Anxiety riddled decisions

[psybrdelic]

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Ok, look, I rarely post on this site. Although, I will admit I sometimes read what others write for input. However, I was unable (or unmotivated) to find anything pertinent.

So...here's my selfish story.

I have had a ton of anxiety and depression as of late, because I am seriously split between two fields. Now, let me preface, when I say what they are, your response will most likely be: "What the f***." General surg or psychiatry. I think the extreme difference between the two is reflective of my own personality, in that, I am fairly extreme in my actions and thoughts. Basically, I don't know which way I want to go in my life.

I think a lot of reservations regarding psych are stigma-based or even culturally based. I feel like I can easily understand it, talk with patients, and so on...it feels natural. However, it almost feels too easy. I'm also displeased with the lack of actualy medicine in psych. I fear that I may end up feeling useless or inferior. I don't want to entirely lose those skills.

Now, surgery also felt natural. Although, I think it would be more of a challenge to learn and practice, for me. That is almost undeniable. I'm not too excited about the work hours and amount of motivation in order to become one. Yet, I think the starkness of it, I mean that in a literal and figurative sense, it so appealing. I think my main reservation is that I feel I may not be good enough to be a surgeon.

Now, this may seem trite, and I apologize if it does, but this has really been upsetting me. I am literaly oscillating between the two, on an hourly basis. I'm setting up rotations for 4th year and I've basically ignored setting up psych ones. I assume for some unconcious reason.

Oh, yea, and my mother is animinate that I should not become a psychiatrist. (shrugs) When I polled my close friends, a majority said surgery, but there have been psychiatry.

I'm not even sure what I'm asking for, just opinons etc. regarding the two fields? What people think, have experienced and so on? I'm really lost as hell.

 

[homeboy]

Ok, look, I rarely post on this site. Although, I will admit I sometimes read what others write for input. However, I was unable (or unmotivated) to find anything pertinent.

So...here's my selfish story.

I have had a ton of anxiety and depression as of late, because I am seriously split between two fields. Now, let me preface, when I say what they are, your response will most likely be: "What the f***." General surg or psychiatry. I think the extreme difference between the two is reflective of my own personality, in that, I am fairly extreme in my actions and thoughts. Basically, I don't know which way I want to go in my life.

I think a lot of reservations regarding psych are stigma-based or even culturally based. I feel like I can easily understand it, talk with patients, and so on...it feels natural. However, it almost feels too easy. I'm also displeased with the lack of actualy medicine in psych. I fear that I may end up feeling useless or inferior. I don't want to entirely lose those skills.

Now, surgery also felt natural. Although, I think it would be more of a challenge to learn and practice, for me. That is almost undeniable. I'm not too excited about the work hours and amount of motivation in order to become one. Yet, I think the starkness of it, I mean that in a literal and figurative sense, it so appealing. I think my main reservation is that I feel I may not be good enough to be a surgeon.

Now, this may seem trite, and I apologize if it does, but this has really been upsetting me. I am literaly oscillating between the two, on an hourly basis. I'm setting up rotations for 4th year and I've basically ignored setting up psych ones. I assume for some unconcious reason.

Oh, yea, and my mother is animinate that I should not become a psychiatrist. (shrugs) When I polled my close friends, a majority said surgery, but there have been psychiatry.

I'm not even sure what I'm asking for, just opinons etc. regarding the two fields? What people think, have experienced and so on? I'm really lost as hell.

First off, don't sweat being torn between 2 seemingly polar-opposite fields.
Not that I have any more experience than you...I'm a 3rd year. But you've at least narrowed it down to 2. Many of us can't even do that...

I guess the only thing comforting I can tell you is that most of us are going through the same thing, and I know several 4th years that narrowed it down to 2 seemingly opposite fields.

As far as which of the 2 to pick...I guess if you can see yourself doing both, look at total picture (ie. outside the hospital: lifestyle, family life, time commitment, etc...) Does a 5(+) surg res sound worse / better than a 3 yr psyche res? Psychiatrists work much better hours than surgeons, though make considerably less.

Where do you see yourself 10 yrs from now? yea, sounds cliche, but seriously: family important? if so, can he/she/they deal with you doing a surg res? if no fam, are you motivated to work the long hours of surg?
do you have the patience to deal with the patient population of psyche?

Not that you're oblivious to these types of questions, but maybe it'll help hearing someone actually ask them.

 

[psybrdelic]

​

Valid, by all means. I should've included the fact that my personal life, including family, is not really...err..vital to me.

I'd rather be happy with my career than anything else. I've worked too hard for it not to be, ya know?


I'm a psychiatrist at heart, but a surgeon at brain. Which organ wins?

 

[psybrdelic]

Errrrrrrrrrr. I'm not ahead of most, b/c that's not my nature. I'm a procrastinating f-face...that wants ultimate happinesss for all...including myself.

Idealism...kills.

What would an anthropologist do?

 

[Lfribble]

I agree that there isn't a problem that the two fields you're interested in are very different. I'm actually not a med student yet, but I've had over 4 years in psych work experience and it is a very interesting field. That being said, the patients can be extremely difficult to work with. I wanted to be a physician to be a psychiatrist but now am not so sure because the patients can be infuriating and at times it is difficult to look past them to remember that they are indeed very sick people.

As far as the field not being medical enough, I think that depends where you practice. If you worked on an inpatient unit, you'd see much more "medical" stuff than if you worked in a very posh private practice. Absolutely, though, don't minimalize the effect of a psychiatrist on a patient. I remember one patient who I saw come in weekly, very nice always put together, didn't really think much was wrong with her until I heard her case study and heard that every day was a struggle for her not to gauge her eyes out or drive over the bridge (she wanted to do both). You are absolutely affecting the lives of your patients. And about the stigmas, probably more people than is realized have psychiatrists or therapists, it's an extremely important field, and no one should think less of you for entering it.

As for surgery, I don't know much about that, but I'd say that to be a surgeon you would need to be very confidant and you should not approach the field not thinking you are good enough, you're through almost all of med school, you're good enough. 🙂

 

[homeboy]

I understand your desire to be happy with your career...there's nothing worse than going to work every day and having to face something you absolutely hate. On the other hand, it's equally hard to go home every day and deal with a family / wife / husband that you don't care about anymore / doesn't care about you anymore.
if you're single, entirely diff story...but saying your personal life / family is not vital to you is kind of startling...
you're very concerned about your career now, and understandably so, but--in my opinion--the object of life is not to work, it is to live. work is something you do during your life, something you enjoy, that makes life worth living. family is similar. when your work becomes your obsession and the overall goal in your life...you burn-out, or live a miserable life controlled not by yourself, but by the hospital and your patients.
i'm not saying people can't be devoted to their job and consequently their patients...we need good doctors that care about their patients...

But...if you're overall goal is helping people and being devoted entirely to your job, you're ignoring people that need your help equally as much (ie. your family)...and someday, your wife, kids, husband, whatever, will probably end up in a psychiatrist office themselves.

 

[Orthodoc40]

Not yet a med student, but FWIW, you sound more interested in psych.
Maybe after you set up some electives (?) it will help solidify your choice? Even give you some more ideas about different challenges inside of psych you'd be happy pursuing??

 

[the1doc]

go with your heart...choose plastics.

 

[psybrdelic]

Well, I think I'm being covertly candid.

To address the family thing, it's not that I don't appreciate and care immensely for my family, but it's rather that I have to remeber that they too are impermanent, like all things (except impermanence itself). Honestly, I have a very small family and perhaps, b/c of that it has never been the core of my life. In no way am I belittling the importance of my family, but realistically, I am neither career nor family oriented. I am happiness oriented. This has also yielded maladaptative behaviours, but some productive ones too. (For reference, I'm single with no children etc. at present.)

In fact, I think, well, for the most part, that the core of my exsistence is the present moment. Which, incidently, has just become hx. Ok, sorry. Anyway, I feel that me expending such mental energy on worrying is selfish and trite. Yet, I know it's affecting my fxnality. I know many go through this during med school.

Personally, I think my med school (I can only speak for mine, no others), needs to somehow integrate a program, class, or whatever to help students that can't pick a speciality. I think this is a fairly critical problem. I also believe, that such an integration may result in better doctoring, b/c perhaps, more people will have followed thier passion.

Wow, I feel like I'm just ranting. I apologize. I just believe that to expend such time and energy on one thing, makes the ultimate decision even more important.

Also, as a sidenote, I have seen some of the arguments on this site. I would like to say that anyone that engages in such insulting and combative behaviour online is not only disgracing themselves, but also our field.

I thank anyone reading or posting for thier time.

 

[McDoctor]

psybrdelic,

The big difference between the two is that in Surgery most of your patients will get better. In Psychiatry, most of them won't. You (hopefully) won't see the same patient over and over in surgery. In psychiatry, you definitely will.

So I think the fundamental question you have to ask yourself revolves around what you like to do. Do you like to fix people and then send then back to the family doctor, never to see them again? Or do you like to form doctor/patient relationships and manage chronic conditions and help people get by from one crisis to the next, without ever truly "curing" them?

Also, IMO whether or not you have a "good lifestyle" is entirely dependent on how much you enjoy what you are doing.

 

[psybrdelic]

Well, I do commend you on bring up yet another parameter, or even percieving the black/white vs. grey idea differently. I think that's really what it amounts to in the end.

And depending what type of surgery I do, I could have f/u appts and what not. (i.e. gastric bypass)

 

[Dartos Vader]

I don't know if I can help you make a decision, but I wanted to clear up a few misconceptions about psychiatry that have been posted on this thread. For starters, I am a fourth year med student, currently applying for psych. I really enjoyed surgery, OB, FP, ER, almost everything in fact. But felt psych was the best choice for me.

On to the misconceptions. In psychiatry you see a lot of progress with your patients. It is a very rewarding field. Psych patients can be difficult, but I think every field is difficult. Try sitting with a non-compliant 300 lb diabetic in an FP office for 20 minutes, and when you try to leave the room they pull the old "Oh and I have this nagging chest pain I forgot to mention. AHHHHH!!! For some reason everyone thinks psychiatry makes no money. Many psych docs outside of academia make over 200,000 and I personally know many docs pulling in over 300K. And these guys are not working surgery hours by a long shot.

Psychiatry is just another specialty of medicine. OB/GYN's don't typically know much if any more medicine than a psychiatrist, neither do neurologists. Pediatricians don't remember how to manage CHF (until the childhood obesity epidemic worsens lol).

All my family members told me not to go into psych, I told them they could go to medical school and become any kind of doctor they would like to. Now they call me up more than ever to ask my advice on everything. You are a doctor because you went to medical school, regardless of what residency you do.

Good luck, God bless.

 

[raspberry swirl]

im a 4th year going into psych (yay!) but if helps you, i had the same dilemmas. i waffled between IM, peds, psych, and the various combo programs. choosing a specialty can be impossible, and there are some days where i am still not sure i made the right choice. but no matter which one i had choosen, i think there would always have been uncertainty. i reconcile it by telling myself there is no reason why more than one specialty can't be right for someone. its possible that surgery would work out awesome for you, and psychiatry would as well. if you think of it that way, you're in a win win situation... either one will make you happy. and the problem is that most of us are type A- we can't accept the fact that there can be more than one right answer (well except when it comes to multiple choice tests!). so the problem lies more in your acceptance that either one could be right ... for you, it has become more of a roll the dice and go for it kind of thing ... which is hard for us to do. i rolled my dice and went with psych ... why? i have no idea. i think i would have been perfectly happy doing a lot of different specialties, considering you can tailor any specialty to suit your needs, once residency is over. i know this really doesn't answer your question. but remember, psych and surgery can BOTH be right answers .... (i suggest psych, its more lifestyle friendly and has lots of different unique ways to practice). its just too bad the system doesn't allow you to pick both 🙂

oh, and psych is 4 years, not 3, to correct the person above who said 3.

 

[psybrdelic]

To the last two posts...

To be blunt, I think your opinions have been the most valuable of all posts. Thanks.

 

[psybrdelic]

Also, I think part of my issue is that the psych residency here...simply feels like a fit. It's right. I like it. I want to stay for this residency. Even though I want to go back to Detroit....it's just right here. I can't explain it.

 

[fly77]

I totally understand what you are going through. I myself had the same exact struggle since I enjoyed all my clinicals. Finally I had narrowed it down to IM, Surgery and Psych.
I spoke with several of my attendings - gathered info about job satisfaction, costs of running an office, lifestyle, insurance issues, malpractice, salaries and their opinion in what would I be good at after interacting with me during rotations. In general all other specialties were horrified I was considering psychiatry. Their comments were such as: "why are you going to waste your brain on such a thing?". The only ones that were enthusiastic about my consideration at the time were my psych attendings. One in particular felt that I would be bored if I selected anything else - unless it was an IM subspecialty. Her opinion was that my personality would be more satisfied at being an expert in one area than a jack of all traits as well as be in an area that is growing and stimulating such as psych. She also was in bw choosing NeuroSurgery and Psych but decided for psych with no regrets and has been practicing for 20 yrs at this point. Interestingly enough she pointed out she had seen quite a lot of residents struggling bw surgery vs psych. I am an example of it as well as my husband. At the end we were both struggling. He is now in surgery and I am in psych 😳)

To make a long story short - reasons I ended up choosing psych:
- job satisfaction: most psychiatrists compared to other specialties all seemed happy, relaxed and none reported regret in their choice;
- some articles I read such as "Should psychiatry be your specialty? Eleven Questions" by Maurice Rappaport, MD, PhD; "Why psychiatry? Part 1" by Mary Ann Barnovitz, MD; increased my enthusiasm for the field; see if u can find it at your med library;
- my psych attending's opinion
- interest in the brain, how it works, what makes it tick and why for some people it just cracks
- the only specialty that your patients have time to share with you their most inner thoughts; the other ones they only have time to listen to the egomaniac physicians;
- and the only field as mentioned in one of the articles that combines body and mind

Also if you are an APA member they have a video that may help you as well on their home page called "Real Psychiatry: Doctors in Action". Students can join for free, but you need one of your psych attendings to fill the form. Hope this helps! Keep an eye on Why not psychiatry as a specialty post. When I get more time I will post a feedback - too many distorted views. It is unfortunate bc psychiatry is a wonderful specialty. As they call it in one of the articles - "Its medicine's best kept secret" 🙂

Let me know how you make out or if you need any more help.