Seeing Psychiatrist during residency

[psicologie]

My program has a free and very confidential service where residents can see a psychiatrist for psychotherapy and medications once or twice a week. This service is extended to all of the residents at the hospital, not just psychiatry residents. I have been having trouble locating a psychiatrist in my area so I was wondering if it would be a good idea to avail of these services. I really would like to see someone this month and it appears that otherwise I will have to wait a while(>1 month), get a referral and pay large sums out of pocket to see a private psychiatrist. I know that at least one other resident at my program uses these services and he has nothing but good things to say about it.

Am I being overly worried? It's not even that I would mind paying out of pocket so much as the fact that I will have to wait an uncertain amount of time before I can otherwise even see a psychiatrist. On top of that by the time the cash only private psychiatrists have availability I'm not even sure I can secure an appointment that will work with my schedule as a resident.

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[splik]

the psychoanalytic field is small enough you will probably have someone with some connection with the program regardless. they are still bound by confidentiality. they wouldn't even be able to tell if you confessed to murder. your nervousness will be good fodder for your first session! at my program people openly talked about seeing therapists being an antidepressants, lithium etc or disclosed severe mental illness to peers.

 

[Doctor Bagel]

Would you possibly see one of your attendings? If so, that would be a problem. These programs are usually set up in some way to protect psychiatry residents, though. My program had a similar type of thing, and psychiatry residents were referred off campus for treatment with the program paying the bill (I think) until they hired a psychiatrist who had no attending responsibilities for residents.

I agree with splik that the field is small, and whoever you see is likely to have some overlap with someone unless you're in a huge city. Also, yes, this is good fodder for discussion and treatment, but I also get not wanting much overlap between your treatment and your professional life. I actually think too much familiarity and overlap is ultimately a hindrance to treatment. I also didn't train at a program where anyone talked about experience with severe mental illness or with taking mood stabilizers, etc..

 

[Crayola227]

the psychoanalytic field is small enough you will probably have someone with some connection with the program regardless. they are still bound by confidentiality. they wouldn't even be able to tell if you confessed to murder. your nervousness will be good fodder for your first session! at my program people openly talked about seeing therapists being an antidepressants, lithium etc or disclosed severe mental illness to peers.

Really? Is the murder thing exempt from the laws where you have to warn someone at risk of harm because it's already a done deal??

The second part shocks me to the core.

I would say something like bipolar disorder would be the absolute worst organic mental health disorder (second maybe to schizophrenia but I don't feel like schizophrenic physicians make it long in the profession) to ever reveal in other fields due to the stigma and association with BPD.

I've even heard this extended to psychiatry, so I'm really surprised. The attitude at your program, how common do you think this is among psych programs???

 

[Crayola227]

I hear about psych residents getting psych care as part of their program.

Why is this the case? No offense, from what I hear, your guys' residency experience is way less, um, SI-inducing than say, gen surg.
Is it done based on actual need, or is it that the very thing that makes you value mental health makes you value it for residents?
Or, can psych residencies be as much "don't practice what you preach" as the rest of medicine??

I'm trying to understand what your culture is like and why it's different than other fields.

I don't mean to derail the thread, if this was your stereotypically malignant to mental health medical field I would have lots to add.

 

[splik]

I hear about psych residents getting psych care as part of their program.
.

it's not really psych care. many psych residency programs encourage psychiatrists to have personal psychotherapy as part of the training experience. This is typically psychodynamic psychotherapy (though some people will have full analysis) though my program being what it was it was quite common for people to seek out CBT, ACT, and FAP too. It gives you a sense of what it is like to be in therapy, your therapist will often be your best supervisor for psychotherapy as they will know you and thus understand how a certain patient might be affecting you. Psychotherapy is hard work, it is quite draining sitting and listening attentively to patients in a deliberate way and genuinely being there. (I often use to fall asleep). It can generate powerful feelings. It can be really hard to switch off at the end of the day. Patients can get under your skin. It is hard not to take things personally, because the work we do is personal. I do think some people go into the field seeking their own personal salvation. From what I can tell this is more common on the coasts, particularly at the more psychotherapy oriented programs. I don't think most programs are like this but the better ones certainly have this kind of thing. Many residencies will also have a t-group or some other kind of experiential group experience or process group. Also your patients force you to confront your own issues in relationships etc

 

[Crayola227]

bipolar disorder isnt an organic mental disorder (organic mental disorder refers to coarse brain disease) but yeah I know quite a few physicians who have bipolar disorder. schizophrenia i think people are much more likely to keep to themselves. It's not always permanent some people just have a few months of madness and get over it, others are very well controlled. Not everyone with severe mental illness needs to take medications long term either (in fact i believe only a minority do, but that is not a view that many people share). One of the more famous psychiatrists with schizophrenia is Carol North, who is a professor of psychiatry at UTSW. she claims her schizophrenia was cured by dialysis. Daniel Fisher was diagnosed with schizophrenia hospitalized 3 times and then went to medical school and did his psych residency at harvard. elizabeth baxter is a psychiatrist who was diagnosed with schizoaffective disorder and hospitalized multiple times during her residency and went onto create the peer BRIDGES program. suzanne vogel-scibilia is a psychiatrist who has psychotic bipolar disorder and she probably sees more patients than most psychiatrists.

really i dont see why it would be a big issue once youre part of the club. the biggest issue is the medical boards ask these outrageous questions about mental illness (often including in the question things like pedophilia and bestiality in the more backwater states). medical boards have no business asking these questions and physician health programs have no business treating mental health physicians by holding their licenses to ransom (not including addiction if using the colorado model). if it werent for that i think more people would feel freer to talk about it. instead we train a cadre of self-hating psychiatrists.

Thank you for correcting me on terminology. I find this is one of the most tolerant and educational forums for those outside the specialty.

We don't use the Axes anymore, and while I learned DSM IV quite well I think for not being a psychiatrist, I'm not in a place to learn DSM 5 ATM

How do you distingush now, between personality disorders, vs some of the psychiatric conditions treated as an imbalance of neurochemicals? How do you classify now conditions like dysthymia, BPAD, MDD, etc?
I think that's what I was trying to get at with saying bipolar was "organic"

I think my med school must have taught me a very dire picture of schizoaffective and schizophrenia based on what you're saying about prognosis etc
Maybe it's similar to the way that work on the gen med floor can sort of warp one's view of aging, I imagine I may have gone through the same thing with inpt psychiatry

Yes, I could see what you're saying if you're part of the psych club, I don't think you hate on patients or doctors for MH issues by trade!!
However elsewhere it's not at all like that, as you seem to be aware. And yes, the med boards and PHPs are nasty nasty busines.

 

[HarryMTieboutMD]

To the original poster: If you can't see anyone respectable in network, then I would go ahead and use your department's setup. From what you describe, it sounds like a good resource with high levels of confidentiality. I would just clarify that whoever is treating you will not be supervising you in the future (unless you really want him or her to...)

This culture that has pervaded psychiatry of needing to be in therapy (starting with but not limited to undergoing psychoanalysis) as part of the learning process is toxic, arrogant, and dangerous and just speaks "false bravado." This does not happen anywhere else in medicine and is completely ridiculous- does a general surgery resident have to be put under and have an ex lap? Of course not! Psychotherapy, as mentioned above, is a very difficult skill to do well and is ideally learned through seeing a wide variety of patients, being closely supervised by someone who knows what he or she is doing, and reading. Being a "patient" is absolutely NOT necessary for training and reflects the vainglory and virulence that continues to plague certain sects of psychiatric elitism. As I have said numerous times before, your program absolutely does not need to know your business, and as long as one is a functional and responsible resident, the less the admin/PD/attendings/staff know, the better. If you are in need of therapy for whatever reason (even if it's just the stress of intern year, your ex gf/bf, etc) by all means seek it out, but DO NOT do it because you want to be a "better therapist." Sorry for the rant- I just think this is one of the stupidest things that has ever happened (and still happens!) in psychiatric training!

 

[thoffen]

To the original poster: If you can't see anyone respectable in network, then I would go ahead and use your department's setup. From what you describe, it sounds like a good resource with high levels of confidentiality. I would just clarify that whoever is treating you will not be supervising you in the future (unless you really want him or her to...)

This culture that has pervaded psychiatry of needing to be in therapy (starting with but not limited to undergoing psychoanalysis) as part of the learning process is toxic, arrogant, and dangerous and just speaks "false bravado." This does not happen anywhere else in medicine and is completely ridiculous- does a general surgery resident have to be put under and have an ex lap? Of course not! Psychotherapy, as mentioned above, is a very difficult skill to do well and is ideally learned through seeing a wide variety of patients, being closely supervised by someone who knows what he or she is doing, and reading. Being a "patient" is absolutely NOT necessary for training and reflects the vainglory and virulence that continues to plague certain sects of psychiatric elitism. As I have said numerous times before, your program absolutely does not need to know your business, and as long as one is a functional and responsible resident, the less the admin/PD/attendings/staff know, the better. If you are in need of therapy for whatever reason (even if it's just the stress of intern year, your ex gf/bf, etc) by all means seek it out, but DO NOT do it because you want to be a "better therapist." Sorry for the rant- I just think this is one of the stupidest things that has ever happened (and still happens!) in psychiatric training!

My program did not have a mechanism to provide psychotherapy, although recommended considering it occasionally to all residents. I didn't seek it out until my 4th year, and I do think it was the most important thing I've ever done for my career. That said, if it had been compulsory or I was otherwise goaded into it from the very beginning, I very much doubt I'd feel the same way.

 

[deleted736562]

How do you distingush now, between personality disorders, vs some of the psychiatric conditions treated as an imbalance of neurochemicals? How do you classify now conditions like dysthymia, BPAD, MDD, etc?
I think that's what I was trying to get at with saying bipolar was "organic"

Many in the field also think that psychiatric disorders are due to impaired functionality in the brain, be it personality disorders or not. This is probably closer to the mainstream view.

 

[HarryMTieboutMD]

One of the more famous psychiatrists with schizophrenia is Carol North, who is a professor of psychiatry at UTSW. she claims her schizophrenia was cured by dialysis.

Whether or not Carol North had actual schizophrenia (vs some other cause for intermittent psychosis since childhood) is up for debate and largely academic, but she definitely was psychotic and is pretty open about it. She did receive dialysis treatment from Bob Cade (UF nephrologist most famous for inventing Gatorade) who was studying dialysis treatment in schizophrenia. She was incidentally one of his rare success stories: https://news.google.com/newspapers?...AAIBAJ&sjid=DeoDAAAAIBAJ&pg=5498,414272&hl=en

 

[smalltownpsych]

Thank you for correcting me on terminology. I find this is one of the most tolerant and educational forums for those outside the specialty.

We don't use the Axes anymore, and while I learned DSM IV quite well I think for not being a psychiatrist, I'm not in a place to learn DSM 5 ATM

How do you distingush now, between personality disorders, vs some of the psychiatric conditions treated as an imbalance of neurochemicals? How do you classify now conditions like dysthymia, BPAD, MDD, etc?
I think that's what I was trying to get at with saying bipolar was "organic"

I think my med school must have taught me a very dire picture of schizoaffective and schizophrenia based on what you're saying about prognosis etc
Maybe it's similar to the way that work on the gen med floor can sort of warp one's view of aging, I imagine I may have gone through the same thing with inpt psychiatry

Yes, I could see what you're saying if you're part of the psych club, I don't think you hate on patients or doctors for MH issues by trade!!
However elsewhere it's not at all like that, as you seem to be aware. And yes, the med boards and PHPs are nasty nasty busines.

Very true. Many people outside the field don't know about the patients who are doing better. The primary care physician might not even know that the patient with well-controlled schizophrenia has this illness unless they see it in the chart. Another good example is with addiction. I had a good talk with a cop during a ride along early in my training and realized that she had absolutely no experience of people with substance use who were in recovery which was pretty obvious once I thought about it a bit. Here's another example from the ED. I always tell the EM docs who say, "I couldn't work with your patients" that these aren't really my patients yet because once they start working on their problems they typically stop showing up at the ED.

 

[MLT2MT2DO]

My program did not have a mechanism to provide psychotherapy, although recommended considering it occasionally to all residents. I didn't seek it out until my 4th year, and I do think it was the most important thing I've ever done for my career. That said, if it had been compulsory or I was otherwise goaded into it from the very beginning, I very much doubt I'd feel the same way.

Started psychotherapy halfway through my intern year, best move I've made. I really think residencies should insist on this, at very least psychiatry residencies. At least for a few sessions.


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