Best and worst parts of being a psychiatrist

[priorities2]

Just wondering, if you are a psychiatrist, what do you like most/least about your position? =) Would you have decided differently if you could decide again? What would you change about the field?

Thanks!

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[SomeDoc]

Just wondering, if you are a psychiatrist, what do you like most/least about your position? =) Would you have decided differently if you could decide again? What would you change about the field?

Thanks!

Not a Psychiatrist (yet), but a Psychiatrist in training:

What I like most: interacting with my patients, learning about them, and learning about the world around me through them, making a difference if at least at that very point in time that we interact, and seeing them appreciate me spending the extra time. Seeing the human experience in all its glamor, delusions, grandiosity, sadness, happiness and fear... and seeing people recover through stabilization. Knowing that I have saved lives of patients and people in the community, literally, along with the help from my colleagues in the ED and psychiatry ward. The flexibility of the practice options, the work-life balance, the reimbursement, the ability to work 60+ hours if I want to, the specialization, the subspecialization, the patients, the generally more empathetic staff and nursing.

What I like least: hard to think of much really. Most of what I can think of is not unique to psychiatry itself, but has more to do with being a resident (hours, night shifts, learning new systems, etc.), but even then, it isn't too bad. The hours were horrible at times, but intern year was actually enjoyable, for the same reasons above.

Would I decide differently? Heck no.

 

[surftheiop]

I'm still just a preclinical medstudent, but one thing I have been pleasantly surprised by during our preclinical hospital visits is just how appreciative (in general) inpatient psych patients are of the psychiatrists caring for them. Obviously some of this could be due to them understanding the power differential, but it really seems genuine in most cases.

 

[notdeadyet]

I'm still just a preclinical medstudent, but one thing I have been pleasantly surprised by during our preclinical hospital visits is just how appreciative (in general) inpatient psych patients are of the psychiatrists caring for them. Obviously some of this could be due to them understanding the power differential, but it really seems genuine in most cases.

As you advance through medical school or residency, you might see it differently. Unless maybe you stick to private insurance inpatient training, most patients are on holds (there against their will).

 

[surftheiop]

As you advance through medical school or residency, you might see it differently. Unless maybe you stick to private insurance inpatient training, most patients are on holds (there against their will).

Fair point

Seemed like most the residents/attendings spun the story such that the patient felt like it was the courts/legal system holding them there and that the doctors would be advocating for them to leave as appropriate, but would always say something about ultimately the court had to decide. I have no idea if this is borderline dishonest on their part or the standard way of explaining commitment?

Seeing as this was just a random preclinical shadowing/write a little paper thing, I have a super small sample size, probably only saw like 30 patients (one which constantly threatened staff and was on forced meds, so it wasn't all rainbows haha)

But going into it I think I was literally expecting every patient to be trying to take a swing at the attending or sprint out the doors, so was surprised to see how much hand shaking went on haha.

Edit: To anyone using this thread to think about their career, be wary of my thoughts seeing as I'm not in the field and am still trying to figure out for myself if this is what I want to do with my life.

 

[nitemagi]

I wouldn't change a thing. Not much that I dislike about being a psychiatrist, though there's plenty about how the healthcare system works that I can grumble about.

If I were to change the field I would put a lot more resources into preventive psychiatry, teaching resiliency skills, identifying vulnerable youth, and improving access for those that need it before they reach the point of emergency. In general in healthcare in the US we're still playing defense.

 

[whopper]

Agree with Nitemagi. I was thinking of things I didn't like in the field and then all of a sudden I'm thinking this happens in every field. E.g. having to drive in rush-hour traffice, prior authorizations, idiot insurance companies...

 

[vistaril]

As you advance through medical school or residency, you might see it differently. Unless maybe you stick to private insurance inpatient training, most patients are on holds (there against their will).

well on many units there are a number of originally voluntary patients who should have beenh discharged from the ER but weren't(borderlines, opiate addicts, homeless guys crashing from cocaine, etc)

 

[notdeadyet]

well on many units there are a number of originally voluntary patients who should have beenh discharged from the ER but weren't(borderlines, opiate addicts, homeless guys crashing from cocaine, etc)

Weird. My inpatient unit experience has been >90% holds, very few voluntaries.

I think this is probably more of a thing with folks whose programs don't have a dedicated psych ER. If you don't, you probably get EM pressuring you to admit these folks if they cant keep and monitor overnight. None of the types you listed would have had the opportunity for an inpatient admission, but might have a shot of staying in the psych ER overnight.

 

[whopper]

At the private facility I work with, the overwhelming majority are voluntary. In my geriatric unit, the overwhelming are involuntary.

In residency, one outpatient place I worked at had over 70% no shows. This was the place people were referred to directly after discharge without insurance, and many of them were malingerers who made it to inpatient or drug-abusers who just wanted to be hospitalized till they sobered up. When they spent their 2-3 days in inpatient, didn't give a damn to get further treatment when discharged. Another place, less than 5% were no shows. These patients were privately insured and wanted treatment. A lot of what happens depends on the clinical setting.

 

[PikminOC]

This quandary: If we treat the patient,and they commit a crime, it must be because of our medications, as perceived by many in this country. If we can't evaluate the patient before they see a psychiatrist and they commit a crime, that is also a fault of the mental health system.

The public does not understand the limitations psychiatrists have in committing patients and the patient rights including not taking medication.

I have heard of a county inpt facility where there were many NGRI patients who severaly assaulted the staff, and nothing could be done, even press charges. The hospital did not have police and by the time the security guards (armed with walkie talkies and with flashlights) got there, it was too late. They could only medicate patients after they harmed someone, and they almost never got consistent medications (were not approved by the judge for court ordered meds).