Top Ten Reasons I chose Psych

[Sporadicus]

Disclaimer: after lurking on SDN for close to 4 years I am finally ready to start contributing; as a newly minted MD/psych intern, I would like to share why I ended up choosing psychiatry with all of those MS3's who are thinking about taking the plunge. Enjoy!



10) psychiatry is interesting

This could actually be number 1. I don't think I had a single interesting story for my significant other for the entire month that I was on neurology, which was my rotation immediately before psych. She would ask me how my day went, it was usually something like this:

"eh, some guy had a stroke, I saw him in the ED; there weren't any major PE findings...we'd missed the window for intervention by the time I saw him and I don't think he would have been a candidate anyhow. Dinner?"



9) the science is coming along

Psychiatry and neuroscience go hand in hand; lucky for us the hot topics in research at the moment involve brain circuits and genomics, both of which will greatly improve what we can offer our patients in the future. More likely than not, our generation is going to see an even greater shift away from psychoanalysis and talk therapy in favor of more imaging, devices, and quick interventions, none of which I feel is a bad thing...



8) psychiatry is mostly outpatient, office based

Our hospitals are full of the sickest of the sick, but this is < 10% of the psychiatric population; ie 18 out of 20 people who have ever been to a psychiatrist are doing fine, walking among the rest of us, living out their lives grateful and happy.



7) the 'stigma' and lack of prestige - not really a big deal

It will probably always be there, but generally I am finding the stigma worse inside the medical community than outside of it. Most people, (probably all people statistically) have at least one member of their immediate family suffering from mental illness, depression or addiction. How well we treat these people will ultimately determine how well we are viewed by the community.

As far as respect goes, everyone in the hospital looks down on everyone else. Essentially if you aren't a neurosurgeon there is probably someone out there who will say 'ours are better doctors than yours.' Sadly a lot of these same people will one day have to call me because their spouse/kid/self is having a hard time and needs a consultation. And that's okay, because like lawyers and dentists, you can hate psychiatrists as much as you want but if you find yourself needing one you are going to want the best one you can get!



6) the patient population is deserving

I found that on most of my third year rotations, 90% of my patients' health problems were caused by a combination of cigarettes, alcohol and generally poor choices with regard to diet, lifestyle and sexual partners. I felt sorry for those who truly didn't know better but mostly I was annoyed by their lack of common sense. We had some frequent fliers on the psych floors but most patients left the hospital in much better shape than when they had arrived.



5) psychiatry is not a particularly competitive field to get into.

At the moment. My clerkship grades were okay but my board scores were only slightly above the US average. I got some pretty amazing interviews. Things will likely change, but for the next few cycles at least you are almost guaranteed a spot in a program assuming you are 1) an American grad and 2) not the guy that passed step 1 on his 3rd attempt.

And things can change pretty quickly with a few reimbursement updates/saturated markets. On the interview trail I met a fair amount of PGY2 radiologists looking to get the heck out while they still could...



4) we work 9 to 5, M to F. Anything else is just extra $$.

No one will ever write this one their personal statement, but seriously working 40 hours a week is great. And for the daredevils who want to work 65+ hours by adding 3 shifts/week in the CPEP or on call on top of their regular job for that extra $75k, some health system out there will accommodate you because:



3) psychiatry is in high high demand, even in the major cities.

I have not yet met a senior psych resident who was lamenting her lack of choices post-residency. Despite all the doom and gloom I read on these forums about NPs and psychologists starting cash only practices on Park Avenue, there are jobs literally everywhere. And most of them start at $220k plus or minus 10%



2) our outpatients tend to be middle class Americans aged 18 to 49

This might be a little controversial, but for me it is huge. I don't generally like having to use a translator to explain that I am not the cardiologist here to tell you your ECHO results. This is not true in inpatient as you cannot choose who gets admitted, but in the office there is little chance you will have to take someone on who 1) cannot speak a word of English 2) cannot afford their care or 3) doesn't "believe" in psychiatry. When paying out of pocket, people aren't going to waste your time like they will if they know they will never see a bill.



1) I like psychiatry.

The most important reason by far; really this could be numbers 1 through 5. Very few people seem to understand this one. I was told throughout med school to "do what you like," by the same faculty who would later explain to me why I shouldn't like psychiatry. By the end of third year I didn't need to play the game for grades anymore so I was quite honest:

attending: "why do you want to do psych instead of my random specialty x?"
me: "because your random specialty x isn't interesting to me and I like psych"

That always took them by surprise.

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[vanfanal]

Awesome post!

 

[MacDonaldTriad]

I agree with everything you say, except maybe #9. I think non-biologic interventions are coming back somewhat. In the 80s, we asked old mentors what it was like practicing before Chlorpromazine came out. They wondered why we thought things were all that different. Medicines exploded in the 70s and by the 90s we were in the belief that biological revolution was the way to go. Genetics, functional imaging and the decade of the brain was going to revolutionize everything. To get into the CINP, you had to write an essay about the predominance of pharmacology. Now our illnesses are still a problem and the medications have better side effect profiles, but are about the same efficacy. Therapy will continue to climb back into a balance.

 

[graden]

I'm only pre-med but the OP piqued my interest.

 

[eastcoastdr]

Sadly a lot of these same people will one day have to call me because their spouse/kid/self is having a hard time and needs a consultation. And that's okay, because like lawyers and dentists, you can hate psychiatrists as much as you want but if you find yourself needing one you are going to want the best one you can get!

Yup!! I've seen residents laugh and roll their eyes when psychiatry is mentioned, BUT the moment their patient starts acting up its funny how fast they scramble to find the pager # for the psych attending on call!!

 

[Zenman1]

I agree with everything you say, except maybe #9. I think non-biologic interventions are coming back somewhat. In the 80s, we asked old mentors what it was like practicing before Chlorpromazine came out. They wondered why we thought things were all that different. Medicines exploded in the 70s and by the 90s we were in the belief that biological revolution was the way to go. Genetics, functional imaging and the decade of the brain was going to revolutionize everything. To get into the CINP, you had to write an essay about the predominance of pharmacology. Now our illnesses are still a problem and the medications have better side effect profiles, but are about the same efficacy. Therapy will continue to climb back into a balance.

I'm with you here. I've seen people completely turned around for the better just through some ritual or ceremony with their local medicine man or shaman.

 

[MacDonaldTriad]

I'm with you here. I've seen people completely turned around for the better just through some ritual or ceremony with their local medicine man or shaman.

Are you saying that our psychodynamic constructs and the empirically validated utility of CBT are no better than the suggestive power of a medicine man? If so, why did you choose this field? If not, don’t you think that giving someone medication and the expectation of improvement goes a long ways toward using suggestion already?

 

[Blitz2006]

Great post, agree with you on all points, except the stigma.

I honestly think there is less and less stigma nowadays compared to 20 years ago. Particularly when I say I want to pursue neuropsychiatry, people (in medical community) appear to be 'impressed', for whatever reason ("neuro" anything seems to impress people for some reason). I mean, my opinion is obviously biased, but I find neuroscience fascinating and much more 'sexy' than doing scopes all day (gastro) or putting in stents (cards). Just my 2 cents.

I mean, you said it perfectly in your post, with the advancements in Neuroimaging, psychogenetics and psychopharmacology, psych is slowly becoming a 'cutting-edge' field which translates into less stigma in my opinion.

And if guys like Biden keep addressing psych, stigma will soon be a thing of the past ->

http://www.elsevier.com/connect/vp-...ion?utm_source=twitterfeed&utm_medium=twitter

I think one huge positive you forgot to mention is: autonomy/flexibility. Psych is great because you have so much control over your show, and it is so diverse, ranging from inpatient to outpatient, telepsychiatry, ect, clinical drug trials, etc.

And you forgot to mention the extremely low overhead costs and malpractice premiums

 

[hamstergang]

I honestly think there is less and less stigma nowadays compared to 20 years ago. Particularly when I say I want to pursue neuropsychiatry, people (in medical community) appear to be 'impressed', for whatever reason ("neuro" anything seems to impress people for some reason.

Aren't you basically saying that the neuro part impresses people, not that the psych part is losing stigma? If not, then you just seemingly chose a bad example for the point you did want to make.

 

[Blitz2006]

No my point was that psych involves a lot of neuroscience, which people in the medical community are aware of and respect. I used neuropsychiatry as a personal example, but I have seen in hospital people respond positively to psychiatrists who are in geriatrics (dementia, neuroimaging) or addiction (psychopharmacology).

But yes, the bread and butter psych is what needs greater exposure and less stimgatised

 

[OldPsychDoc]

You had me until #2--neglects HUGE segments of our patients served by community clinics, the growing gero population, and of course, the ever-popular child/adolescent sector.

 

[Sporadicus]

I agree with everything you say, except maybe #9. I think non-biologic interventions are coming back somewhat. In the 80s, we asked old mentors what it was like practicing before Chlorpromazine came out. They wondered why we thought things were all that different. Medicines exploded in the 70s and by the 90s we were in the belief that biological revolution was the way to go. Genetics, functional imaging and the decade of the brain was going to revolutionize everything. To get into the CINP, you had to write an essay about the predominance of pharmacology. Now our illnesses are still a problem and the medications have better side effect profiles, but are about the same efficacy. Therapy will continue to climb back into a balance.

There will always be a place for talk therapy, and yes the therapeutic alliance can be quite effective. Non-physician providers have been filling in those gaps for years. When I say there will be a greater movement away from these therapies, what I should have said is that I believe there will be even more of a shift from us, the psychiatrists, offering them. As physicians we are uniquely positioned to apply our knowledge of biologic and neurological science to move above and beyond current treatment paradigms in a way that no one else in the behavioral health field can offer.

You had me until #2--neglects HUGE segments of our patients served by community clinics, the growing gero population, and of course, the ever-popular child/adolescent sector.

Also a very good point. By default, we are trained in general adult psychiatry and serve that population, but there are plenty of opportunities to sub-specialize into whichever patient population we so desire. I may decide down the line that I love treating children or seniors, but for now I really enjoy my interactions with working age adults, a demographic that I can see more or less exclusively if I so choose. This is what psych uniquely offers, hence #2.

 

[OldPsychDoc]

Also a very good point. By default, we are trained in general adult psychiatry and serve that population, but there are plenty of opportunities to sub-specialize into whichever patient population we so desire. I may decide down the line that I love treating children or seniors, but for now I really enjoy my interactions with working age adults, a demographic that I can see more or less exclusively if I so choose. This is what psych uniquely offers, hence #2.

Not just objecting to the age issue--but when you work in the world of community clinics, especially in urban areas, you'll see a full spectrum of ethnicity, language, and socioeconomic class. Yes, I like the fact that we work with a lot of younger, healthier folks--but psychiatry is charged with folks on the margins--and it rather upsets me when prospective residents appear to forget that.

 

[Merovinge]

Few others that I often tell my medical students:

1) Psychiatry, more than any other field of medicine I have experienced, provides you a great oppertunity to mature and grow wiser at an extremely fast rate. Between putting out fires between pts and other services on consults, learning and conducting therapy, dealing with personality disordered pts, and dealing with acutely agitated patients all provide so much room for personal growth.

2) Interacting with other psychiatrists is generally very positive. It's a field less likely to attract big egos and people tend to be very accepting of others just due to the nature of the work. There's a lot to be said about working with people that you would also to choose to spend happy hour or weekends with.

3) Great teaching/administration/leadership oppertunites for those interested in them. The very nature of the field and crossover with psychology gives us a leg up. My friends in other fields are not getting didactics or readings on adult learning, group dynamics, or occupational psychology.

 

[notdeadyet]

psychiatry is charged with folks on the margins--and it rather upsets me when prospective residents appear to forget that.

I try to screen for this when interviewing potential residents. I wonder which programs are hungry for folks who aspire to treat exclusively cash paying English-only folks?



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[Jorje286]

One of my psych rotations was with a very underserved population. There was quite a bit of violence, foul smells and body fluids (and solids) flying around. Psych is not always the "high end" specialty some imagine it to be. You can still pick what you want to do, but this is the patient population where we need to (and can) make a difference. A lot of suffering simply due to negligence by state authorities and providers sometimes.

 

[JMC_MarineCorps]

Because they told me to take my tie off on the first day of rotation. The said I was likely to get choked with it! Oh, and my hours are 7-3 now, God Bless America!

 

[notdeadyet]

Because they told me to take my tie off on the first day of rotation. The said I was likely to get choked with it!

I have a hunch this was largely born from psychiatrists who really didn't wan to wear a tie. Try that move on a buddy as an experiment. I would love if a patient who attacks me went for the tie. It's a lot less threatening than clawing my eyes, choking me out, or stabbing me with a pen.



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[rkaz]

I would love if a patient who attacks me went for the tie. It's a lot less threatening than clawing my eyes, choking me out, or stabbing me with a pen.

Did patient(s) actually attempt do this to you?

I'm female and on the shorter-end (the patients often tower over me). Now I'm wondering if I need to take some self-defense courses before starting residency.

 

[notdeadyet]

Did patient(s) actually attempt do this to you?

Nope. And I've never had a patient go for my tie, either...

I'm female and on the shorter-end (the patients often tower over me). Now I'm wondering if I need to take some self-defense courses before starting residency.

Many hospitals offer staff a short course for exactly this reason to prevent staff being injured by patient assaults. Wherever you end up, I'd look into whether or not your hospital offers this.

Outside of that, your best defense is going to be your psych training to learn how to intuit a patient's frustration and anger level and conducting on the fly risk assessments. At the end of the day, no one of any worth is going to think less of you if you walk away from an interview that made you uncomfortable. That's good practice. It's always safety first.

 

[Sporadicus]

Not just objecting to the age issue--but when you work in the world of community clinics, especially in urban areas, you'll see a full spectrum of ethnicity, language, and socioeconomic class. Yes, I like the fact that we work with a lot of younger, healthier folks--but psychiatry is charged with folks on the margins--and it rather upsets me when prospective residents appear to forget that.

I guess we will have to agree to disagree there! I remember those folks well. I had some amazing psych inpatients who also happened to be on the bottom of the socioeconomic ladder, and I learned a lot from them. At our psych clinic however, the self-pay/Medicaid population were the least likely to show up and least likely to follow-up despite the miracles performed by our excellent social workers coordinating their medications and transportation. Seeing private patients was personally more fulfilling for me and it is eventually where I see myself.

I try to screen for this when interviewing potential residents. I wonder which programs are hungry for folks who aspire to treat exclusively cash paying English-only folks?



Sent from my iPhone using Tapatalk

I do think it is admirable that you aspire to select for students who are the most likely to work with those populations after residency. But you must acknowledge the fact that the majority of private psychiatrists do not accept Medicaid. And the fact that this alone makes it unlikely that they will ever extensively treat the 'marginalized' population after residency. Or the fact that a significant percentage of our colleagues choose to practice exclusively in such an environment, including as I am sure, graduates of your program.

 

[myPsychAlt]

Working in an academic setting with a huge "underserved" population, I have to ding you on #2 as well.

I also have to give caution on #6. While all of my patients are certainly "deserving," I have a huge chunk of patients who simply don't take good care of their mental health. I compare them to the PCP patients who live on cheeseburger diets with sedentary lifestyles. If you're not exercising, if you're not using the slightest bit of behavioral activation, if you're not showing up to your therapy appointments and not doing the homework that's given to you in CBT, then it's not your psychiatrist's fault that you aren't "getting better."

General life rule: you physician will never make you healthy. That's up to you.

 

[Zenman1]

Are you saying that our psychodynamic constructs and the empirically validated utility of CBT are no better than the suggestive power of a medicine man? If so, why did you choose this field? If not, don’t you think that giving someone medication and the expectation of improvement goes a long ways toward using suggestion already?

Sometimes better; sometimes worse. A few days ago the psychologist next to me told me she was sending over a guy who has no intention of ever doing any CBT homework. Other patients have gained something from it. It made me puke when I had to study it. Intellectual understanding means little and I've had patients who were treatment failures have some kind of experience which really made them "get it." An "ah ha," Zen sort of moment if you will. All forms of therapy are just snapshots of the person who created it and IMO are just means to pigeon hole a patient into a form of therapy vs approaching the patient with something more creative and appropriate.

 

[notdeadyet]

All forms of therapy are just snapshots of the person who created it and IMO are just means to pigeon hole a patient into a form of therapy vs approaching the patient with something more creative and appropriate.

If you believe this, your toolbox is now pretty much limited to being a life coach. Which is different from psychotherapy with actual evidence of efficacy.

 

[smalltownpsych]

Sometimes better; sometimes worse. A few days ago the psychologist next to me told me she was sending over a guy who has no intention of ever doing any CBT homework. Other patients have gained something from it. It made me puke when I had to study it. Intellectual understanding means little and I've had patients who were treatment failures have some kind of experience which really made them "get it." An "ah ha," Zen sort of moment if you will. All forms of therapy are just snapshots of the person who created it and IMO are just means to pigeon hole a patient into a form of therapy vs approaching the patient with something more creative and appropriate.

I agree with you about trying to apply a formulaic treatment from a treatment manual. The concept of assigning homework makes me ill, as well and if I assigned homework to some of my adolescents, forget it. One of my colleagues spent a lot of time trying to understand why her clients would not do their homework and did not improve. Meanwhile, I would focus on building solid rapport and an empathic relationship and get results. Of course I do throw some behavioral therapy into the mix. Why not? It's been proven to work, too.

 

[Zenman1]

If you believe this, your toolbox is now pretty much limited to being a life coach. Which is different from psychotherapy with actual evidence of efficacy.

Seriously? If I only did CBT for example, I'd only have one tool and would only need a beltloop and not a toolbox. Have you read about how research is hardly worth the paper it's written on? So much for efficacy. It's the relationship that matters more than anything.

What is really funny is that one of the psychologists here teaches in a Functional Restoration Program for Soldiers with chronic pain issues. He inherited the CBT class from a psychiatrist and was having a hard time keeping his class involved and awake. I was asked to take over his class to make it more exciting. I refused. The guy finally came up with the idea of showing movie clips to illustrate CBT principles. My class on Medical Qigong is the all time favorite in the program. Go figure.

 

[smalltownpsych]

If you believe this, your toolbox is now pretty much limited to being a life coach. Which is different from psychotherapy with actual evidence of efficacy.

I have to agree with the Zenman on this one. The CBT people love to promote their research as being the end-all be-all, but there is a lot of research that challenges that. Just take a look at some of the research on relational factors or look at the neurobiology of attachment for starters. Of course, systematic exposure works for anxiety issues and addressing cognitive distortions is helpful for depressed patients, but that is just the basics. My research question would be, "Why do I get better results than many of my peers who are more strict CBT folks?" Usually, my patients have stated that the reason that they have improved with our therapy as opposed to the 4 or 5 others before is that they like me and they trust me. How does that fit into evidence-based practice? In physical medicine, it was once called having a good bedside manner and at one time was considered a plus. I'm not so sure nowadays. Maybe we should research that more or do we even need to since most of the research is there already and we ignore it because it is too hard to decipher as opposed to a simplistic paint-by-numbers manualized treatment?

 

[shan564]

Not just objecting to the age issue--but when you work in the world of community clinics, especially in urban areas, you'll see a full spectrum of ethnicity, language, and socioeconomic class. Yes, I like the fact that we work with a lot of younger, healthier folks--but psychiatry is charged with folks on the margins--and it rather upsets me when prospective residents appear to forget that.

+1. The diverse spectrum of patients is actually one of the things I like about psychiatry.

2) Interacting with other psychiatrists is generally very positive. It's a field less likely to attract big egos and people tend to be very accepting of others just due to the nature of the work. There's a lot to be said about working with people that you would also to choose to spend happy hour or weekends with.

This is one of the many things that annoy me about internal medicine.

Did patient(s) actually attempt do this to you?

I'm female and on the shorter-end (the patients often tower over me). Now I'm wondering if I need to take some self-defense courses before starting residency.

I don't have a huge amount of experience, but even the most psychotic patients seem to know better than to assault the doctor. I have pretty high pain tolerance, so I've actually been actively seeking this sort of situation... I figure that the epicity (btw, that's a neologism for an adjective intended to quantify the extent to which something is epic) of the story will outweigh the brief pain. When I have a particularly violent high-risk patient, I often take off my glasses and go into the room... also partially because the nurses and techs continually express annoyance that the doctors are never in close proximity for the high-risk physical situations (i.e. when somebody needs to be sedated), so it makes it easier to earn their alliance if they see that I'm in the trenches with them. And despite all of that, I've never had a patient so much as make a threatening gesture toward me.

That said, I'm probably physically stronger than the average psychiatrist, so I can understand why a smaller person would be concerned.

 

[Nasrudin]

+1. The diverse spectrum of patients is actually one of the things I like about psychiatry.


This is one of the many things that annoy me about internal medicine.


I don't have a huge amount of experience, but even the most psychotic patients seem to know better than to assault the doctor. I have pretty high pain tolerance, so I've actually been actively seeking this sort of situation... I figure that the epicity (btw, that's a neologism for an adjective intended to quantify the extent to which something is epic) of the story will outweigh the brief pain. When I have a particularly violent high-risk patient, I often take off my glasses and go into the room... also partially because the nurses and techs continually express annoyance that the doctors are never in close proximity for the high-risk physical situations (i.e. when somebody needs to be sedated), so it makes it easier to earn their alliance if they see that I'm in the trenches with them. And despite all of that, I've never had a patient so much as make a threatening gesture toward me.

That said, I'm probably physically stronger than the average psychiatrist, so I can understand why a smaller person would be concerned.

The psychology of size and strength cannot be underestimated. It's not fool proof by any stretch. But even a floridly psychotic person seems to grasp the size difference between themselves and another. I don't think I would be as keen on psych if I were a very small person. You flirting with the thrill of pain would be an entirely different proposition if your neck could be snapped or skull bashed within seconds.

My wife is a very athletic and strong person but is also small. And it never ceases to amuse me how easily I can toss her around in jest given our size difference. The thought of someone else being able to do that at will makes me squeamish about recommending psych to people her size.

I'm the more wary and pragmatic sort than PC and uber sensitive so that's where I'm coming from with that.

 

[shan564]

The psychology of size and strength cannot be underestimated. It's not fool proof by any stretch. But even a floridly psychotic person seems to grasp the size difference between themselves and another. I don't think I would be as keen on psych if I were a very small person. You flirting with the thrill of pain would be an entirely different proposition if your neck could be snapped or skull bashed within seconds.

I'm overall pretty nerdy-looking and most of my muscle is masked by a thick layer of fat, so I'm not sure if it's the size thing entirely... but still, being 5'11" is probably better than being 5'2"...

 

[notdeadyet]

Seriously? If I only did CBT for example....

Exactly. If you're limited to just CBT, you're very limited. When all you've got's a hammer, everything begins to look like a nail... But I would disagree with the idea that therapy modalities are just ways to "pigeon hole" a patient. That's only true if all you have in your tool belt is one modality.

For example, my work is heavy on PTSD patients. Most of my sessions include flavors of psychodynamic, CBT, and MI. Some patients have a course of PE or CPT. Some need ACT.

All of these require a good rapport with the patient. There is good research that shows the importance of this in a therapeutic relationship. But if all you have is rapport, you've got friendship, not treatment. You build the rapport and the relationship so that you can then do the work with the patient effectively. But you have to have the training and experience in different modalities in order to do that. If you don't have that, and you're just building trust and giving advice without a methodology... As they're fond of saying in the Army, you're just out there flappin'. Essentially acting as life coach.

 

[Armadillos]

I have to agree with the Zenman on this one. The CBT people love to promote their research as being the end-all be-all, but there is a lot of research that challenges that. Just take a look at some of the research on relational factors or look at the neurobiology of attachment for starters. Of course, systematic exposure works for anxiety issues and addressing cognitive distortions is helpful for depressed patients, but that is just the basics. My research question would be, "Why do I get better results than many of my peers who are more strict CBT folks?" Usually, my patients have stated that the reason that they have improved with our therapy as opposed to the 4 or 5 others before is that they like me and they trust me. How does that fit into evidence-based practice? In physical medicine, it was once called having a good bedside manner and at one time was considered a plus. I'm not so sure nowadays. Maybe we should research that more or do we even need to since most of the research is there already and we ignore it because it is too hard to decipher as opposed to a simplistic paint-by-numbers manualized treatment?

Not sure why you make it sound like the importance of bedside manner has gone by the wayside. Even as medstudents, its almost always seeing certain physicians bedside manner that makes us aspire to be like a particular attending. We may love to tell war stories about the wild cowboy attendings, but thats just because its fun. On the other hand when it comes to what we really want to be as a physician, bedside manner is the revered trait for most of us.

 

[smalltownpsych]

Not sure why you make it sound like the importance of bedside manner has gone by the wayside. Even as medstudents, its almost always seeing certain physicians bedside manner that makes us aspire to be like a particular attending. We may love to tell war stories about the wild cowboy attendings, but thats just because its fun. On the other hand when it comes to what we really want to be as a physician, bedside manner is the revered trait for most of us.

I apologize for making that assumption as I have not been to med school, and as a researcher, I try not to make unfounded assertions like that. I probably should have phrased it as an overall concern that with the ever changing climate of healthcare and the focus on procedures and measurable outcomes, that we could lose some of emphasis on the intangibles which can often contribute more to outcomes than what we are looking at. A good example I can think of would be reassurance that a GP would provide to an anxious patient through a gentle pat on the hand. I wonder if we could compare that to the efficacy of Benzo's. My hunch is that the better clinicians rely on interpersonal factors to alleviate suffering as well as other more accepted as scientific tools whereas the less effective just keep upping the dosage.

 

[smalltownpsych]

Exactly. If you're limited to just CBT, you're very limited. When all you've got's a hammer, everything begins to look like a nail... But I would disagree with the idea that therapy modalities are just ways to "pigeon hole" a patient. That's only true if all you have in your tool belt is one modality.

For example, my work is heavy on PTSD patients. Most of my sessions include flavors of psychodynamic, CBT, and MI. Some patients have a course of PE or CPT. Some need ACT.

All of these require a good rapport with the patient. There is good research that shows the importance of this in a therapeutic relationship. But if all you have is rapport, you've got friendship, not treatment. You build the rapport and the relationship so that you can then do the work with the patient effectively. But you have to have the training and experience in different modalities in order to do that. If you don't have that, and you're just building trust and giving advice without a methodology... As they're fond of saying in the Army, you're just out there flappin'. Essentially acting as life coach.

That makes more sense. Sometimes these threads get argumentative because of miscommunications, except for one poster I can think of who just seems good at agitating! I know that I don't think that rapport alone is sufficient, but I actually implement relational factors into my conceptualization and treatment. Especially when working with adolescents, a rarely studied animal, where social development and interpersonal development, are undergoing dramatic growth and I believe that there is corresponding neuronal development related to this development that I am not sure anyone is looking at. I equate the social developmental phase of adolescence as akin to the language development in early childhood, it is almost like flipping a genetically programmed switch. I digress, but it is Saturday a.m. so I should be allowed to and it relates to the original topic. my number one reason for psych is we know so little and the field is wide open for new research!

 

[BobbyB]

bedside manner is the first thing nurses mention about the attending
time spent with the patient is second

no mention about his diagnostic, administrative, or medical management skills at all

 

[whopper]

• I love the behavioral sciences
• You can make your own hours.
• It pays well (not compared to other fields of medicine but compared to most jobs overall, bear in mind I chose to be a psychiatrist before I went to medical school).
• People have a mysterious perception of us. They think we can read minds, read people conclusively with a glance, well in short think we are ninjas without the black outfits or katanas. Yeah I know that isn't what we're about but it's fun to once in awhile screw with people's heads. E.g. stare at them, and tell them I know their darkest secrets, pause for a few seconds and then tell them I'm just screwing with them. (Of course never to patients. I usually do that at parties).
• The human mind and it's pathologies is a much more interesting field of study (at least for me) than for example a GI tract, a patch of skin, or a pair of lungs.

The following reasons are why I chose it but the pertain to all of medicine.

• I love science. I feel I've gained more wisdom and clarity of mind from science vs every other field I've seen and this is coming from someone that almost became an artist
• The field is dynamic, ever changing, and I can't ever see it getting boring.
• I get to be in a position where I am highly respected. (A bad thing when the attending in charge is a bad doctor).
• I'm doing good and have no doubts or ethical second thoughts about what I do (except for the really weird cases that could be a medical drama, e.g. a person on my unit that wants to die and if I were in his shoes I would too).
• I get to work with other people who want to do good. It does make a big difference when almost everyone you know you have no respect for them vs being with several people you highly respect.

 

[NMoren]

I'm overall pretty nerdy-looking and most of my muscle is masked by a thick layer of fat, so I'm not sure if it's the size thing entirely... but still, being 5'11" is probably better than being 5'2"...

Well...I'm just a 5' 3'' pre-med student lurking the forum but now I'm a little scared of my decision to go into psychiatry. Maybe I should reconsider Neurology...

 

[Nasrudin]

Well...I'm just a 5' 3'' pre-med student lurking the forum but now I'm a little scared of my decision to go into psychiatry. Maybe I should reconsider Neurology...

Crap. I don't mean to scare you. There's plenty of small people in psych. And Emergency Medicine which is probably a more dangerous field. Or surgey if hepC and other blood borne pathogens are brought into the mix. I'm a carrier of TB from being exposed to patients after working in the ED. It's a dangerous world. Don't hide from it and miss something you would like. Plenty of patients would be settled and more at ease by talking to a small possibly female provider. Rather than a big oaf like me. And that's the goal--soothing, calming, and welcoming patients so we can get a good history and be able to treat them.

Have a look for yourself.

You just have to be more wary. Which is not unlike anything else in this world as a small person.

 

[OldPsychDoc]

Well...I'm just a 5' 3'' pre-med student lurking the forum but now I'm a little scared of my decision to go into psychiatry. Maybe I should reconsider Neurology...

One of the best psychiatrists in my city is a petite 5'-something, 60-yr old female with a grey ponytail. She treats the sickest of the sick, and wields professional authority like you wouldn't believe. Amazing lady.

 

[splik]

Well...I'm just a 5' 3'' pre-med student lurking the forum but now I'm a little scared of my decision to go into psychiatry. Maybe I should reconsider Neurology...

i'm 5'3" myself (though i usually add a few inches ha!) and i am not sure how height would have a bearing on whether or not one would choose psychiatry. there are some fields where being short are harder (ortho, general surgery, actually any surgical specialty because surgeons tend to be tall and the operating table is too high!) but there are midgets in surgery too you just have to stand on a stool.

if anything, being short is an advantage in terms of being attacked because its much harder for someone big to lunge down and its easier to duck and get out of way if you're a short person! also i have never, not once been attacked. the only times anyone has tried to take a swing at me, they were aiming for someone else, and missed!

also neurology and psychiatry are vastly divergent field, and are only likely to become more divergent as time goes on. the mythical reunion that was suggested never happened and never will. most psychiatrists would rather gouge their eyes out than do neurology and vice versa. hell, i think neuroscience is sexy and have a particular interest in neuropsychiatry, but it's almost never gonna be an extensive knowledge of neuroscience that is going to make any difference to your clinical care, and for most bread and butter clinical psychiatry is frankly irrelevant. it is a rare occassion for someone to be deciding between neurology and psychiatry. in fact it's probably more common for people to decide between psych and surgery, EM, IM, FM, peds, OB/GYN, anesthesia, even pathology than between neuro and psych

 

[Nasrudin]

i'm 5'3" myself (though i usually add a few inches ha!) and i am not sure how height would have a bearing on whether or not one would choose psychiatry. there are some fields where being short are harder (ortho, general surgery, actually any surgical specialty because surgeons tend to be tall and the operating table is too high!) but there are midgets in surgery too you just have to stand on a stool.

if anything, being short is an advantage in terms of being attacked because its much harder for someone big to lunge down and its easier to duck and get out of way if you're a short person! also i have never, not once been attacked. the only times anyone has tried to take a swing at me, they were aiming for someone else, and missed!

also neurology and psychiatry are vastly divergent field, and are only likely to become more divergent as time goes on. the mythical reunion that was suggested never happened and never will. most psychiatrists would rather gouge their eyes out than do neurology and vice versa. hell, i think neuroscience is sexy and have a particular interest in neuropsychiatry, but it's almost never gonna be an extensive knowledge of neuroscience that is going to make any difference to your clinical care, and for most bread and butter clinical psychiatry is frankly irrelevant. it is a rare occassion for someone to be deciding between neurology and psychiatry. in fact it's probably more common for people to decide between psych and surgery, EM, IM, FM, peds, OB/GYN, anesthesia, even pathology than between neuro and psych

Interesting. I am a bigger target. And speaking of midgets my nuts are too close to their teeth. So...there we go. Size is neither here nor there in the medicine of the mind. Perhaps it's just that I'm interested forensics and prison work. But those are heavily secured environments. Also wtf do I know. I'm a proto-intern.

 

[splik]

oh my reasons for liking/choosing psychiatry are vastly different to the OP who I pretty much entirely disagree with! Which just goes to show you how vast the field is and can accommodate different interests.

10. I wanted to work with the most disenfranchised and marginalized sections of society. it's humbling and i think it's a true privilege to be able to help those that everyone else has washed their hands of.

9. I get paid to talk about sex and sexuality. it's really fascinating to learn about the rich array of sexual behaviors and interests, address risky sexual behaviors and HIV risk, and one of things patients are likely you to most thank you for is addressing their sexual dysfunction, relationship problems, and enhancing their satisfaction with this important area of life.

8. I'm nosy. I like asking personal questions and learning about people on a deeper level.

7. I'm interesting in meaningful connection, and using that connection as vehicle for transformation.

6. i like words. i like stories. i think they are powerful and dare i say healing. psychiatry is all about stories.

5. i enjoy writing. there is a lot of scope to write articles, books, and even wax lyrical with your documentation.

4. i enjoy teaching. there is huge scope beyond teaching residents and med students, to educating other physicians about mental illness, educating patients and their families to empower them, and educating the public

3. psychiatry can be about social justice. psychiatrists are more likely to care about social issues than most other physicians (exception of family physicians and pediatricians) - you get to the deal with the direct consequences of social exclusion, inequality, prejudice, discrimination, stigma, and the opportunity to try and address these issues. you get to be an advocate for your patients.

2. despite regular prophesies about the death of psychiatry from the 1960s onwards, naught has come from it. psychiatry is going nowhere. despite claims of infringement from other professionals such as nurse practitioners and psychologists, the reality is that no one is actually interested in doing the job of the psychiatrist and even those states with the fewest psychiatrists are not trying to entirely replace us with other professionals. psychiatrists are supposed to be able to formulate complex patients with multiple comorbidities from multiple perspectives, something that other mental health professionals are not able to do. we are also work with the most severely ill and risky patients, and no one else wants to take the responsibility for managing homicidal patients or high-risk suicidal patients. in the geriatric and medically ill population, psychiatrists are uniquely placed to deal with medical-psychiatric interface.

1. as a resident, i get to laugh at the residents in pretty much every other specialty who toils away for almost twice the hours, and yet spend less than a 1/4 of the time I get to spend in direct patient care. call me smug, but it makes my work even more enjoyable.

 

[NMoren]

It is a rare occassion for someone to be deciding between neurology and psychiatry. in fact it's probably more common for people to decide between psych and surgery, EM, IM, FM, peds, OB/GYN, anesthesia, even pathology than between neuro and psych

Really? I'm actually surprised by that...I mean considering they both get certified by the same board, that there is behavioral neurology and neuropsychiatry, etc. (Not saying you're wrong, I'm just surprised). I'm currently studying Psychology and taking all the pre-med courses and I know for a fact I love behavioral sciences but I also love neuroscience...and most of my research experience has been with neuroscience/neurobiology. I'm just waiting until I can shadow a neurologist and a psychiatrist (though I'm not sure if it's even possible to shadow a psychiatrist...).

Also thanks all for the encouragement haha

 

[sprin001]

You forgot:
Psychiatrists, when asked, "if you could do it all over again, would you choose psychiatry?"
-Psychiatrists actually say yes...

To me, that speaks volumes

 

[postbacpremed87]

You forgot:
Psychiatrists, when asked, "if you could do it all over again, would you choose psychiatry?"
-Psychiatrists actually say yes...

To me, that speaks volumes

I just think it is sad to go through life with that much regret over what you've been doing...or to question a portion of your life that takes up 30-40 years. Do what you love!

 

[Jorje286]

Really? I'm actually surprised by that...I mean considering they both get certified by the same board, that there is behavioral neurology and neuropsychiatry, etc. (Not saying you're wrong, I'm just surprised). I'm currently studying Psychology and taking all the pre-med courses and I know for a fact I love behavioral sciences but I also love neuroscience...and most of my research experience has been with neuroscience/neurobiology. I'm just waiting until I can shadow a neurologist and a psychiatrist (though I'm not sure if it's even possible to shadow a psychiatrist...).

Also thanks all for the encouragement haha

If you do a behavioral neurology/neuropsychiatry fellowship there will be plenty of overlap. And you can do that from both psychiatry or neurology. There are plenty of clinicians who straddle the line between psychiatry and neurology but these are at the large tertiary centers where they get difficult referrals. I worked with psych attendings in one of those places, and you absolutely need to have very solid knowledge in both medicine and neurology. But these positions are most likely to be found in tertiary academic centers, not in community hospitals.

And hey, Mayberg is a trained neurologist. She's one of the pioneers in biological psychiatry, so I don't really agree that the disciplines have nothing to do with each other. DBS for treatment-resistant depression is now in large controlled trials, so obviously a lot can come out from those interested in both fields. There are also promising results with DBS in OCD. All of this requires extensive collaboration between neurologists, psychiatrists and neurosurgeons. I think it's going to be less likely in the future that psychiatrists can get away with shaky knowledge of the brain. It's true that a lot of neurologists hate psych and the other way around, but this is not uniform.

 

[Nasrudin]

You cute, little people. (just kidding)
Pushing 6'4'' here.

I don't know about height being very relevant to safety.

Maybe only the extremes are relevant (if you are <5 feet versus 6'10'').

I guess it depends on the patient. Schizophrenic in the throes of psychosis likely isn't going to be thinking "Better not mess with that guy, his reach is definitely longer than mine. He'll prob stay on the outside and pick me apart with his jab. No thanks!"

I'm a supporter of littles and their cause. And there's nothing that should prevent anyone from pursuing whatever they want. Except for me. I'm not spending 5 years bending forward over a table to benefit my short attendings in surgery.

But I disagree with you. We estimate the size of the beings around us and behave on at least a preliminary basis with our lizard brains.

I just shouldn't have been clumsy in making the point. Smashing whole smurf villages by accident.

 

[Frazier]

I'm a supporter of littles and thier cause as well. And there's nothing that should prevent anyone from pursuing whatever they want. Except for me. I'm not spending 5 years bending forward over a table to benefit my short attendings in surgery.

But I disagree with you. We estimate the size of the beings around us and behave on at least a preliminary basis with our lizard brains.

I just shouldn't have been clumsy in making the point. Smashing whole smurf villages by accident.

That's an interesting point.

I wonder if anyone formally looked at that (psych patients' perceptions of size pertaining to onset of violence/aggression in healthcare setting).

 

[OldPsychDoc]

I'm a supporter of littles and their cause. And there's nothing that should prevent anyone from pursuing whatever they want. Except for me. I'm not spending 5 years bending forward over a table to benefit my short attendings in surgery.

But I disagree with you. We estimate the size of the beings around us and behave on at least a preliminary basis with our lizard brains.

I just shouldn't have been clumsy in making the point. Smashing whole smurf villages by accident.

Smurf smasher.

 

[Nasrudin]

Smurf smasher.

. Awesome. I've been listening to the Song of Fire and Ice audiobooks constantly for weeks and had thought our modern names are quite weak and without proper titles.

Nasrudin, Smasher of Smurfs.

Gregor Clegane style. Who cares if it's no contest. It's just fun to smash the lil blue buggers.

Thanks.