Anyone "bored" with psych?

[Healer777]

I am a US IMG about to take step I. I started med school with the intention of becoming a psychiatrist.

I have heard twice now, however, that psychiatry is "boring". Granted, neither of the physicians who shared that opinion were psychiatrists...

The first doctor to tell me that was a pediatrician I shadowed before going to med school. He told me that he thought about being a psychiatrist while in med school, but ultimately chose peds because "all he would see as a psychiatrist is depression and it would be boring." Granted, all that he appeared to see as a pediatrician were kids with asthma and ear infections (which are way more boring than depression, in my opinion).

The second doctor I spoke to was my preceptor during my final semester of medical sciences. He asked me which specialty I was aiming for. When I told him I wanted to be a psychiatrist, he told me that I would be bored with the field "about three years after completing my residency" because (again) all I would see would be patients with depression. This physician was an OB/GYN and I have a lot of respect for him. He is brilliant, and non-conventional in his thinking and teaching approach. And I did learn from his class that the internal medicine side of things could be interesting. I had a lot of fun coming up with differential diagnoses for the patients we did our case studies on.

Ever since taking that class, I have wondered if I should go into internal medicine.There is something fun about the "puzzle solving" of looking a concrete evidence such as a lab report, patient history and physical, and making an accurate (and concrete) diagnosis.

My preceptor told me that his father-in-law was a brilliant physician who could observe people at a bar and (accurately) diagnose them with physical illness. He told me that he believes I have the intellectual capacity to reach that level. And part of me would love to be that intuitive and that in touch with my craft.

But I also do like psychiatry. I don't think I would be bored treating psych patients, because even if the majority of them had mood disorders like depression, they will all present differently. There are so many neurons in the human brain that can be wired in so many different configurations...no brain works the same as any other brain, even if we are comparing patients with the same "label".

But I do know that if I choose psych, I won't have the satisfaction of concrete "puzzle solving". There is no way to "prove" that a psychiatric diagnosis is correct. Though I'd imagine that helping my patients recover from their pain and regain functioning that they thought they had lost forever would still be very rewarding, regardless of the fact that I would never really know if my diagnosis was actually correct.

So, practicing psychiatrists and residents...have you ever felt "bored" by the field? Do you ever wish you had chosen a different medical specialty, one where you could interpret some lab results and imaging tests and have a little more "concrete-ness" in your practice?

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[WisNeuro]

My preceptor told me that his father-in-law was a brilliant physician who could observe people at a bar and (accurately) diagnose them with physical illness. He told me that he believes I have the intellectual capacity to reach that level. And part of me would love to be that intuitive and that in touch with my craft.

How exactly did he confirm his diagnosis? Did he ask those people to come in for confirmatory tests? Did he carry around ROIs for people at the bar to fill out so that he could access their medical record? People who say they can do this, are usually FOS. House is a TV show, not a real person.

Back to the question at hand. I don't know many psychiatrist's who "only see depression." If that's all you want to see, I'm sure you can make it work, but most people practicing in institutional settings have a much more varied patient population.

 

[FlowRate]

My preceptor told me that his father-in-law was a brilliant physician who could observe people at a bar and (accurately) diagnose them with physical illness.

His dad must have been a real genius to diagnose all of that liver disease.

And on a half-serious note, there are plenty of obvious physical signs which have a rather narrow differential.

Psychiatry can be boring if you're not interested in other people. If you're interested in other people, you will always be able to make psychiatry interesting.

 

[Taddy Mason]

...a pediatrician claiming psych is boring - I guess I didn’t realize well child checks from 9-5 could be so exciting.

 

[TexasPhysician]

Boring? Probably one of the best jobs on the planet.

Other possibly better options would be blogging on my private island, pro-athlete legal/finance team, and yacht captain for an old wealthy person.

 

[dl2dp2]

I'm about 3 years out of training, and it's anything but boring. If anything it's a bit "too exciting" at times. I've told my wife that my job is like watching an HBO show, but in real life and you can alter the characters' stories in a (hopefully) benevolent way.

This is not an issue for psych IMHO in particular if you eschew the garden variety med mgmt facility jobs. Agree with ^^^, in terms of repetition to income ratio this is one of the best in medicine especially in private practice.

 

[clozareal]

Psychiatry definitely has the potential to be very boring depending on how you structure your practice. I would rather go into surgery working 100 hours per week than have to do 15-minute med management for major depressive disorder 8 hours a day. That's a very myopic view of the wide scope of psychiatric practice from someone who probably didn't have enough exposure to psychiatry during medical school. Is the diagnosis of a collection of symptoms in psychiatric disorders as difficult as diagnosing hemophagocytic lymphohistiocytosis in the ICU? No. But the challenge in psychiatry largely doesn't come from the diagnosis or deciphering obscure laboratory results (with some notable exceptions such as ANA/UPB results in neuroleptic-naive catatonia cases in pts without a psych history) but rather the diversity in treatments and the patient population.

You have the potential to structure your practice to include all kinds of therapy (CBT, IPT, psychodynamic/analytically-oriented therapy, couples/family therapy, mentalization, schema, etc. and these are just the ones I'm learning about during intern year through my curriculum), "interventional" psychiatry (ECT, TMS, tDCS, botox), consult-liaison, forensic practice being an expert witness in criminal/civil cases, management of substance use disorders, clinical education for medical students/residents, child/adolescent psych and parent skills training, palliative care, functional neurologic disorders, neuropsychiatry, sleep disorders, clinical trials, consulting for companies, etc. These are a few of the tons of ways you can practice afterward. Given the lack of supply of psychiatrists, having a boring practice is the fault of the lack of creativity or laziness on the psychiatrist's part. If you love psychiatry, other fields in medicine won't cut it.

See this thread for more about why people love psychiatry:
What do you love about being a psychiatrist?

 

[Stagg737]

I have heard twice now, however, that psychiatry is "boring". Granted, neither of the physicians who shared that opinion were psychiatrists...

When a physician in one field starts railing on another field or talking negatively about it, it usually means 1 of 3 things: Either they had a bad personal experience with the field, they have limited experience with the field and don't know what they're actually talking about, or they dove into the field expecting to love it and it just didn't live up to their expectations (personal preference). The pediatrician definitely sounds like they didn't know what they were talking about if they think all psychiatrists do is treat depression. Idk about the OB/Gyn, but it sounds like the last option for them (had an interest, wasn't what he expected).

But I also do like psychiatry. I don't think I would be bored treating psych patients, because even if the majority of them had mood disorders like depression, they will all present differently.

This is something that I've loved about psych and why I think it's NOT boring. Even if there is a relatively narrow set of pathologies we work with compared to a field like IM, they can present in wildly different ways and severity can drastically change both the presentation and treatment course. I'm just starting residency in July, but in my ~6 months of psych rotations, I've seen depression present in dozens of different ways. Same with the anxiety, schizophrenia, bipolar, and insert any psych disease here patients I've worked with. Imo psych cases are more of a puzzle than most other fields as you can't just use an algorithm to diagnose and treat like you can for some patients. It's why I ended up loving the field (when I initially thought there was zero chance I'd ever pursue this route).

Plus remember that just because we're in psych doesn't mean we don't deal with medical cases as well. I had one patient who was severely depressed (would literally lie in bed and stare at the ceiling all day except for dinner, which he had to almost be forced to eat) and was incredibly treatment refractory even after multiple rounds of ECT. Turns out no one had checked his testosterone levels which came back in the single digits. We started him on testosterone and his symptoms magically improved to mild to moderate depression to the point that he actually started cracking a few jokes on the unit before he was discharged (still needed some psych treatment, but likely never would have needed ECT). So you can still put more medical knowledge to use in psych if you really want to, especially if you do something like consults where your patients will certainly have medical co-morbidities occurring.

There is something fun about the "puzzle solving" of looking a concrete evidence such as a lab report, patient history and physical, and making an accurate (and concrete) diagnosis.

But I do know that if I choose psych, I won't have the satisfaction of concrete "puzzle solving"

So, practicing psychiatrists and residents...have you ever felt "bored" by the field? Do you ever wish you had chosen a different medical specialty, one where you could interpret some lab results and imaging tests and have a little more "concrete-ness" in your practice?

I won't talk about getting bored as I don't feel like I'm far enough along to really answer that yet. I do want to make one more point about the "concrete" aspects of other fields though, especially regarding lab results. Medicine is not as concrete as you think. In the first two years you're taught that if a patient has a positive ANA you should be thinking lupus or that a positive drug screen means they've used recently. This is not so concrete irl. One of the best pieces of advice I got on rotations was from an EM attending who told me the first thing I should do if I take a hospital job is to find out what companies perform their labs and figure out the reliability of those results. At that hospital, he said their opiate screen was basically useless because the screen would come back negative about 40% of the time when a patient had clear symptoms of use and actually had the drug on them when brought in. So if he just trusted that lab he'd likely have had quite a few patients die on him. That doesn't mean labs are useless or can't be trusted, it just means you have to be conscious of the fact that they may be wrong and that you have to consider all possibilities when treating. So yea, there are other fields that are certainly more "concrete" than psych (surgical fields being the most concrete imo), but realize that even medicine and many other fields are more of an 'art' than many students may realize.

 

[Gavanshir]

It really depends on what you're into and what part of the field you're evaluating. I do agree that psych can be boring from an "academic medicine" point of view, the diagnostic and therapeutic options are limited compared to every other field in medicine so things can feel old and repetitive pretty quickly. There isn't much technological innovation in daily practice, most of the mechanisms for everything are unknown and the treatments themselves have like limited effectiveness.

Overall what keeps it from being uncomfortably boring is the good lifestyle, control over your practice style and creative freedoms that you don't have in other fields. In my opinion you have to be willing to somewhat step away from traditional modern medicine to keep things interesting, ie. learn psychology, phlilosophy, new research, etc

 

[MacDonaldTriad]

If Peds docs think Psych is boring, they have a very impressive undoing dynamic called "The Grass is Always Browner". It probably helps to think that your specialty isn't worse than anyone else's. The good thing about psychiatry is that it is true, ours isn't worse than anyone else's.

 

[Nasrudin]

The structure of your thinking seems to be: these other people...listing their credentials... feel this way. But I’m not sure. What am I supposed to think?

I can’t tell you what pickles taste like. What would I say... it’s like a lemon, but more salty, shriveled from cucumberishness, but still juicy.

Or you could try the pickle.

The problem there being how do you try it. When you have to be in it. To truly taste it.

You have to imaginitvely approximate it. As realistically as possible. What is the person who likes or dislikes this thing experiencing. How am I like this person or not. What it feel like if it was me doing this or experiencing this that I’m seeing.

And you feel your way along thusly.

But one thing you can drop. Is what’s so and so’s credentials and gee-whiz they must know what they’re talking about...

It’s pickles. You either like them or don’t. Doesn’t matter if Queen Elizabeth loves them or hates them. It’s your sandwich their going on.

 

[OldPsychDoc]

It may be telling that neither of the preceptors who dismissed psych as "boring" has actually done Psychiatry, apart from a brief exposure in medical school.

(And I'd also venture that if your goal is to be making observational diagnoses in bars--Psychiatry is MUCH more relevant training for that!)

 

[nitemagi]

I'm never bored at work.

 

[tr]

No, I felt like the *rest* of medicine was boring. Psychiatry is the only field where there is so much that is totally unknown about pathophysiology. Everything else in medicine seemed very cut and dried in comparison.

Medical training tends to attract conventional personalities, often people who are relatively low in their openness to experience, and who can be repelled by the uncertainty associated with a field where so much remains to be discovered.

Personally I find the unknown far more fascinating than the known. But that's just me.

 

[Shufflin]

I'm an inpatient psychiatrist, and as such I review lab results every day. I treat not only psychiatric disorders, but also pain issues, addiction and withdrawal issues, and some neurological disorders that cross over into psych such as catatonia, RLS, and delirium. So your desire for a more "scientific" modus operandi can be had in psychiatry. I'm a big proponent of inpatient work. (You can also earn more than a surgeon with the right setup.)

 

[Attending1985]

Strictly medication management is terribly boring. A practice with psychotherapy included is not boring at all.

 

[erg923]

I think its great that the majority of responses refute this claim. It is of course ridiculous that another medical specialty would presume to dictate that another specialty is "boring." No Doy! It is to them...that's what they didn't pursue it. "Boring" is of course subjective and dependent on interests, personality, and other life preferences.

That said, 'med management," which is terrible term, can be boring if the patient in front of you isn't of much interest to you. Psychotherapy can be boring too if the patient in front of you isn't of much interest to you. So could college basketball or the Grand Canyon.

Also, keep in mind that "interesting" does not always make a career. Psychotherapy was/is interesting to me, but so is how sand is turned into glass. This fact that its "interesting" didn't make it a viable long-term career trajectory for me.

 

[Stagg737]

Another thing that someone briefly touched on before that is worth noting is time commitment. There aren't a lot of fields which are true lifestyle specialties, but psych is certainly one of them. So if you did end up pursuing psych and felt like it was boring, you would at least have time to pursue other interests in your free time. The same can't be said for many other fields.

 

[Onions]

But I do know that if I choose psych, I won't have the satisfaction of concrete "puzzle solving". There is no way to "prove" that a psychiatric diagnosis is correct. Though I'd imagine that helping my patients recover from their pain and regain functioning that they thought they had lost forever would still be very rewarding, regardless of the fact that I would never really know if my diagnosis was actually correct.

Freud supposedly saw himself as a surgeon of the mind, settling patients down on his couch and cutting, excising, and reconstructing mental anatomy through the process of psychoanalysis. I always found this to be an appealing comparison, but there's a powerful distinction that shatters it: the surgical patient, in deep anesthetic coma, submits utterly to the hands of the surgeon; the psychotherapy patient, in contrast, can get up and leave whenever he wants. Or not tell you something. Can you withhold your cystic artery from surgical dissection while allowing the doctor to ligate the duct? Of course you can't, you're passed out on propofol.

For me, the point is this: I learned to think like a doctor in medical school, solving puzzles, dutifully plodding my way through the Bayesian sandbox of differential diagnosis. I got good at it. Not in the sense that I know so much medicine that I can accurately diagnose things, but in the sense that I get the process. Thinking like a doctor is a good thing. It's a clear-headedness that ensures that we don't miss rare and obscure clinical entities. But I have spent my residency thus far unlearning this intellectual militarism. Even in the inpatient setting, I find that Bayesian-inspired differential diagnosis is a bit like road-tripping on an Italian crotch-rocket. It'll take you so far, and then you run out of gas and you need to start looking for other ways to transport yourself.

You can stand in a bar and look at people and say "hey, that guy looks like he's schizoaffective" or whatever. But what's the point of doing that anyway? My purpose is to build models of other minds within my mind. This is what talking with patients means to me. Unlearning doctorism has brought me more questions than answers. Is there actually no such thing as mental "illness?" Or, by contrast, is all mentation somehow pathological? Does the schizophrenic lady on my unit who hallucinates the retired mental hygiene judge who used to rule in favor of her treatment over objection all the time have some sort of brain booboo that Science will someday discover? Or does she actually occupy just a distant outskirt of the same broad landscape as the rest of us?

So there's all that. And also manic/psychotic people say the darndest things, so fun is had by all.

 

[clausewitz2]

Freud supposedly saw himself as a surgeon of the mind, settling patients down on his couch and cutting, excising, and reconstructing mental anatomy through the process of psychoanalysis. I always found this to be an appealing comparison, but there's a powerful distinction that shatters it: the surgical patient, in deep anesthetic coma, submits utterly to the hands of the surgeon; the psychotherapy patient, in contrast, can get up and leave whenever he wants. Or not tell you something. Can you withhold your cystic artery from surgical dissection while allowing the doctor to ligate the duct? Of course you can't, you're passed out on propofol.

For me, the point is this: I learned to think like a doctor in medical school, solving puzzles, dutifully plodding my way through the Bayesian sandbox of differential diagnosis. I got good at it. Not in the sense that I know so much medicine that I can accurately diagnose things, but in the sense that I get the process. Thinking like a doctor is a good thing. It's a clear-headedness that ensures that we don't miss rare and obscure clinical entities. But I have spent my residency thus far unlearning this intellectual militarism. Even in the inpatient setting, I find that Bayesian-inspired differential diagnosis is a bit like road-tripping on an Italian crotch-rocket. It'll take you so far, and then you run out of gas and you need to start looking for other ways to transport yourself.

You can stand in a bar and look at people and say "hey, that guy looks like he's schizoaffective" or whatever. But what's the point of doing that anyway? My purpose is to build models of other minds within my mind. This is what talking with patients means to me. Unlearning doctorism has brought me more questions than answers. Is there actually no such thing as mental "illness?" Or, by contrast, is all mentation somehow pathological? Does the schizophrenic lady on my unit who hallucinates the retired mental hygiene judge who used to rule in favor of her treatment over objection all the time have some sort of brain booboo that Science will someday discover? Or does she actually occupy just a distant outskirt of the same broad landscape as the rest of us?

So there's all that. And also manic/psychotic people say the darndest things, so fun is had by all.

I would say that being preoccupied with detecting rare and clinical entities is sort of the opposite of Bayesian reasoning, but I do agree that one has to disengage somewhat from the medical mindset to find this field not terribly dull. If your only interest is finding a DSM label based on a checklist and writing a script, it is a mouth-breathing sort of endeavor.

 

[DD214_DOC]

Every specialty or subspecialty gets boring after some time. In fact, anything you do over and over again with minimal variation gets boring. The monotony is occasionally interrupted by unusual or complex presentations, unexpected medication reactions, or any other thing that is novel, reinvigorating your interest. Until you master this new thing you've been confronted with, then it also becomes boring.

 

[Healer777]

Thanks so much for your replies.

I think that I probably wouldn't get bored with psychiatry unless I just saw patients for 15 min med management appointments (which seems to be the only psychiatry I've been exposed to so far). It is good to know that more is out there.

I could see myself doing forensics. I would really like to help the people who are in prison because they have very hard lives. I could also see myself doing research, though not full time. And not on rat brains-did that in college, and wasn't for me.

I think what I want to do is to help people find a way to get past their difficulties. I want to help people who are hopeless find hope again. I want to help people know that their pain is valid, and that suffering is a human experience and they are not alone. I'm such an idealist and romantic, I know...but I really want to help people heal.

At the same time, I like solving puzzles and I don't want to feel like all the time I spent learning about cardiovascular disease and lupus and whatnot was wasted, haha.

But I do think that if I am honest with myself I would likely enjoy a career in psychiatry more than one in IM, and I might be able to help people in a way that would be more meaningful to me than just controlling their hypertension or diabetes.

 

[Candidate2017]

If a med student doesn't express interest in psych, 90% of their psych rotation will be watching other people interview patients. That's very boring. At most they may be told to talk to an "easy" depressed patient. Then they grow up to be docs in other specialties who believe psych is boring.

Compare that experience to busy services where students are thrown into the mix to do tasks like procedures which can be exciting to wide eyed students.

 

[DisorderedDoc417]

If a med student doesn't express interest in psych, 90% of their psych rotation will be watching other people interview patients. That's very boring. At most they may be told to talk to an "easy" depressed patient. Then they grow up to be docs in other specialties who believe psych is boring.

Compare that experience to busy services where students are thrown into the mix to do tasks like procedures which can be exciting to wide eyed students.

Tasks like procedures? Like what, press the button in the ECT suite?

 

[DisorderedDoc417]

If a med student doesn't express interest in psych, 90% of their psych rotation will be watching other people interview patients. That's very boring. At most they may be told to talk to an "easy" depressed patient. Then they grow up to be docs in other specialties who believe psych is boring.

Compare that experience to busy services where students are thrown into the mix to do tasks like procedures which can be exciting to wide eyed students.

The "exciting" part is connecting to that first patient. Mine, an 18 y.o. gal struggling with recurrent suicidal thinking, under immense pressure to do well in school and who slowly watched it all implode before her eyes despite her best efforts to keep things together. As a med student, you bet there were things there in which I could relate. That first time you help to change someone's life trajectory for the better, 2 parts art and empathy and 1 parts medicine. Thats exciting.

 

[thoffen]

Every specialty or subspecialty gets boring after some time. In fact, anything you do over and over again with minimal variation gets boring. The monotony is occasionally interrupted by unusual or complex presentations, unexpected medication reactions, or any other thing that is novel, reinvigorating your interest. Until you master this new thing you've been confronted with, then it also becomes boring.

If you are treating people and not illnesses, nothing ever gets boring. In psych it's a lot easier to center your daily work around treating people. It also supplies you with a lot more ways to put language to your observation of the person and to refine your interactions with them. It is done scientifically, but things quickly grow to such complexity that very few hypothesis can be definitively tested. Thus, it can become much more of an art. In this way it is probably much closer to the clinical mastery / physical diagnostic skills referenced by the OP. In many areas of medicine, this is being superseded by laboratory/imaging/pathologic examinations and development of algorithms. The actual evidence base supporting that kind of practice of medicine is nowhere near as robust as it appears on the surface, but nonetheless is a different kind of science that makes hypotheses more testable but IMO quite impersonal and boring. In the end, regardless of specialty, if you are going to be treating patients, the thing most predictive of success is the quality of your treatment relationship. Whatever you do, good medicine is always about people.

 

[futuredo32]

YES. Psychiatry isn't for everyone. I LOVED it as a med student. But realized early in residency I missed the rest of medicine. I should have switched then. MANY people LOVE psychiatry. It just isn't for me. You have to pick what is right for you. I made a big mistake. That doesn't make psychiatry a "bad or boring" field, it just means psychiatry isn't the right fit FOR ME. I had an amazing attending and I think that STRONGLY colored my view of my "love" of psychiatry as a med student. The down side of being a physician (one of them) is that you are stuck by your residency unlike an NP or PA where you can switch specialties................ There are a lot of subspecialties in psych, I have tried many and find private practice with therapy the least offensive, but therapy doesn't pay all that well. For now I work as few hours as possible. I am trying to pass the board exam so my former PD will write me a LOR with the slight hope I will match into FP, it's unlikely, but I would like to try. Most people in psychiatry are very happy, I think I am definitely an outlier. Find your passion in medicine and go with it.

 

[Shufflin]

I had a different experience as a med student, one that many of my peers echoed. A handful of specialties seemed very alluring, and I could find things I loved about each of them as well as off-putting aspects of each. Nothing was true love, nothing was true dislike. I loved ObGyn and bringing children into the world, but not all the other surgical stuff involved. I loved radiology, the art of reading images and connecting the dots to pathology, but hated sitting all day especially in a dark room and not interfacing with others. I loved building differentials under pressure in emergency medicine, but not the bureaucratic pressure to do more and more in less and less time and shift work sleep disorder. I loved the complexity, scope, and surgical aspects of neurosurgery, but not the very sad cases and the terribly taxing hours. I don't know, perhaps we could thrive in any number of specialties saying the grass is greener under my feet on some days, and under your feet on others.

 

[Liquid8]

If you are treating people and not illnesses, nothing ever gets boring. In psych it's a lot easier to center your daily work around treating people. It also supplies you with a lot more ways to put language to your observation of the person and to refine your interactions with them. It is done scientifically, but things quickly grow to such complexity that very few hypothesis can be definitively tested. Thus, it can become much more of an art. In this way it is probably much closer to the clinical mastery / physical diagnostic skills referenced by the OP. In many areas of medicine, this is being superseded by laboratory/imaging/pathologic examinations and development of algorithms. The actual evidence base supporting that kind of practice of medicine is nowhere near as robust as it appears on the surface, but nonetheless is a different kind of science that makes hypotheses more testable but IMO quite impersonal and boring. In the end, regardless of specialty, if you are going to be treating patients, the thing most predictive of success is the quality of your treatment relationship. Whatever you do, good medicine is always about people.

Signed in while on annual leave just to like this post - this is exactly how I feel!