Psychiatry's place in medicine

I've heard that some people have expressed concern that psychiatry will become subsumed under neurology with advances in neuroscience. Someone gave me a great quote about that, though. Can't quite remember it, but something about how even the neurologists who take that to be the case seem more than happy to refer patients on to psychiatric treatment!

On the other side of that is the worry that if psychiatry isn't subsumed under neurology with advances in neuroscience then how is psychiatry's status as a branch of medicine legitimated????

Damned if you do and damned if you don't...

I hope this isn't off topic... But I've been wondering about other field divisions in medicine. I'm guessing that there are fairly 'arbitrary' divisions sometimes (I'd love some examples) where some condition is on a borderline between one speciality and another...

I wonder if part of the reason for psychiatry's 'bad rep' is that the treatments aren't as well worked out as for some other parts of medicine. I mean, when it was discovered that a certain sub-group of people regarded as schizophrenia could be treated (for neurosyphilis) those people were handed off to some other speciality. That seems to be an ongoing concern - discover an effective treatment then hand the 'success' off to another speciality. Hence the thought that neurology will eventually take over, I guess...

I guess there is a problem with evidence, too. I mean... You can get an x-ray to spot that someone has a broken leg and get some test result back to spot some kind of bacteria whereas psychiatric diagnoses seem to be made on the basis of behavioural symptoms. Maybe this is an epistemic problem (which will be solved with future neurological advances) or maybe it is more fundamental than that. Kind of like... Looking for a hardware fault when microsoft word goes buggy on you...

How could you fall for a comment like that?! Did you go into medicine just so you could climb some proverbial totem pole?? I mean, come on, people are always questioning other people's professions, and most of the time it's highly unfounded. (Not really trying to be sarcastic, just kidding here of course. But still.)

If someone started debating whether radiation oncologists were real doctors, they would sound ridiculous. I think the same pertains here. Psychiatrists help patients in many of the same ways other doctors do, plus in ways that are unique to psych, every day. It's not like it's some practice way out there on the fringe.

Also, as far as non-real medicine, I think you can find it in every field. For example, just remember that there are "radiologists" out there who drive around America in vans selling "whole body scans" at discount prices. (I once saw a picture of this, so I know they're out there.)

I hope to go into psych too, but I don't really care if other doctors look down on psychiatrists, since I doubt the vast majority of them actually do. However I guess I would feel sorry for those who do, for having such a limited perspective on things. In a way, I kind of hope those attitudes don't change--because you can look at those views as being part of a whole different kind of totem pole--the totem pole of stupid opinions and comments that would have been better left unsaid, and for now it sounds like we'll be on top of that one!

toby jones said:

Maybe this is an epistemic problem (which will be solved with future neurological advances) or maybe it is more fundamental than that.

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I didn't get the feeling that the comment made by the nurse or the resident were meant to spark actual philosophical debate about the validity of psychiatry as a medical field. I got the sense they were just kind of being mean, in a rather baseless way.

The totem pole idea is kind of bunk. I used to hear that in med school, "You're smart, why waste it on Psych...why go to medical school for 4 years if you're not going to use your medical knowledge..." We're a young field, from a research standpoint, some of the technologies for studying the effects of psychotherapy, or even psychopharm, from a mechanistic or neuroscientific standpoint, are 10 years old or less. And from a clinical perspective, our words, language, and facilitation of a narrative structure for our patients are skills unique to our specialty. Most neurologists and neurology residents I know don't want to spend 30 minutes or more talking with patients. And particularly for psych patients, if they don't trust you or have a therapeutic alliance with you, you can be sure they won't take their antidepressant or antipsychotic for the rest of their lives. And if any other unit has an acutely psychotic patient, or suicidal patient, the unit flips and wants psych on board yesterday. My wife who is a FM intern at a university affiliated community hospital for her residency training has related to me on at least a half dozen occasions already, how one acutely psychotic patient has turned the staff on its head, and they flip out. Sure, my sphincter tone gets a little tight at a condition code, but a patient who states they're "going to kill every m%^&erF*&%er in this godd&^mned place" I have no problem with, with the help of a diesel nurese/murse and 5/2/1. Just something to keep in mind, with any psych poopooing.

One could assume that the nurse was just being mean...
Or one could wonder why many people (and not just that particular nurse) have been similarly led to express concern about psychiatry's status within medicine (and why it is considered to be 'down the totem pole').

I think there are reasons why some people regard it to be 'down the totem pole'. To know whether they are good reasons or not one would have to know what they are and have a think about them...

Personally... I don't think that psychiatry should worry too much about neurological encroachment. I'm hoping that the arbitrary nature of field divisions is such that even if every mental disorder turned out to have an identifyable neurological (or even genetic) basis - there would still be the field of psychiatry treating these people. I mean, biological advances aren't likely to have... Uh... (making this up - better example will help) hand specialists merged into shoulder specialists even if there are funny elbow conditions (I hope the point is clear enough even though that is a crappy example).

But... I'm not even sure on what neurologists actually treat. Epilepsy? Sleep disorders (not sure on that one)? Is there a neurology equivalent of the DSM or is there a neurology section of the ICD? (Ignore me if you think I'm deviating from the topic)

But then... If one shouldn't worry about neurological encroachment then maybe one should worry that the difficulty we are having in identifying relevant genes (for example) or neurological differences is a function of their not really having that kind of substrate rather than just a problem of waiting for neurological advancement. If there is a problem in principle (e.g., if looking for neurological abnormality for mental disorder is like looking for hardware abnormality when software goes buggy) then... How is psychiatry's status as a branch within medicine justified????? Maybe the encroachment will be from psychology...

Is it just that psychiatrists prescribe medication (and are appropriately qualified to do so)?

If the most effective interventions turned out to be sociological (e.g., restricting people from modelling when they are underweight in order to reduce the prevalence of eating disorders) then would psychiatry deal in sociological intervention or would eating disorders be properly regarded as non-psychiatric? If the most effective interventions turned out to be psychological (e.g., teaching mindfulness meditation for people with OCD) then would psychiatry deal in psychological intervention or would OCD be properly regarded as non-psychiatric?

There are interesting issues for 'what is supposed to be distinctive of medicine anyway???' If it is just the most effective treatment then I guess psychiatry will adapt... If it is psychosurgery and medication then if other interventions prove to be more effective disorders might have to be taken away from psychiatry. One could make empirical bets, I suppose... But empirical bets they are...

Thread's happened before but with each new year, there's a new generation that must go through similar if not the same things.

toby jones said:

One could assume that the nurse was just being mean...
Or one could wonder why many people (and not just that particular nurse) have been similarly led to express concern about psychiatry's status within medicine (and why it is considered to be 'down the totem pole').

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Sure, of course what you are saying is right, it's just that when a person I don't know very well (like I'm assuming is the case for the OP and the nurse) manages to incorporate a phrase like "totem pole" into an informal discussion about my career interests, I pretty much assume that what they're getting at is status. I can't tell you how many times in my mere three months of 3rd year rotations that various interns, residents and other staff have made comments to me about things like salary, lifestyle, and other status or happiness-related issues in relation to which specialty I plan on choosing. This always blows me away. It's so crass! And the crassness reveals that this is not an invitation to deep, meaningful discussion! It's also weird that a PSYCH NURSE would say such a thing. Anyway, it seems like the OP's concern is not about the ACTUAL validity of psychiatry as a form of medicine, but about other doctors' (and nurses') opinions of psychiatrists. That's all I was responding to. I wouldn't want that kind of petty judgmentalism to influence MY choice of a career... However, I do understand your point and it's well taken.

I guess all I'm saying is, if a totem pole is your yardstick, what is it exactly that you must be measuring?

At most medical centers, the psychiatry department actually sits at the top of the totem pole in terms of the almighty (grant) dollar. All of the millions of dollars being spent by the NIMH (that's the National Institute of MENTAL Health), which funds all of the really interesting neuroscience research on things like memory and emotion, is ultimately being spent for the benefit of psychiatric patients. Consider, also, that 2 additional Institutes in the NIH, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, are also devoted to mental health. So, as far as your tax dollars are concerned, psychiatry is very important.

You have to ask yourself what it really means to be a physician. The holistic answer is that a physician is someone who improves the well-being of others through a combination of scientific understanding and caring. In this view, psychiatrists are no less physicians than any other specialty (even though we don't always understand the basic mechanisms, we do apply the scientific method in clinical trials). If you want to define being a physician simply in terms of who saves the most lives, psychiatrists save quite a few; in case you forgot, suicide is a very common way to die, especially if you are young and have your whole life ahead of you. Also, addiction to nicotine and alcohol, which are psychiatric illnesses, are among the most common preventable causes of death in the world. Of course, we don't always remember how to use our stethoscopes, but some piece or rubber hanging around your neck doesn't define a physician.

1) there will always be people who judge other people by labels and status. It doesn't matter if you're in medicine, athletics, or appliance sales. Someone will always make a big deal over whether you went to Humble State U vs. The College of Prestigious Snobbery. Someone will always care that they paid $50K for German engineering while you're inexplicably satisfied driving a reliable $20K vehicle. Maybe the nurse was just testing you to find out if you were the kind of person who would like hanging around the base of the totem pole with the rest of us.

2) What is a "real doctor"?
Is it cutting people open? Then there are a LOT of non-psychiatric MDs who don't qualify as "real" doctors?
Is it using a lab test or image instead of a clinical presentation to diagnose? I guess neurologists don't "really" diagnose migraines then, and rheumatologists have no context for their fancy ANAs and FANAs.
Is it about curing disease and saving lives? Then say goodbye to the geriatricians, pathologists, and radiation oncologists--because they're sure as heck not doing much "real doctoring".
Meanwhile, I know more neuroanatomy than most orthopods, and more pharmacology than most internists--but I don't think they're not "real" doctors. Every branch of medicine looks weird and crazy to the folks in some other branch--the surgeons mock the internists for their cerebral attention to detail, the internists are baffled by the orthopods' disregard for lab values, everybody wonders what those radiologists are doing in the dark, and we're sure the pathologists are looking at everyone as a source of tissue specimens. Get over it. We need each other.

I'm tempted to quote a bit of the New Testament here--the Apostle Paul wasn't writing to doctors in the letter to the Corinthians, but there might be a drop of wisdom from him for us. Maybe this is relevant:
" 14Now the body is not made up of one part but of many. 15If the foot should say, "Because I am not a hand, I do not belong to the body," it would not for that reason cease to be part of the body. 16And if the ear should say, "Because I am not an eye, I do not belong to the body," it would not for that reason cease to be part of the body. 17If the whole body were an eye, where would the sense of hearing be? If the whole body were an ear, where would the sense of smell be? 18But in fact God has arranged the parts in the body, every one of them, just as he wanted them to be. 19If they were all one part, where would the body be? 20As it is, there are many parts, but one body. 21The eye cannot say to the hand, "I don't need you!" And the head cannot say to the feet, "I don't need you!" 22On the contrary, those parts of the body that seem to be weaker are indispensable, 23and the parts that we think are less honorable we treat with special honor. And the parts that are unpresentable are treated with special modesty, 24while our presentable parts need no special treatment. But God has combined the members of the body and has given greater honor to the parts that lacked it, 25so that there should be no division in the body, but that its parts should have equal concern for each other. 26If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it." (First Corinthians, Chapter 12).
As they say in AA, "Take what you can use and leave the rest".

This thread is interesting. As a fourth year med student applying to psych, I've certainly encountered a lot of these same biases and stereotypes that psychiatry is not "real" medicine. For most of my medical school career, I planned to pursue a surgical subspecialty. When people asked what my plans were and I responded "ENT," I inevitably got positive feedback, whether from peers, residents, or attendings. Once I (THANKFULLY!!) realized that psych was my true calling, however, I've found a much less enthusiastic response. For example, when I told an ED preceptor that I'm applying for psych his response was "you have such good history and physical exam skills, why waste them in psychiatry?" (Yeah, apparently good history skills are irrelevant to psychiatrists it's not like we ever talk to our patients ). When I told him I was originally considering ENT, however, he regaled with stories of great ENT docs he knew and went on (and on and on) about how great a field it is. This was probably the most egregious example of encountering this stereotype, but it's happened multiple times since I decided on psych. I appreciate that there tends to be a lot of inter-specialty bashing but I think psychiatry gets it the worst. I've tried to figure out why this is and I think, in part, a lot of it has to do with the patients. From my experience, nonpsychiatrists, in general, have a lot of disdain for psych patients because they're not your run of the mill "easy" patients. It's harder to relate to a 38 year old floridly psychotic person than it is to relate to a 38 year old person suffering a bout of appendicitis. Psych patients, in general, certainly aren't your "glamor" patients. I could go on rambling, but I think I'll stop because I'm really tired.

There is more than one totem pole.

In terms of income, we are in the bottom third (though some are in the top third).

In terms of board scores, we as a group are apparently at the bottom (though obviously some of us are at the top).

In terms of scrub-wearing, epithet-throwing, NCAA-basketball-pool-completing gym rats, we scrape the ground (though some of us certainly swing from trees).

In terms of ability to use a stethoscope, we're probably in the ground ( at least after a few years away from residency).

In terms of ability to read a novel, many of us are at the top (though some of us isn't).

In terms of medical school clout, we may be near the top (b/o grants) and departmental size but range all over in terms of donations and administrative involvement (ie, when one o your faculty is a senior member of a committee, thank him or her since visibility and clout are keys to keeping psychiatry from being marginalized).

And when the ENT or ER doc becomes depressed, or her husband becomes manic, or her child gets adhd or--God forbid--autism, we are off the top of the totem pole (and when that happens, it would be good for you to know your stuff, be appropriately humble, do a good job, and be patient with the swirl of idealizations and deidealizations that are sure to come your way, particularly since there is a lot we don't know how to fix).

And in terms of intellectual rigor, scientific accomplishment, clinical care, and efforts to help people, that totem pole is up to you.

Oh, and one of the nice things about residency and later life is that you get to hang out with a whole bunch of other psychiatrists who won't reflexively place you on a totem pole because of your specialty and won't necessarily think you're weird or dumb. Unless of course you are, but then, that's what therapy is for...

What CEG said, but also, when you take care of the most stigmatized patients in the hospital, some of that stigma rubs off on you. And most things I hear about psychiatry pre-1980, well, let's just say I don't think the history of ENT is quite as sordid.

House is a great show because the team constantly A) attempts to parse complex pathology, B) considers psychosocial contributions to illness, C) and refuses to accept massive uncertainty. There's no specialty called "diagnostic medicine," but there is psychiatry, which gets A+ grades on A) and B), but we accept massive uncertainty that the rest of our colleagues refuse to accept. It's much easier to think poorly of another specialty that does something of which you can't even imagine the value.

Throw in our excellent work hours, which other specialties view as a weakness. As much as I love psychiatry, I imagine that doing psychiatry for 55 hours a week would be approximately as exhausting as standing in an OR for 80 hours a week, in a completely different way. But tell that to a surgeon, and she'll probably spit in your face. Because, you know, they do that stuff

As for that psych nurse, have you met anyone in a hospital that didn't have fully formed, mostly irrational opinions about something? All people have soapboxes they like to jump on, and you gave that nurse an opportunity to hop on hers. Why is hers so apparently self-loathing? I dunno, get back to me when we're getting our dynamic training in a few years

MrBurns10 said:

It also doesn't help that I go to a school where it seems like everyone and their brother wants to become a surgeon and it's fairly uncommon to go into psych, so I wonder how my classmates perceive the profession. Just out of curiosity, have you all gotten the same vibes from any of your classmates that it's an inferior field?

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I had the experience of having residents & attendings on ObGyn, Peds, and surgical subspecialties make positive remarks (often in front of the team) about psychiatry. It generally stemmed from positive experiences they'd had with C/L psych. I even had the bizarre experience of having a gyn-onc attending (who was dreaded throughout the hospital for her treatment of residents and med students) request me in surgeries so she could discuss her "interesting" observations about her patient's defense mechanisms in the face of illness. She was not throwing instruments and seemed to actually have a sense of humor, so the ObGyn residents were nice to me that rotation.

i was never shy about saying i wanted to pursue psych once i finally figured it out. i actually had an orthopedic spine surgeon from columbia say he almost went into psych, and if i wasnt scrubbed in i would have smacked him and said "GET OUT!" thats not something you hear every day (how to you choose between psych and ortho anyway? they are so different!)
you could say bad things about any specialty. i personally would poke my eyes out if i had to do IM for the rest of my life. from what i've seen all they do is call other doctors to take care of their patients and they just organize all the info (i know this is a poor generalization and i mean no disrespect to IM docs, but you see my point, you can make any field sound bad)
i really feel that no other field of medicine has the potential for growth like psychiatry. the research out there is booming. we still have no clue about 95% of what goes on in the brain. and who knows if we will figure out anything new in our lifetime. but the potential is there. that alone is exciting to me.
and i feel that no other field can impact a patient's life like psychiatry. people always come at me saying, "but no one ever gets better in psych". that is so not true! people dont recover from diabetes or htn. it just gets controlled. its all about perspective, and how you measure progress. if you can get your schizophrenic pt to stop telling you he's hearing voices, he gets to go home to his family. i think thats a pretty big deal.
maybe the nurse was just bitter, because from a nurse standpoint psych is pretty low on their "totem pole" also (from what i hear at least).
people always have something to say.

toby jones said:

Hence the thought that neurology will eventually take over, I guess...

....Looking for a hardware fault when microsoft word goes buggy on you...

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Hardware-software metaphor sounds to me like cognitive dualism. Rather than computer metaphors i prefer the brain "metaphor". So there is no software hosted within our brains and the way the information is encoded is through subtle neuroadaptations. I´m not saying you´re wrong about that maybe there´s no "hardware" fault in schizophrenia, in the sense of gross brain damage as seen in neurological conditions. Also, we wont find the gene of delusions, because most, if not all psychiatric disorders, are polygenic in nature and rely heavily on early brain development and early experiences. So psychiatry is all about "subtle" changes in brain functioning that lead to complex phenotypes.
Neurology won´t take over because Psychiatry is a different kind of clinical neuroscience.

MrBurns10 said:

It also doesn't help that I go to a school where it seems like everyone and their brother wants to become a surgeon and it's fairly uncommon to go into psych, so I wonder how my classmates perceive the profession. Just out of curiosity, have you all gotten the same vibes from any of your classmates that it's an inferior field?

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One classmate of mine whom I otherwise really like is forever talking about how much she hated her psych rotation, because of what it required of her. There's quite a bit of this at my school, I think. I would say most of my classmates aren't really "people" person type of folks. It gets frustrating to hear them constantly bash any occupation in which good communication skills are required.

If it's any consolation, I'm originally from a small town in the Midwest, where people look down on psychiatry for a whole different set of reasons. They think it is too highfalutin. (That's a quote.) A lot of people are of the mind that "talking" and "thinking" are way inferior to being out in the world "working" (i.e. fixing boats or selling insurance or growing corn.) Just by spending all these years wasting away in an institution (ie med school), I know I could never get true respect again in my hometown. But then if I have to say I became a psychiatrist, that will just be the end.

That's something I really do worry about.

nancysinatra said:

If it's any consolation, I'm originally from a small town in the Midwest, where people look down on psychiatry for a whole different set of reasons. They think it is too highfalutin. (That's a quote.) A lot of people are of the mind that "talking" and "thinking" are way inferior to being out in the world "working" (i.e. fixing boats or selling insurance or growing corn.) Just by spending all these years wasting away in an institution (ie med school), I know I could never get true respect again in my hometown. But then if I have to say I became a psychiatrist, that will just be the end.

That's something I really do worry about.

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I have a bunch of relatives in small towns in the midwest--they were initially wary about my becoming a psychiatrist, and I could tell they thought it was weird. I now live in a big city, am an analyst, etc. (ie, weird on multiple fronts--though I do basically look like them, and I don't wear all black at the drive in). Anyway, while some probably still think it's weird, a couple of decades have gone be, and not only did they lay down their view of me a long time ago (in that way, it's like someone coming out o fthe closet; the most hardboiled anti-gay crusader will make allowances if it's their old high school buddy), they have weathered life and either they or their first degree relatives have alcohol or crystal meth problems or depression or dementia. When you help someone out with such things, you not only get instant access to a part of them that wouldn't otherwise be available, you earn their trust and respect, and they can see that your work is as useful as the guy who grows corn). True story: was hanging out with construction guys (I barely own a hammer). One said, "drywall screws changed my life." I waited and then privately told a guy with big biceps and a baseball cap, "I feel a bit lame since I don't even know what a drywall screw is." His response was a smack on the back and, "I hope you're kidding--there's plenty of stuff you know that we don't. The only thing that bothers me about you is that you are a Giants fan." In other words, it'll work out as long as long as you want it to (and it sounds like you do).

I tend to agree with OPD. No matter where you go or what you do there is always going to a "rat race" aspect. People who love to talk about how much better their specialty/school/income/house blah blah blah. If that sort of thing gets to you then I might keep that in mind when choosing a specialty. However, in the end YOU have to happy with what you choose.

I personally have recently decided on psych. I was considering another specialty that is highly compensated (radiology). But I finally opted for what feels right to me and for my family. I can't pick something because everyone keeps telling me I'll "make so much money", "its the bomb". Or "people will roll their eyes at you" if you do psych or "you aren't wierd enough" to be a psychiatrist. I just finally said ENOUGH to other peoples opinions (because everybody has one) and asked myself what I wanted.

Also, think about how you feel when you think about doing X specialty. If you feel good, peaceful, happy when you think about psych then do it. If you feel stressed, anxious, like something isn't right then try to figure out what that is about...maybe it isn't for you.

And forget about that nurse. Not to disrespect, I am an RN after all, now a third year med student, but she obviously has an agenda/bias/grudge...something. Whenever someone says something like that I try to figure out why. It has more to do with her than you.

OldPsychDoc said:

1) there will always be people who judge other people by labels and status. It doesn't matter if you're in medicine, athletics, or appliance sales. Someone will always make a big deal over whether you went to Humble State U vs. The College of Prestigious Snobbery. Someone will always care that they paid $50K for German engineering while you're inexplicably satisfied driving a reliable $20K vehicle. Maybe the nurse was just testing you to find out if you were the kind of person who would like hanging around the base of the totem pole with the rest of us.

2) What is a "real doctor"?
Is it cutting people open? Then there are a LOT of non-psychiatric MDs who don't qualify as "real" doctors?
Is it using a lab test or image instead of a clinical presentation to diagnose? I guess neurologists don't "really" diagnose migraines then, and rheumatologists have no context for their fancy ANAs and FANAs.
Is it about curing disease and saving lives? Then say goodbye to the geriatricians, pathologists, and radiation oncologists--because they're sure as heck not doing much "real doctoring".
Meanwhile, I know more neuroanatomy than most orthopods, and more pharmacology than most internists--but I don't think they're not "real" doctors. Every branch of medicine looks weird and crazy to the folks in some other branch--the surgeons mock the internists for their cerebral attention to detail, the internists are baffled by the orthopods' disregard for lab values, everybody wonders what those radiologists are doing in the dark, and we're sure the pathologists are looking at everyone as a source of tissue specimens. Get over it. We need each other.

I'm tempted to quote a bit of the New Testament here--the Apostle Paul wasn't writing to doctors in the letter to the Corinthians, but there might be a drop of wisdom from him for us. Maybe this is relevant:
" 14Now the body is not made up of one part but of many. 15If the foot should say, "Because I am not a hand, I do not belong to the body," it would not for that reason cease to be part of the body. 16And if the ear should say, "Because I am not an eye, I do not belong to the body," it would not for that reason cease to be part of the body. 17If the whole body were an eye, where would the sense of hearing be? If the whole body were an ear, where would the sense of smell be? 18But in fact God has arranged the parts in the body, every one of them, just as he wanted them to be. 19If they were all one part, where would the body be? 20As it is, there are many parts, but one body. 21The eye cannot say to the hand, "I don't need you!" And the head cannot say to the feet, "I don't need you!" 22On the contrary, those parts of the body that seem to be weaker are indispensable, 23and the parts that we think are less honorable we treat with special honor. And the parts that are unpresentable are treated with special modesty, 24while our presentable parts need no special treatment. But God has combined the members of the body and has given greater honor to the parts that lacked it, 25so that there should be no division in the body, but that its parts should have equal concern for each other. 26If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it." (First Corinthians, Chapter 12).
As they say in AA, "Take what you can use and leave the rest".

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!!!!!!!!!

beezley said:

I just finally said ENOUGH to other peoples opinions (because everybody has one) and asked myself what I wanted.

Also, think about how you feel when you think about doing X specialty. If you feel good, peaceful, happy when you think about psych then do it. If you feel stressed, anxious, like something isn't right then try to figure out what that is about...maybe it isn't for you.

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From Scrubs:

Molly: Anyway, this morning Dr. Kelso told me that since psychiatrists are the Wal-Mart greeters of medicine --

Dr. Cox snickers his agreement.

Molly: -- that I need to start publishing a paper to earn my keep. So I'm gonna do this study about conflict resolution between hospital personnel, and I was wondering if I could observe you?

Dr. Cox: Look, "Doctor," us real doctors are here to work, so there's not a whole lot of conflict. Now, my day is already bad enough on account of I gotta tell Mr. Roman that he--

He flips through the chart.

Dr. Cox: That.... Oh, my God. Mr. Roman doesn't need to have surgery. I ne-hever get to give good news!

Molly: Subject elongates words when excited!

Kluver Bucy said:

From Scrubs:

Molly: Anyway, this morning Dr. Kelso told me that since psychiatrists are the Wal-Mart greeters of medicine --

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Apropos--especially as the recent thread on consult-liason psychiatry amply demonstrated that many of our colleagues in other disciplines seem unable or unwilling to fetch their own damn carts!

Hey, what did you guys think of Molly on Scrubs? I kind of thought she didn't really do a great service for the image of psychiatrists...

solumanculver said:

Hey, what did you guys think of Molly on Scrubs? I kind of thought she didn't really do a great service for the image of psychiatrists...

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Who cares?
She was HOT!

Ya think?

solumanculver said:

Hey, what did you guys think of Molly on Scrubs? I kind of thought she didn't really do a great service for the image of psychiatrists...

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And JD is a good image for medicine?...and The Todd for surgery???

Chimed said:

And JD is a good image for medicine?...and The Todd for surgery???

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Anyone that promotes the use of 'banana hammocks' is NOT a good image!!

-t

Chimed said:

And JD is a good image for medicine?...and The Todd for surgery???

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Good point... but at least JD treats patients and The Todd does surgeries. All Molly did was write a report on conflict resolution in the workplace... or whatever it was. She could have at least prescribed some anti-psychotics to a schizophrenic, or done some consultation/liason or something. I mean do you guys write reports on conflict resolution in the workplace?

solumanculver said:

Good point... but at least JD treats patients and The Todd does surgeries. All Molly did was write a report on conflict resolution in the workplace... or whatever it was. She could have at least prescribed some anti-psychotics to a schizophrenic, or done some consultation/liason or something. I mean do you guys write reports on conflict resolution in the workplace?

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This brings up an interesting point about the use of psychiatry as a dramatic (or comedic) device. It seems that psychiatrists are often there not to tell you something about psychiatrists, but rather to reflect upon the other characters. They usually show up to "analyze" other characters, report about conflict resolution in the workplace (presumably Molly's subjects were the characters of Scrubs), or some such thing. This was the function of the psychiatrists in MASH, if I recall.

strangeglove said:

It seems that psychiatrists are often there not to tell you something about psychiatrists, but rather to reflect upon the other characters.

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Where were you when I needed an undergrad thesis topic?

solumanculver said:

I mean do you guys write reports on conflict resolution in the workplace?

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Heh...

No.

billypilgrim37 said:

Where were you when I needed an undergrad thesis topic?

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Watching TV.

strangeglove said:

This brings up an interesting point about the use of psychiatry as a dramatic (or comedic) device. It seems that psychiatrists are often there not to tell you something about psychiatrists, but rather to reflect upon the other characters. They usually show up to "analyze" other characters, report about conflict resolution in the workplace (presumably Molly's subjects were the characters of Scrubs), or some such thing. This was the function of the psychiatrists in MASH, if I recall.

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It's been said that if psychiatrists didn't exist, Hollywood would have invented them.

Now back to Molly Clock acting ditzy and discrediting the profession:

Janitor: Um. We should be friends.
Molly: Okay.
Janitor: Do you like vanning?
Molly: I don't know what that is.
Janitor: It's kind of my thing. It's like taking a long drive in a car, only uh... it's in a van.
Molly: I'm still not getting it.
Janitor: Could you hang on for one sec?... (To JD) She's an idiot.

solumanculver said:

I mean do you guys write reports on conflict resolution in the workplace?

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Yup. Will be published next month.

I did not read the entire thread but read a bunch and put my .02 spin on things. I personally never cared about the whole totum pole issue. I have had nothing but respect from every service, especially all the surgery services when they need my help. What they say behind our backs I am sure is the same ole stuff as we make fun of them

However when they need a consult and I come help them out they are appreciative and really respect us because often it is after they donot know what else to do for the patient.

On another note I personally LOVE medicine and diagnosing various cool things. What I do not like is the boring long medicine life of seeing HTN and DM etc. I am more the type who wants a job like House where I only see cool stuff and to me psych offers you a bit of that as well. A good psychiatrist will delve into the medical issues of your patient as well. More so on an inpatient basis, especially as residents since our attendings could usually care less. Every patient I get-I investigage medical issues to a degree.

A few cool examples this year were

1. Caught a pheo in a 16 y/o kid who has gone with HTN for the past year or so without ever having been worked up by his primary care, pscy or the ED where he had been 2 times this year. The kid had some flat T waves that the ED said were nothing due to age, a bp of 160s/90/s which is not crazy high so they said do not worry about it but to me seemed suspect. Admitted the kid and after seeing the T waves suspected low K-sure enough 2.9 pottasium-which even made me more suspcious of pheo with all those catecholamines pushing K into cell-ordered the urine mets and ct diagnosed the pheo.

2. Liver transplant guy with new onset psychosis at 55 after the transplant-admitted to psych 3 times this year since the transplant and loaded up on anti-psychotics and he was still psychotic. Came to my service and looked through his labs, the last three psych visits and the last 6 months of follow up labs from the transplant team did not include ONE single ammonia level. Checked a level and 140-treated him, and his psychosis resolved and he was fine. Taking 3 minutes to do some research was all it took that the last 3 times he was here nobody did nor did the transplant team-sad

3. Although this is in our realm-person with lewy body dementia has been treated for the last year with anti-psychotics with no suspicious of LBD-rather people thought she was psychotic and confused from her mania which they thought got worse to create psychosis. 63 years old. She came to me-read all her outpatient stuff-not even a clue of any thought of this. She had been hospitilized 4 times in psych in the last year for pyschosis and every time upped on the D2 blockers. Well came to me-same story. Gave her 10 abilify and she turned into a Board stiff-could not move. Was incontinent at various times and had a magnetic gate she didnt have 3 weeks ago. MRed to r/o NPH and after that r/o settled on LBD-put her on CEI drugs and 4 days later psychosis gone and she was perfectly normal with no D2 drugs.

The sad thing was this is how she presented numerous times this year and nobody did this.

All I am saying is you can earn respect of other fields by being a good doctor. Does not matter what you technically are-you are a doctor and can do the job of any speciality except operating on someone. If you care about respect and rank on a totum pole-you can earn your place at the top.

If you do not care like myself than you can just be a good doctor for fun and the help of your patients.

Psychiatry is the best field!