for them, but don't get wrapped up in their problems as your own.
Many psychiatrists also pursue their own therapy to process issues that get stirred up during their clinical (and non-clinical) work.
Bartelby has a good take on the generalities, and you can find solid exceptions to every positive or negative, depending on what's a priority for you. No physical/labs could be moot if you do Consult/Liaison psychiatry, for example.
Wise clinicians develop appropriate emotional coping skills throughout their training. I always emphasize the idea of detached compassion - feel for them, but don't get wrapped up in their problems as your own.
Many psychiatrists also pursue their own therapy to process issues that get stirred up during their clinical (and non-clinical) work.
Bartelby has a good take on the generalities, and you can find solid exceptions to every positive or negative, depending on what's a priority for you. No physical/labs could be moot if you do Consult/Liaison psychiatry, for example.
- Joined
- Jun 23, 2003
- Messages
- 5,786
- Reaction score
- 912
I think the best thing is when, through talk therapy, I help a patient get their life back and they leave happy, motivated, and on top of the world after arriving depressed and wanting to die. It's really a great feeling -- and I'm only a PGY2 and have not even really had any training in psychotherapy! I get much more fulfillment out of this than I ever did getting some fat guy's A1c from 12 to 9. It's just so awesome to see the lights turn on in some patient you've been working with for awhile, and you suddenly have helped them make sense of the universe.
The point about, "detached compassion" is great. I basically sum it up as this -- I really care about my patients, but only while I'm at work. Unless they're a borderline.
The point about, "detached compassion" is great. I basically sum it up as this -- I really care about my patients, but only while I'm at work. Unless they're a borderline.
- Joined
- Feb 21, 2007
- Messages
- 3,205
- Reaction score
- 253
Yet. I think we'll have some imaging available to us, possibly within the next decade. There's tons of psych neuroimaging research being done, and soon enough, someone's going to tap onto something clinically useful.
- Joined
- Feb 8, 2004
- Messages
- 8,026
- Reaction score
- 4,154
Doing psychiatry will provide many options. E.g. long-term vs. short-term inpatient, ER, outpatient, day-programs etc.
At least for me, the most emotionally taxing aspect is psychotherapy in private practice. You deal with people that are often times pouring themselves out to you every single moment. In settings such as inpatient, while this too can happen, it's not happening every single moment. A lot of time is spent doing other things.
- Joined
- Oct 16, 2001
- Messages
- 2,871
- Reaction score
- 996
This is the first step, leaving work at work. But the tougher skill is practicing this AT work. It goes to my other tenet -- never work harder than your patient (they always should meet you halfway). If they're not, you're working too hard, and that's a recipe for burnout. The exception being the severely psychotic patient that really can't make sound decisions for themself.
The hardest part for me has been just listening to people "complain" all day without letting it get to me and the patients who want to be fixed without having to do anything themselves. Everything else is good.
I recommend finding something you can really sink into outside of work that will take all of your attention while you are doing it (no matter what field you go into).
I recommend finding something you can really sink into outside of work that will take all of your attention while you are doing it (no matter what field you go into).
Glen Gabbard talks about everyone having "hooks" that certain patient's can hang their psychopathology on. For instance, Anti-social patient's really get caught on my "hooks" and tend to really get under my skin. Thus, I need to be mindful about my interactions with these people so I don't carry it home with me.
Physical exercise (running) helps a lot.
Physical exercise (running) helps a lot.
- Joined
- Nov 12, 2010
- Messages
- 231
- Reaction score
- 0
are you referring to countertransference or something else?
- Joined
- Feb 8, 2004
- Messages
- 8,026
- Reaction score
- 4,154
At least for me, borderline PD and antisocial PD patients no longer phaze me much. With borderlines, learning much more about DBT reduced my own countertransference. It's done two things--make me realized I'm not screwing up if I don't get them better in immediately (so don't blame myself), and realize that I need to set boundaries. Once set, it's there, no need to get mad.
With antisocial PD patients, the work I do, that does not violate HIPAA, actually puts them in a direction that'll either help them or be more likely put them in a direction in tune with the law and I'm fine with that. On forensic units, courts often times have more access to patient health records because those patients are there for forensic reasons. Things like malingering testing are often fully open to the Court.
- Joined
- Dec 2, 2004
- Messages
- 6,366
- Reaction score
- 4,298
A "both pro and con" that hasn't yet been mentioned (and which can relate to the issue of countertransference, etc.) is the awesome continuity of care psychiatry allows you to do. I think as residents you often get into a mode in which "continuity" means that you see a patient more than once, or they're in your therapy clinic for a whopping 18 months. Now that I've been doing this gig for 6 1/2 years (and many of my patients show no sign of leaving) I think I'm appreciating this more. The downside of course is that you can have a few PITAs that you wish you could rotate away from, but even with these, the ongoing repeated encounters gives a better idea of who they are as people, why they rely on the hospital for their socialization, what factors contribute to their repeated relapses, etc. As an admitting resident, I know that the frequent flyer is someone that you just want to scorn and turf off as quickly as possible. However, as an attending, each subsequent admission can be an opportunity to assess what they're doing well, or what safety outlets we failed to put into place last time, or why the medications that seemed to be working well for the past year suddenly stopped helping. I've follow a number of patients now who 3-4 years ago were the med seekers and frequent flyers who looked like they'd never leave the hospital, or who would be back in the ER the minute you discharged them--but now are relatively stable (albeit not always "high functioning") outpatients. I need to add that these aren't people I've done a lot of real therapy with--it's mostly been through repeated monthly 20 minute med checks and occasional repeat admissions that I've gotten to know them well and help them make these incremental lifestyle adjustments.
yes - everyone has their own issues in themselves that allow certain patients to elicit stronger than usual countertransference from them. It's important to know your Achilles heal, so that you can anticipate and deal with negative countertransference.
