3rd year, the tough decision...

[Red Beard]

Advertisement - Members don't see this ad

I came into medical school with a sense that I was more attracted to 'physical' medicine--touching patients, listening to hearts and lungs, physical exam....I guess working with more palpable kinds of issues. However, I have always been interested in psychology and psychotherapy, and spend a lot of my leisure reading time learning about the brain, the mind, relationships, etc.

Now I am doing my pysch rotation and I am really enjoying it, especially the part where I get to intellectualize with the attending about what's going on for each patient and what we are going to do about it. I also like working alongside the kinds of people who are in the mental health field. As I already said, I have a long standing interest in the human mind/brain from both a biological and psychological standpoint--its what I regularly choose to read about for fun. Lastly, I like seeing people with serious mental health issues get better, it can be very dramatic and it is quite rewarding to be a part of it.

So a psychiatry residency would seem to be a perfect fit for me, right?

My only hesitation about setting my sites on a psychiatry residency is my reluctance to essentially give up doing physical diagnosis and medical management, which I do also enjoy quite a bit.

So I feel pretty stuck and am wondering if any of you currently active in the forum grappled with this and how you resolved the conflict for yourselves, if at all.

Thanks for your time!

 

[OldPsychDoc]

Paging Doc Samson. Doc Samson. Stat call on the "Real Doctor" thread.
😀

 

[Anasazi23]

Paging Doc Samson. Doc Samson. Stat call on the "Real Doctor" thread.
😀

Yuppers....call in the best. He's done lots of these cases.

I think I saw him near the soda machine on 7West an hour ago, so I know he's in the hospital. Give him an overhead page if he doesn't call back.

Don't worry Red Beard. Your help is coming soon.

 

[Doc Samson]

Hi this is Doc Samson from Psychiatry returning a page... Yeah, I left a note in the chart a while ago... Did you read the note? OK, in a nutshell:

There's plenty of physical diagnosis to go around in psychiatry, especially in the CL arena. Mental status is often the "canary in the coalmine" of disease, so we get called in all the time for "depression", or "anxiety", or "psychosis" and the patient is clearly delirious, so we are at the driving point of diagnosis. Just last week got called in for "anxiety" on a guy with restlessness and dyspnea. Anxious? Not so much. Massive empyema obscuring an entire lung field? Yes sir! Mental status issues are often shrugged off into the trash can of "psych illness." Because we are trained in what psychiatric illness actually looks like (first break psychosis at 50? not very common. Lung CA metastatic to brain in a 50 yo with a 35 pack-year history? More realistic) we are less likely to attribute a abnormality on MSE to "psych illness" and actually rule out likely physical causes. House is (at least loosely) based on a CL psychiatrist - all his cases have mental status issues, and he only gets called in when no-one else has a clue what's going on.

 

[BabyPsychDoc]

Hi this is Doc Samson from Psychiatry returning a page... Yeah, I left a note in the chart a while ago... Did you read the note? OK, in a nutshell:

There's plenty of physical diagnosis to go around in psychiatry, especially in the CL arena. Mental status is often the "canary in the coalmine" of disease, so we get called in all the time for "depression", or "anxiety", or "psychosis" and the patient is clearly delirious, so we are at the driving point of diagnosis. Just like week got called in for "anxiety" on a guy with restlessness, and dyspnea. Anxious? Not so much. Massive empyema obscuring an entire lung field? Yes sir! Mental status issues are often shrugged off into the trash can of "psych illness." Because we are trained in what psychiatric illness actually looks like (first break psychosis at 50? not very common. Lung CA metastatic to brain in a 50 yo with a 35 pack-year history? More realistic) we are less likely to attribute a abnormality on MSE to "psych illness" and actually rule out likely physical causes. House is (at least loosely) based on a CL psychiatrist - all his cases have mental status issues, and he only gets called in when no-one else has a clue what's going on.

I would not have believed the part in bold emphasis if I had not been asked once to do a consult on a 60 yo 4 days post CABG with "?delirium ?EtOH withdrawal" diagnosis by cardiothoracic surgeons. The guy seemed confused and looked oddly blue...he turned out to have had PE...(BTW, I never knew where the "?EtOH withdrawal" came from - both pt's family and PCP denied any excessive EtOH consumption.)

 

[OldPsychDoc]

I would not have believed the part in bold emphasis if I had not been asked once to do a consult on a 60 yo 4 days post CABG with "?delirium ?EtOH withdrawal" diagnosis by cardiothoracic surgeons. The guy seemed confused and looked oddly blue...he turned out to have had PE...(BTW, I never knew where the "?EtOH withdrawal" came from - both pt's family and PCP denied any excessive EtOH consumption.)

If you were in the US, I would have attributed this to it being at a Veterans' Affairs hospital...

 

[Red Beard]

Hi this is Doc Samson from Psychiatry returning a page... Yeah, I left a note in the chart a while ago... Did you read the note? OK, in a nutshell:

There's plenty of physical diagnosis to go around in psychiatry, especially in the CL arena. Mental status is often the "canary in the coalmine" of disease, so we get called in all the time for "depression", or "anxiety", or "psychosis" and the patient is clearly delirious, so we are at the driving point of diagnosis. Just last week got called in for "anxiety" on a guy with restlessness and dyspnea. Anxious? Not so much. Massive empyema obscuring an entire lung field? Yes sir! Mental status issues are often shrugged off into the trash can of "psych illness." Because we are trained in what psychiatric illness actually looks like (first break psychosis at 50? not very common. Lung CA metastatic to brain in a 50 yo with a 35 pack-year history? More realistic) we are less likely to attribute a abnormality on MSE to "psych illness" and actually rule out likely physical causes. House is (at least loosely) based on a CL psychiatrist - all his cases have mental status issues, and he only gets called in when no-one else has a clue what's going on.

Thanks for taking the time to write (on this apparently common question.)

So I will go read up on consultation-liaison psychiatry. Sounds like my cup of tea! 👍

 

[Doc Samson]

Thanks for taking the time to write (on this apparently common question.)

So I will go read up on consultation-liaison psychiatry. Sounds like my cup of tea! 👍

Browsing the most recent issues of Psychosomatics and General Hospital Psychiatry will give you a feel for what's being worked on. For the nuts and bolts (as always), I recommend "the bible of CL":

http://www.amazon.com/Massachusetts...r_1_45?ie=UTF8&s=books&qid=1222792955&sr=8-45

 

[Red Beard]

Thanks again, I will check out those resources.

As an aside, is there any reason a psychiatrist couldn't moonlight in an urgent care clinic? It seems like there are quite a few of those docs who only did an intern year...

 

[BabyPsychDoc]

If you were in the US, I would have attributed this to it being at a Veterans' Affairs hospital...

I just attributed it to communication skills on the surgeons' part...🙄

 

[BabyPsychDoc]

Thanks again, I will check out those resources.

As an aside, is there any reason a psychiatrist couldn't moonlight in an urgent care clinic? It seems like there are quite a few of those docs who only did an intern year...

can I second this question?

 

[masterofmonkeys]

can I second this question?

there's a psychiatrist or two out in this area that now practice primary care. They did not do residencies in family/internal/pediatrics. I don't know if that answers your question or not.

 

[Anasazi23]

can I second this question?

You could, but the liability factor increases greatly. If you carry your own insurance, it will jump up high. And, if one isn't actively practicing or is boarded in IM or FP, this becomes more liability for the hospital should, God forbid something go wrong, a case winds up in court.