Anyone have this experience?

[The Long Way]

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Just wondering if anyone has had a similar experience?

At the start of MS-III, there were two rotations that I knew I would have no interest in. The first was OB/Gyn, and I loathed the rotation. Not even the OB's like OB. The second was Psych. I thought I wouldn't like dealing with the "crazy patients" and the "whiny" depressed patients. However, once I got onto the rotation, I realized within about three days that I had a completly inaccurate preconception of what psychiatry is and really liked it.

So the problem has been this... I had been really attracted to radiology since second year and really liked the idea of the consultant role, spending each day doing diagnosis, etc. However, I was kinda ambushed by my psych rotation and absolutely loved it. It was definitely my favorite rotation of the entire year. However, I am having some difficulty dealing with some of my own preconceptions.

I'm competitive for fields like radiology and going into psychiatry is 100% my own choice, but for some reason, I feel like I am struggling with the idea that I totally like psychiatry. Anyone else experience this?

I realize that this may sound somewhat condescending to psychiatry, but please do not take offense. I'm simply stating my own prior ignorance and I have come to realize that psych is a great field. My apologies to anyone who finds my preconceptions offensive.

 

[diosa428]

I actually was positive that I wasn't going to like Psych either (not exactly insightful on my part, considering I was a Neuroscience major as an undergrad). My perception of the field was that it was all "talking about feelings", which was not my cup of tea. On my rotation I discovered that #1 - psych involves a lot more medicine than I had previously thought, #2 - I enjoyed working with the patients, and #3 - I don't really mind talking about feelings, as long as they're not mine.

For me it was psych and ophtho - I liked all the toys in ophtho, and the ability to work with my hands, which was not available in psych. So I did an elective in each. By the end of third year, I was bored with the OR and ophtho, but I did a child psych elective and REALLY loved it (I really really really like kids much more than adults, and again, I was totally wrong in assuming that child psych would be nothing but ADHD med visits), so I decided on psych. I think it did take me a while to come to terms with this decision, as it was totally unanticipated, but luckily I had psych early so I adjusted after a while. I would definitely do an elective as early as possible to give yourself a chance to experience psych in a different way (different team, different job - do C&L or child or something) to see if you still like it in a different context.

Also - which would you prefer doing? Reading about psych patients or looking at films? I think that was another thing that got me - I find psych very intellectually interesting, and I like the research going on in the field, but reading about ophtho or doing ophtho research was very unappealing to me.

 

[whopper]

I feel like I am struggling with the idea that I totally like psychiatry. Anyone else experience this?

Psychiatry is an unorthodox choice for most medical students. For me, I chose psychiatry before I even went into medical school so it wasn't anything strange for me. I had a few rotations that made me consider other fields. FM was the field I liked the best next to psychiatry. Surgery--I loved it, but didn't want to work 100 hrs per week. After about 60 hrs, I think I would start hating any field.

You need to do what you want to do. It may take some time for you to decide which path to pick, and which will make you the happiest. The issue of psychiatry being one of the more unorthodox choices doesn't faze me at all. Almost all my colleagues now are psychiatrists. The non-psychiatric doctors I do work with, I work very well with them, and even on a few occasions correctly diagnosed a medical problem they overlooked. Where I did residency, people from the IM department asked me to consider switching from psyche to IM. For that reason none of that "oh you're a psychiatrist" bull that medstudents seem to worry about affects me in the slightest.

Also consider where you are. You're surrounded by people where being a radiologist may have more street cred to them, but later in life that may have no relevance, kinda like how a high school kid with the light up bling shoes is higher up on the social scale. It won't matter years from now. The ultimate judge you have to answer to in the end is yourself.

As for difficulty--while radiology-at least for now is more competitive, things change, trends go up or down. Any field, no matter what field it is has a pool of knowledge you can never hope to entirely master in lifetime. If you want competition to define what field you go into, without thinking of your job satisfaction, that IMHO is a poor measure (not that you specifically are doing this, just that I see this in several medstudents).

Pick the one that will make you feel most satisfied based on a life scale, not on measures that only affect you in the here & now. Whether that will be radiology or psychiatry--best of luck. Do more research into both fields and do some electives in both.

Not even the OB's like OB.

Aw geez. Seems to me that several people in the medical field really are masochists and being in the field is a test of wills on pain tolerance &/or strong obsessive compulsive personality disorder--where they really have to outdo, out-tolerate hardship, one up everybody. It becomes a thing where they pick the most competitive thing just to say they were able to do it without thinking about several other things--like their trophy wife is sleeping with the air conditioner repairman, who in a few short years will be taking half the money that the guy spent 12 years working 100 hrs a week accumulating.

 

[Regnvejr]

.

 

[kugel]

As I entered MS-III, a very kind anesthesiologist told me,
"Stop worrying about finding your niche. Your niche will find you."

I think maybe that's already happened to you.

 

[OldPsychDoc]

Just wondering if anyone has had a similar experience?
...So the problem has been this... I had been really attracted to radiology since second year and really liked the idea of the consultant role, spending each day doing diagnosis, etc. However, I was kinda ambushed by my psych rotation and absolutely loved it. It was definitely my favorite rotation of the entire year. However, I am having some difficulty dealing with some of my own preconceptions.
....

Keep in mind that plenty of what we do in psych is the "consultant role" as well--not just Consult/Liason Psychiatry such as our good friend and esteemed moderator Doc Samson makes a career of, but much of what we do in other psychiatric niches has this quality as well of taking a fresh look at someone's problem and directing them in its management.

 

[notdeadyet]

The first was OB/Gyn, and I loathed the rotation.

Not disputing this, as most people seem to hate their OB/GYN rotation with a passion, but I'm puzzled by it. You get a taste of surgery, but it's all short surgeries, with none of the 8-hours-holding-retractors nonsense. You get patient visit encounters, and it runs the gamut from education/women's health pretty bad pathologies.

I thought for sure I'd hate OB/GYN going into med school, mostly from hearing folks tear it apart on SDN, but I as pleasantly surprised to be really happy with it. Maybe it's just a bad department at a lot of places and my school has a strangely good one.

Not even the OB's like OB.

They were a mixed bunch at my place, running from disgruntled to happy. Pretty much like any other workplace.

Way- choosing between two things you're passionate about is a good problem to have. You'd probably be happy in either.

 

[chameleonknight]

"Not even the OB's like OB"


I wish I could put this on a plaque and mount it on the front of my old med school. 😀

 

[MoodDoc]

When I started med school, the likelihood of me going into psychiatry was a little below that of becoming a tree surgeon. As a first year we had a course where we went out to different venues each week and just talked to patients--one week a spinal cord unit, the next a center for the blind, a psych unit. Each week the group I was in got larger. I asked a friend and he said "we like the questions you ask." I went through my second and third years liking the surgical subspecialties but not identifying well with the attendings in those fields. I wound up feeling much more in tune with the neurologists and psychiatrists. I took a year off between third and fourth year to do research and to give me time to figure out where I would apply for residency. Ultimately, I realized I tended to do more reading in psychiatry than neurology. As was said, the niche finds us.

 

[rpkall]

Ultimately, I realized I tended to do more reading in psychiatry than neurology. As was said, the niche finds us.

Lots of medical students who are interested in "brain" medicine struggle with choosing between psych, neuro, and neurosurgery; I think this boils down to what kind of person you are and what kind of doctor you want to be when you grow up.

Specialists in all these fields generally have an appreciation for how amazing the brain is, how cool neurobiology is, and how interesting the presentations across all those fields can be (from MS to schizophrenia to a subdural bleed).

I always loved behavioral neurobiology and I enjoyed sitting and talking with patients, getting to know them and learning things that no other provider might ever get to know about patients (fears, hopes, dreams, worries, behavioral issues they often find troubling or embarassing)--and I wanted to be able to offer something other than just a procedure or prescription to help. And I enjoyed the relationship, and the nuances of how we as providers can learn to be therapeutic in every interaction with people and in the power of the doctor patient bond.

It sounds counterintuitive, but I actually chose psych because I felt it would give me the tools to offer something besides just medication management for behavioral/mood disorders, which is often the only thing primary care docs can offer (a little zoloft here, a little paxil there, and 15 minutes of their time). Not to say that relationship isn't important and powerful too--but they lack specific tools (and the time to spend with patients) other than meds that can really make a difference (i.e., psychotherapy knowledge and experience).

In med school, I tried to like a lot of other fields BUT psych because I was overly concerned about prestige, money (LOANS!), perception in the medical community, etc. Then I started to see that psychiatry when done well (meds and therapy and longer term relationships with patients) actually can help people live more functional, fulfilling lives. The money turns out actually to be very good, as are employment opportunities (especially for child psychiatry now) and chances for loan forgiveness/repayment from federal and state programs.

What made the difference for me was finding my "medical identity"--which was more than just "what do you want to be when you grow up." It concerns what kind of impact you as a person and physician want to make on your community; what are the values you will stand for as a professional; what is the patient population you love most and wish to advocate for over the course of your career; when other doctors refer their patients to you, what kind of patients do you want to become "expert" in managing--and what kind of education do you want to be able to provide to other doctors in consultation? In short, what do you want to be known for in your community, and among your patients? Do you want to be the ear, nose and throat guy, the one who does great management of migraneurs and epileptics, the expert researcher on amyotrophic lateral sclerosis, the psychiatrist who is gifted when it comes to adolescent drug addicts, or the institution's only brain surgeon with the skills to clip that aneurysm? And what does "being" each of those things mean for your career--your life, both professionally and personally, how you will spend your time, and how much fulfillment will you get from your life?

 

[Doc Samson]

Keep in mind that plenty of what we do in psych is the "consultant role" as well--not just Consult/Liason Psychiatry such as our good friend and esteemed moderator Doc Samson makes a career of, but much of what we do in other psychiatric niches has this quality as well of taking a fresh look at someone's problem and directing them in its management.

Or for even more distance there's forensics where you get to offer a diagnostic opinion without having to broach treatment.

 

[cowboy_x]

I'm ending my 3rd year of psychiatry residency and devoting a great deal of time and energy to choosing a fellowship versus just becoming an attending, and recently received some great advice from one of our department's elders: Do what ever it is that makes you most curious, whatever it is that you can imagine yourself reading about and learning about for the rest of you life.

For me, that meant child psychiatry - but it's a great perspective to use no matter what the choices are.

Good luck!

 

[Faebinder]

Just wondering if anyone has had a similar experience?

At the start of MS-III, there were two rotations that I knew I would have no interest in. The first was OB/Gyn, and I loathed the rotation. Not even the OB's like OB. The second was Psych. I thought I wouldn't like dealing with the "crazy patients" and the "whiny" depressed patients. However, once I got onto the rotation, I realized within about three days that I had a completly inaccurate preconception of what psychiatry is and really liked it.

So the problem has been this... I had been really attracted to radiology since second year and really liked the idea of the consultant role, spending each day doing diagnosis, etc. However, I was kinda ambushed by my psych rotation and absolutely loved it. It was definitely my favorite rotation of the entire year. However, I am having some difficulty dealing with some of my own preconceptions.

I'm competitive for fields like radiology and going into psychiatry is 100% my own choice, but for some reason, I feel like I am struggling with the idea that I totally like psychiatry. Anyone else experience this?

I realize that this may sound somewhat condescending to psychiatry, but please do not take offense. I'm simply stating my own prior ignorance and I have come to realize that psych is a great field. My apologies to anyone who finds my preconceptions offensive.

I went from surgery to psych... never looked back.

How can you... you will soon realize how much you hate being on call and being paged CONSTANTLY. Your kids never see you and your life is miserable. Basically your career sucks you in fully. Psychiatry is a much happier life style and eventually you will realize that and love the field for allowing you to be that way.

I highly suggest you actually do a rotation with an OUTPATIENT psychiatrist if you want to see the real feedback that you wont see in the inpatient units. Consultation liason is also good for decent feedback. Inpatient can be difficult to feed off mentally.

 

[The Long Way]

Thanks for the feedback everone. As I vacillate between psych and radiology, I think that I am starting to settle on psych. Both are great fields, but I am thinking that psychiatry fits my temperment best. I am going to try and schedule an outpatient or mixed outpatient/CL (or some other combination) rotation early this upcoming year. Still one question remains...

Right now when I round on any given rotation, I see general medical things in the chart that I know I should know about, but don't. I am learning slowly, but am constantly immersed in general medical rotations. Probably my favorite areas in my psych rotation were "medicine" heavy (CL, ER, and addiction). In your experiences, did you have enough general medical exposure during psychiatry residency that you could converse with a surgeon or internist about your paitent's medical issues and not be blown off as "just a psychiatrist" and assumed to not know anything about medicine? I have looked and have seen a number of medicine/psych residencies and am considering whether I would want to apply to a program such as these or go straight psych. Also, is there any advantage/disadvantage of going med/psych versus going psych and then doing a CL fellowship?

Thanks in advance for the replies.

 

[sunlioness]

I definitely had and have the medical knowledge to converse with peers in other specialties. Of course that didn't stop some of them from blowing me off anyway. I asked an ED doc to borrow his stethoscope once because I had left mine in the call room and he said, "Yeah, if you know how to use it." 😉 (He said it good humoredly and I actually had a good laugh too.)

I should say that I did an entire internship in internal medicine as this is what I initially matched into so I did have more of that training that my peers who started in psychiatry right out of med school. But I don't think they were at a disadvantage either.

The chair of the department where I did residency is med/psych. I asked him about it once and he said he chose med/psych because it was the "last refuge of the terminally undecided." He practices psychiatry exclusively now and told me that most people who do combined residencies still end up practicing one or the other exclusively when they are done.

 

[OldPsychDoc]

Yesterday afternoon of my 7 revisits, 6 had significant medical Axis III issues as well as their Axis I (and substantial Axis II 🙄) pathologies. (And the 7th is a young man on lithium, so I suppose it's just a matter of time...) These ranged from diabetes to chronic pain, to a history of severe, severe burns. So it was kind of important that I was able to take some history to figure out what has been going on with their medical issues too.

There's plenty of medicine out there in psych.

 

[Regnvejr]

3rd patient on the psych floor came in sicle-cell crisis. There is plenty of medical care in psychiatry

 

[siamesekat]

Your story is similar to mine...Did the whole uber competitive thing, research at Hopkins, yadda yadda. Kinda had the same thoughts as you...but I realized that I didn't want to die of some cancer at an early age or stroke out from the stress. oh well, maybe you can learn from my mistakes. And psych really has a nice lifestyle that a lot of people don't realize. And its the one field where I feel like you really do get to know your patients as people.

 

[stn2006]

Since we are on this path, I am in internal medicine but always wondering if i should switch to psych. unlike me, my wife pretty much wants to go into psychiatry. However, recent event in Oregon make us pondering. Can any practicing psychiatrists shed some light, please?

 

[Regnvejr]

Since we are on this path, I am in internal medicine but always wondering if i should switch to psych. unlike me, my wife pretty much wants to go into psychiatry. However, recent event in Oregon make us pondering. Can any practicing psychiatrists shed some light, please?

Depending on where you are, that's not a problem. Only where there is a psychiatrist on every corner will there ever be real competition. Now, the quality of providers prescribing medications when not trained, that's a whole different story, especially with the psychotropics and their myriad of side-effects and interactions.

 

[sunlioness]

Since we are on this path, I am in internal medicine but always wondering if i should switch to psych. unlike me, my wife pretty much wants to go into psychiatry. However, recent event in Oregon make us pondering. Can any practicing psychiatrists shed some light, please?

We need more psychiatrists. That's WHY things are happening like what happened in Oregon. I wouldn't worry about not being able to find work. 🙂

 

[Regnvejr]

.

 

[surftheiop]

We need more psychiatrists. That's WHY things are happening like what happened in Oregon. I wouldn't worry about not being able to find work. 🙂

Very true, CNN has this "Ask an Expert" website where you can send in questions for MD's , here is a recent one.


"My husband's bipolar disorder was diagnosed several years ago. He has tried several medications and the side effects have far outweighed any benefits. Now he refuses to see a doctor about it because he thinks it's hopeless. Not to mention we have moved and discovered that there are few psychiatrists in the area, and the ones who will take him have a six-month waiting list. Our primary care doctor won't treat him for the bipolar (he asked). It is terrible to see him suffer from this disease without any relief in sight. Any suggestions?"



http://www.cnn.com/2009/HEALTH/expert.q.a/06/09/bipolar.care.frustration.raison/index.html