Can't decide on psychiatry

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Mezo

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Hi everyone,

I'm a fresh graduate who is interested in psychiatry but I'm facing some troubles in taking the right decision. I'm also interested in radiology as well, with a little interest in IM as well but I can't decide. I like psychiatry because it is interesting, rewarding, intellectually challenging and the hours are great. There are a few things holding me back from choosing psychiatry, I know they might sound silly for some. I'm asking this because I'm sure there are others who had the same concerns i have..

I did an attachment for about 2 months in a private psychiatry facility, I really thought that 4 weeks was enough for me to decide but still after 2 months, I can't!

-personality. I'm shy, anxious and generally indecisive. I'm fairly normal in everyday normal life but "internally" I'm anxious. A senior college has picked up this anxiety once and told me "you should work on yourself" because patients are going o pick that up too, he said!

- I feel distressed around violent/potentially violent patients, specially addicts (am I too timid for psychiatry?). I'm also a bit naive, and sometimes patients can manipulate me without me noticing that they are making up stories, etc.

-I know this is bad, but sometimes I felt repulsion/abhorrence towards some patients (it is rare), we are not supposed to judge anyone as doctors but this was stronger than me. I don't know how do you guys cope with this feeling (dealing with really "evil" patients without judging them as "evil" but in the same time paying attention to their "evilness"!)

-Legalities just scare me! Having to testify, carers trying get rid of their relatives. An example a college told me was a psychiatrist who was treating an addict who was a homosexual! The patient "wanted" the doctor and threatened he will accuse him of abuse if he didn't ... with him. Hearing such stories really raises the question: and why bother with all of this?

Sorry for the long post!
 
Mezo said:
Hi everyone,

I'm a fresh graduate who is interested in psychiatry but I'm facing some troubles in taking the right decision. I'm also interested in radiology as well, with a little interest in IM as well but I can't decide. I like psychiatry because it is interesting, rewarding, intellectually challenging and the hours are great. There are a few things holding me back from choosing psychiatry, I know they might sound silly for some. I'm asking this because I'm sure there are others who had the same concerns i have..

I did an attachment for about 2 months in a private psychiatry facility, I really thought that 4 weeks was enough for me to decide but still after 2 months, I can't!

-personality. I'm shy, anxious and generally indecisive. I'm fairly normal in everyday normal life but "internally" I'm anxious. A senior college has picked up this anxiety once and told me "you should work on yourself" because patients are going o pick that up too, he said!

- I feel distressed around violent/potentially violent patients, specially addicts (am I too timid for psychiatry?). I'm also a bit naive, and sometimes patients can manipulate me without me noticing that they are making up stories, etc.

-I know this is bad, but sometimes I felt repulsion/abhorrence towards some patients (it is rare), we are not supposed to judge anyone as doctors but this was stronger than me. I don't know how do you guys cope with this feeling (dealing with really "evil" patients without judging them as "evil" but in the same time paying attention to their "evilness"!)

-Legalities just scare me! Having to testify, carers trying get rid of their relatives. An example a college told me was a psychiatrist who was treating an addict who was a homosexual! The patient "wanted" the doctor and threatened he will accuse him of abuse if he didn't ... with him. Hearing such stories really raises the question: and why bother with all of this?

Sorry for the long post!
Click to expand...

so I am a little confused...if you are a "fresh graduate", what residency are you in now?
 
I'm not. In Egypt, we have to spend sometime working as GPs in rural health units (between 6 months- 1 year) then you apply for residencies. People with the highest grades (about 1/10th of the class) get residency posts at university hospitals immediately.
 
Legitimate concerns which I believe can be addressed with 4 years of Psychiatry training if you're up for the challenge. I believe the core training in Psychiatry is being able to work with the mentally ill, and in doing so furthering your own growth and development. Your diagnostic skills and expertise in pharmacology, IMO, is 20% and the other 80% is "procedural" or working with the patient.
 
Mezo said:
I'm not. In Egypt, we have to spend sometime working as GPs in rural health units (between 6 months- 1 year) then you apply for residencies. People with the highest grades (about 1/10th of the class) get residency posts at university hospitals immediately.
Click to expand...

well...you're not going to get a radiology spot here, so if that was the choice(between rads and psych), maybe that would make things easier?
 
vistaril said:
well...you're not going to get a radiology spot here, so if that was the choice(between rads and psych), maybe that would make things easier?
Click to expand...

By "here", you mean the U.S.? I'm not really planning on coming to the U.S. but I understand what you mean. (I'm considering the UK, I know, sounds crazy!).

I'm actually trying to neutralize all other factors and find out what I really like/want to do. If I calculated it with regards to competitiveness and chances I would go for Family medicine or IM in the US or psychiatry or IM in the UK. I totally understand these concerns.

If I find that my passion is and I'm more suitable for radiology, but I'll have to stay at home, I will. The problem is: I really don't know.

The third option is to go for IM as it is less competitive and I can tolerate it. (last resort)
 
F0nzie said:
Legitimate concerns which I believe can be addressed with 4 years of Psychiatry training if you're up for the challenge. I believe the core training in Psychiatry is being able to work with the mentally ill, and in doing so furthering your own growth and development. Your diagnostic skills and expertise in pharmacology, IMO, is 20% and the other 80% is "procedural" or working with the patient.
Click to expand...

Thanks for you comment and support. I didn't really think most of these concerns was normal.
 
I think your concerns are very common and, more importantly, you have identified them as concerns, which to me suggests that you possess the right kind of insight and introspection psychiatry requires.

You will get more comfortable with addicts with more practice. Same for the violent types. I'd make sure to train at a place with good security and good procedures in place to keep you safe. But, in reality, psych patients are safer than IM (esp. Geriatrics) and ED patients.

Shyness can also be overcome. Again, practice. Once you learn more of the "script", you'll be much more confident with a basic psych interview.

The core issue here is: Do you want to work with patients or not?
 
Mezo said:
By "here", you mean the U.S.? I'm not really planning on coming to the U.S. but I understand what you mean. (I'm considering the UK, I know, sounds crazy!).

I'm actually trying to neutralize all other factors and find out what I really like/want to do. If I calculated it with regards to competitiveness and chances I would go for Family medicine or IM in the US or psychiatry or IM in the UK. I totally understand these concerns.

If I find that my passion is and I'm more suitable for radiology, but I'll have to stay at home, I will. The problem is: I really don't know.

The third option is to go for IM as it is less competitive and I can tolerate it. (last resort)
Click to expand...

There aren't residencies in the UK, postgraduate training is more complex. You won't get into radiology it is very competitive and generally people have done medicine or surgery first. Likewise for core medical training, there are generally enough people it would be difficult if you are not from the EU. There is no family medicine, there is general practice, which is, again competitive, and you would not get it. You would also first have to complete foundation training and there are limited jobs for people outwith Europe.

Most people in psychiatric training in the UK are foreign, but increasingly from European countries.
 
My take:

Personality/timidity: will come with practice. You gain confidence and skill as you see more patients, just like with any other specialty. If you love the work and are willing to put real effort into improving I don't think this will be an obstacle.

Repulsed by "evil" patients: sometimes this is an appropriate response. Many antisocial patients do genuinely terrible stuff, you don't have to pretend to get all gooey-eyed and sympathetic when it just isn't called for. Recognize your own emotional response, confront it, process it, and maintain as professional and non-judgmental of an outward stance as possible.

Blackmail lawsuits: probably a real rarity, and if it happens then just tell the individual to bring the suit. I doubt they will. If they do, I doubt they will win. Again, conduct yourself with professional integrity. Caving to a demand like that would cost you not only your integrity but most likely your license (and by the way, psychiatrists don't have a monopoly on being blackmailed or named in frivolous lawsuits!).

Good luck, choose what you would most like to do each day whatever that specialty may be!
 
Thanks you so much for your replies 🙂.

digitlnoize: That was helpful, thanks a lot. Yes, I don't mind working with patients.

splik: Thanks for replying. Actually that wasn't the main question in my post. I'm totally aware of how difficult the situation is in the UK. I know that people do CMT or CST and membership exams before going to radio and I know about foundation. I'm just neutralizing and trying to figure what I want and if I'm "competent" for psychiatry.

There is a chance that I couldn't go to the UK, in this case I'm staying in Egypt, where both specialties would be available to me.
 
Wow to get into rads in UK you have to complete an entire training in another specialty?! How long does that take? seems unnecessarily arduous. And general practice is competitive there?! Interesting.
 
toothless rufus said:
Wow to get into rads in UK you have to complete an entire training in another specialty?! How long does that take? seems unnecessarily arduous. And general practice is competitive there?! Interesting.
Click to expand...

general practice has much shorter training, is generally well paid, in fact you have the potential to make much more than many other specialties if you are business savvy, and the hours are better, so it became very competitive. There is a geographic element to it as you might expects.

You don't HAVE to have completed internal medicine or surgical training to get into rads, but it helps. There is something like 11 applicants for radiology training post and you are more respected if you have significant clinical experience as a radiologist. I think there is also a trend for people to start out in medicine and surgery and prefer the lifestyle for radiology (i.e. taking call from home etc). Also most medical students don't realize that radiology can be quite lucrative until some years later and then defect...

Psych on the other hand is the least competitive specialty, many unfilled posts. There isn't actually a shortage of applicants, there are about 4 applicants per training post, but many of them are applying as a back up, and many are so bad (e.g. can barely speak English) that they would rather have no one than those people.
 
That is correct. You don't have to, but to be up to the competition, most people do 2 years of core medical/surgical training and finish MRCP/S.
 
splik said:
There aren't residencies in the UK, postgraduate training is more complex. You won't get into radiology it is very competitive and generally people have done medicine or surgery first. Likewise for core medical training, there are generally enough people it would be difficult if you are not from the EU. There is no family medicine, there is general practice, which is, again competitive, and you would not get it. You would also first have to complete foundation training and there are limited jobs for people outwith Europe.

Most people in psychiatric training in the UK are foreign, but increasingly from European countries.
Click to expand...

So how exactly does this work without residencies? At some level there must be residents, right? I guess they're called registrars?

Even if general practice pays well, I'm surprised that people are that interested in doing it. It's not the most... stimulating field, and the hours and lifestyle can't be too much better than psychiatry, right?

Edit: Ha, radiologists are more respected if they have also been boarded in medicine or surgery? I imagine so, but that "respect" is coming at a pretty high price with no actual difference in outcomes
 
Last edited:
aphenomenon said:
Though I'm not sure about this...
Click to expand...

Yeah, this scenario seems pretty ridiculous and apparently has nothing to do with psychiatry or homosexuality... Like: what if a patient is attracted to you? Indeed, what if...?
 
Enkidu said:
So how exactly does this work without residencies? At some level there must be residents, right? I guess they're called registrars?

Even if general practice pays well, I'm surprised that people are that interested in doing it. It's not the most... stimulating field, and the hours and lifestyle can't be too much better than psychiatry, right?

Edit: Ha, radiologists are more respected if they have also been boarded in medicine or surgery? I imagine so, but that "respect" is coming at a pretty high price with no actual difference in outcomes
Click to expand...

I don't really know. Maybe because GPs don't have ward work to do, and the training years are shorter.

Yeah, this scenario seems pretty ridiculous and apparently has nothing to do with psychiatry or homosexuality... Like: what if a patient is attracted to you? Indeed, what if...?
Click to expand...

I agree it can happen in other specialties. It is the most recent example that came to my mind (this dr left this job cuz he was too worried, so it was one of those bad stories). What I meant was that psych exposes you "more" to these types of problems/patients. Of course, patients in other specialties could blackmail a doctor by threatening of charging abuse but I guess psychopaths or addicts for example would be more likely to do it.
I guess it needs a good knowledge of the legal system and good practice.

Thanks a lot for your replies. I would be happy if more people could give their opinion on this.
 
Enkidu said:
So how exactly does this work without residencies? At some level there must be residents, right? I guess they're called registrars?
Click to expand...

There are various jobs or "posts" which can be training or non-training. training posts are more competitive than specialty doctor jobs which are mostly not competitive and dead-end. Residency to me means a stream-lined process where you apply once and at the end of it you are trained in whatever. There isn't something like that in the UK - you have to apply multiple times for various levels of training with no guarantee you will progress. It is the norm for people to take time to travel, to work overseas, to do MDs (a research degree by thesis), PhDs, or masters' degrees and thus interrupt their training or working in the UK, which is not typical of say US residency training. Any of those aspects would be incorporated, rather than something separate. In general, UK postgraduate training, despite efforts of reform, is longer, and less structured than in the rest of the world. Compared to the US it is in general more service-driven, with training as a secondary concern.

For example, in the UK it takes a *minimum* of 8 years after graduating from medical school to become a consultant psychiatrist, there is no guarantee once you have finished training, and most people take longer, indeed, half of those who train in psychiatry never become consultant psychiatrist (equivalent to a senior attending in the US but with more of a management role and less of a patient contact role).
 
That is true. In some cases as in radiology and other specialties there is "run through" training which is 5 years of residency but these are very competitive. The majority have to apply multiple times (called uncoupled training) first to core training then to higher training. Yes, I agree it makes the training longer in the UK, e.g. to finish and get a CCT in pediatrics you need about 8 years of training.

In your comparison you said that the US is more service driven with secondary focus on training, do you mean it is the opposite in the UK?
 
Does anyone have something else to say?
OPD, maybe?:help:
 
I really don't know enough about you or the training or practice environment in Egypt to give you much specific help. I will say, though, if your reservations against psychiatry are as strong as they seem to be, you might be better off doing something else. Whereever you are, you WILL have to deal with addicts, the manipulative, the disturbed, the threatening. If there isn't a some part of you inside that says, "Yeah, I can handle that", then you probably shouldn't be thinking about a career working with the mentally ill.
 
Thanks for stopping by and replying 🙂 I like your posts and wanted to know what do you think about this.
It is not about where or the system, as you said, it is about being comfortable/able to deal with these types of patients. There is a part of me that says "It is an adventure, you can do it" but there is the other part that wrote the first post!
I have experienced part of the work with mentally ill people but it was under supervision and with "controlled" patients. I'm thinking of pushing this further and actually taking a "part time psychiatry house officer/resident" or even full time to put this to the real test!

Thanks for the reply! 🙂
 
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