Psychiatry = the bad rep?

[HeyThereJude]

Growing up, I always had a lot of admiration for psychiatrists, in part because a relative close to me had autism and was under the care of a good psychiatrist. I was therefore surprised to find when I entered college and medical school, that many did not hold the profession in the high regard that I did. Even though I know I shouldn’t and don’t want to, I sometimes find myself upset and frustrated when I hear classmates or other physicians say things like psychiatry is not “real” medicine, or that no one wants to go into psychiatry, or that people don’t respect psychiatrists. Now, I didn’t go into medicine for respect… and even though I clearly do not believe psychiatry is not “real medicine” I still find myself annoyed when people make such comments.

Did any of you ever feel this way? Are you able to just ignore? Any thoughts of advice for me? Also, do you think these attitudes will change anytime in the near future?

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[erg923]

I always ask these people what "real medicine" means to them....

 

[notdeadyet]

Also, do you think these attitudes will change anytime in the near future?

Their attitudes might change, if they get more exposure to psychiatry or if psychiatry starts doing a better job marketing itself.

Or your attitudes might change. One of the very few certainties about aging is that you progressively care less and less about what other people think about you, your career, and your lifestyle choices.

Between the two, you're golden...

 

[whopper]

You'll notice several doctors have what I consider a high type of popularity contest when it comes to several issues including psychiatry.

Most doctors do not like the psychosocial aspects of the biopsychosocial model. They have a mentality that medicine is simply ordering a test and giving a pill. Psychiatry requires careful attention to a person's behavioral presentation. This is foreign to many doctors even though this is something that all doctors should be carefully watching.

Internal medicine doctors often balk at surgeons, sometimes referring to them as "plumbers." Several people in the natural birth movement balk at OB-Gyn doctors because of the rise of C-sections.

So too, in medschool will you find several doctors who balk at psychiatry. They are often professors who find psychiatry foreign to them. After all, most of the medical school education is internal medicine based. So too will you often hear the biases that go along with that profression.

I challenge any doctor that works in a hospital that thinks psychiatry is not "real" that anytime they need to order a psychiatry consult, I get to drop-kick them in the nuts.

 

[peppy]

Nah, psychiatrists aren't real doctors. Likewise, EM docs are just glorified triage nurses. PM&R docs are glorified physical therapists. Dermatologists just pop pimples. Surgeons are just glorified mechanics/technicians. IM doctors just consult a bunch of specialists to take care of their patients (though with IM patients, of course, all you're really doing is
playing keep away against the grim reaper for a while). Family medicine docs aren't even glorified; they're just plain old nurse practitioners.
Point is, everyone is "not a real doctor" in someone's opinion in this hierarchy-driven profession. I don't even worry about it. I love the work in psychiatry (psych patients usually have good stories!) and I'm kind of glad that the stigma keeps people from going into the specialty just for the sweet lifestyle when they don't give a crap about the mentally ill.
I mean, think about it, there are probably people out there who have a sincere interest in and compassion for people with stage IV melanoma or horrible skin conditions like epidermolysis bullosa who would make great dermatologists, but the only people who get to do derm are the people who have good numbers and want something easy yet prestigious. I'd hate to see that in psych, since this is a field where it makes a huge difference whether you care about your patients or not.

 

[HCE]

Nah, psychiatrists aren't real doctors. Likewise, EM docs are just glorified triage nurses. PM&R docs are glorified physical therapists. Dermatologists just pop pimples. Surgeons are just glorified mechanics/technicians. IM doctors just consult a bunch of specialists to take care of their patients (though with IM patients, of course, all you're really doing is
playing keep away against the grim reaper for a while). Family medicine docs aren't even glorified; they're just plain old nurse practitioners.
Point is, everyone is "not a real doctor" in someone's opinion in this hierarchy-driven profession. I don't even worry about it. I love the work in psychiatry (psych patients usually have good stories!) and I'm kind of glad that the stigma keeps people from going into the specialty just for the sweet lifestyle when they don't give a crap about the mentally ill.
I mean, think about it, there are probably people out there who have a sincere interest in and compassion for people with stage IV melanoma or horrible skin conditions like epidermolysis bullosa who would make great dermatologists, but the only people who get to do derm are the people who have good numbers and want something easy yet prestigious. I'd hate to see that in psych, since this is a field where it makes a huge difference whether you care about your patients or not.

Well stated Peppy.

 

[Fejj316]

Nah, psychiatrists aren't real doctors. Likewise, EM docs are just glorified triage nurses. PM&R docs are glorified physical therapists. Dermatologists just pop pimples. Surgeons are just glorified mechanics/technicians. IM doctors just consult a bunch of specialists to take care of their patients (though with IM patients, of course, all you're really doing is playing keep away against the grim reaper for a while). Family medicine docs aren't even glorified; they're just plain old nurse practitioners.
Point is, everyone is "not a real doctor" in someone's opinion in this hierarchy-driven profession. I don't even worry about it. I love the work in psychiatry (psych patients usually have good stories!) and I'm kind of glad that the stigma keeps people from going into the specialty just for the sweet lifestyle when they don't give a crap about the mentally ill.
I mean, think about it, there are probably people out there who have a sincere interest in and compassion for people with stage IV melanoma or horrible skin conditions like epidermolysis bullosa who would make great dermatologists, but the only people who get to do derm are the people who have good numbers and want something easy yet prestigious. I'd hate to see that in psych, since this is a field where it makes a huge difference whether you care about your patients or not.

My first instinct after reading this was to look around for a "Like" button, ha ha! Blame Facebook, they've conditioned me. Ah, this will work:

I think you're absolutely right. Sometimes specialties are treated in the same way as political parties, where a person's identity and value are seen as solely based on the stereotypical image of the group he or she chose.

 

[maranatha]

Well stated Peppy.

Ditto. Good post. In the end of the day, you've got to feel good about what you do and know that you're making some kind of difference. Psych is still one of the best fields to do that in and that alone keeps me from giving a rats a*% what other's think.

 

[Manicsleep]

Whats that joke about hiding the hundred dollar bill?

 

[MissAmanda]

I have felt this frustration before as well. However, as far as I can tell, specialties with a "good reputation" are always changing. Decades ago, internal medicine seemed to be much more prestigious than it is now, and radiology was not considered prestigious at all. Now radiology is considered a "ROAD" specialty, for whatever that is worth. Also, I read somewhere that among lay people, dermatology is considered one of the fields with the lowest prestige, even though that it is well known among medical students and professionals that it is one of the most difficult specialties to get into... it's hard to predict what people will think

 

[whopper]

There's no doubt that a decade from now all the medical professions will undergo changes. These changes may be better or worse for the providers in the category.

I can tell you this. There will always be a need for a physician to treat the severely mentally ill. The state institutions are filled with patients who if released will likely do something violent, are treatment resistant to medications and/or are often noncompliant on their medications. The only thing that will change that will be an advance in the field on the order of something that will most likely not happen in our lifetimes. (E.g. a pill without side effects that has 100% efficacy in treating all mental illness that only has to be taken every few months!)

I can see some realistic advances changing some things about our profession, but nothing that'll significantly change it within the next 10 years to the point where practice will be very different other than the recent government healthcare legislation. How that legislation will change things I'm not certain. I have not read the thousands of pages in the bill, and many of the things I do know about it could have effects that may not live to my expectations.

I remember an IM doctor telling me in medical school that psychiatry will be dead in less than a year. Really? That was about 10 years ago. Psychiatry applicants are up, the parity bill passed, psychiatrists are doing well as a whole (from my anectdotal experience better than IM doctors), the social stigma of getting treatment for a mental illness has decreased. Where did thatguy come up with the data to support his opinion? (Heh, if you asked me the evidenced based data for this guy's IM treatment approaches was lacking as well....)

From my experience, most of the people making critical comments about psychiatry within the medical field but outside of psychiatry often don't know what they're talking about, and the consults they've ask me to do reflect their lack of knowledge of psychiatry, yet they make comments about the field such as "It'll be dead in a year."

 

[nancysinatra]

Now, I didn’t go into medicine for respect… and even though I clearly do not believe psychiatry is not “real medicine” I still find myself annoyed when people make such comments.

If it's any consolation, people in the hard sciences like physics, chemistry, and quantitative fields like math don't even think medical science is real science at all.

 

[nancysinatra]

Nah, psychiatrists aren't real doctors. Likewise, EM docs are just glorified triage nurses. PM&R docs are glorified physical therapists. Dermatologists just pop pimples. Surgeons are just glorified mechanics/technicians. IM doctors just consult a bunch of specialists to take care of their patients (though with IM patients, of course, all you're really doing is
playing keep away against the grim reaper for a while). Family medicine docs aren't even glorified; they're just plain old nurse practitioners.

You know, this could be true...

Point is, everyone is "not a real doctor" in someone's opinion in this hierarchy-driven profession.

Ok, come on, what about radiation oncology, cardiothoracic surgery, cosmetic plastic surgery, and that most mind-numbingly-boring-of-all sounding of all medical specialties (but very well paying I'm sure), hand surgery? Please don't tell me you think anyone accuses these people of not being "real doctors." ;-)

 

[HeyThereJude]

Thanks for the great perspectives everyone. It's nice to hear your thoughts.

I'd love to know if anyone has anything more to add.

 

[Manicsleep]

I remember an IM doctor telling me in medical school that psychiatry will be dead in less than a year. Really? That was about 10 years ago. Psychiatry applicants are up, the parity bill passed, psychiatrists are doing well as a whole (from my anectdotal experience better than IM doctors), the social stigma of getting treatment for a mental illness has decreased. Where did thatguy come up with the data to support his opinion? (Heh, if you asked me the evidenced based data for this guy's IM treatment approaches was lacking as well....)

From my experience, most of the people making critical comments about psychiatry within the medical field but outside of psychiatry often don't know what they're talking about, and the consults they've ask me to do reflect their lack of knowledge of psychiatry, yet they make comments about the field such as "It'll be dead in a year."

I heard a similar comment when the first psych Rx bill got passed in New Mexico in 2002 from a psychologist working with an internist. It was supposedly the beginning of a landslide. Now 8 years later, people have wised up and politicians have been educated.

The part about this is that psychologists had surprise on their side. Now they face an uphill battle every time, against the public, the medical profession and even from within their own ranks.

http://www.quackwatch.com/07PoliticalActivities/rxp1.html

http://www.scientificamerican.com/article.cfm?id=inner-turmoil

 

[VA Hopeful Dr]

Ok, come on, what about radiation oncology, cardiothoracic surgery, cosmetic plastic surgery, and that most mind-numbingly-boring-of-all sounding of all medical specialties (but very well paying I'm sure), hand surgery? Please don't tell me you think anyone accuses these people of not being "real doctors." ;-)

Easily...
1. Rad Onc - Point and shoot at cancer, my 15 year old brother plays Halo enough that I bet he could do it
2. CT surg - diabetes whatitus?
3. Cosmetic surg - Small breast disease is not a medical diagnosis
4. Hand Surgery - My patient's hand is numb and almost useless due to out of uncontrolled diabetes whatitus?

I think every specialty is vauable when its needed, but every specialty can find some reason why every other specialty doesn't have "real doctors".

 

[notdeadyet]

Hand surgeons = Podiatrists of the hand

 

[sideways]

To steal one from another thread: orthopods = bone dentists

 

[carlosc1dbz]

You'll notice several doctors have what I consider a high type of popularity contest when it comes to several issues including psychiatry.

Most doctors do not like the psychosocial aspects of the biopsychosocial model. They have a mentality that medicine is simply ordering a test and giving a pill. Psychiatry requires careful attention to a person's behavioral presentation. This is foreign to many doctors even though this is something that all doctors should be carefully watching.

Internal medicine doctors often balk at surgeons, sometimes referring to them as "plumbers." Several people in the natural birth movement balk at OB-Gyn doctors because of the rise of C-sections.

So too, in medschool will you find several doctors who balk at psychiatry. They are often professors who find psychiatry foreign to them. After all, most of the medical school education is internal medicine based. So too will you often hear the biases that go along with that profression.

I challenge any doctor that works in a hospital that thinks psychiatry is not "real" that anytime they need to order a psychiatry consult, I get to drop-kick them in the nuts.

Drop kick them in the nuts. That made me LOL.

 

[milesed]

The only time I ever heard comments like this was in medical school from other specialties who hoped I'd follow their paths. Once I got to residency and out into practice, it stopped.

I was annoyed by the comments made mainly because those making them held a lot of power over me at that point and I felt as if I had to simply take it or get a bad grade. As I look back on it now, I realize that I was being taught some valuable lessons on managing frustration, patience when dealing with ignorance, and solidifying my own stance on my chosen life's work.

Most docs in other specialties now make comments of respect and admiration for what we do. I think that as time goes by, we are all touched by mental illness and that leads to the development of compassion for those suffering and a wiser viewpoint towards those treating them. Hang in there. It gets so much better.

 

[dl2dp2]

Most docs in other specialties now make comments of respect and admiration for what we do...

I think this is a significant change even in the span of this thread (which was first posted ~ 5 years ago). I think it's in a lot of ways directly related to the significant ramping up of the top-down marketing effort from large institutional players to portray (all) mental illness as a "brain disease". These days even from a relatively unbiased perspective, the video posted above has a certain anti-vax, fringy quality to it that renders it jarring to the average upper middle class consumer of healthcare. Between celebrity Facebook confessionals and TV commercials featuring synapses, it feel like getting a pill (and, if I'm fancy, a course of therapy) to treat the everyday ills of mind has never been more mainstream.

The professional view of the field has changed even faster...I'd say it's fairly rare for a younger attending in other fields to describe psych pejoratively these days at least in the open, especially as this field has a very advantageous work: lifestyle ratio. IM attendings cannot stop complaining about THEIR job...

I'm of two minds about if/how we need to keep pushing this narrative.