Cold Feet

[YOOOUK09]

Anyone else having (or had) cold feet about choosing psychiatry? (I'm not going to change my mind - my aps are in).

I didn't make this choice rashly - I worked as a psych aid for several years prior to med school. And I enjoyed both my 3rd year and 4th year rotations in psych - more so than other areas of medicine.

Cold Feet are probably natural with any major life decision. However, it seems particularly acute with psych b/c of the stigma that everyone's gonna think I'm crazy myself, or that I'm not smart enough to practice real medicine (when I'm actually in the top 1/2 of my class and have better than average board scores).

How do other applicants and more experienced practitioners deal with this stigma when they face it?

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[OldPsychDoc]

Anyone else having (or had) cold feet about choosing psychiatry? (I'm not going to change my mind - my aps are in).

I didn't make this choice rashly - I worked as a psych aid for several years prior to med school. And I enjoyed both my 3rd year and 4th year rotations in psych - more so than other areas of medicine.

Cold Feet are probably natural with any major life decision. However, it seems particularly acute with psych b/c of the stigma that everyone's gonna think I'm crazy myself, or that I'm not smart enough to practice real medicine (when I'm actually in the top 1/2 of my class and have better than average board scores).

How do other applicants and more experienced practitioners deal with this stigma when they face it?

Welcome to the team.

1) Keep in mind that most of the nay-sayers are imaginary.
In reality, your colleagues in other fields will a) envy you for your regular hours in 2 years, and b) run screaming to you for help with their seriously disturbed patients. (Right, Doc Samson?)
2) Surround yourself with like-minded people. We know the world out there doesn't "get" us--but you're going to share this experience with a lot of other people who are like you.
3) Cultivate interests outside of medicine--sports, hobbies, start a rock band in your garage, whatever floats your boat. This will enhance your own sanity.
4) Nurture relationships with people who care about you--not your profession.

Others?

 

[Doc Samson]

Welcome to the team.

1) Keep in mind that most of the nay-sayers are imaginary.
In reality, your colleagues in other fields will a) envy you for your regular hours in 2 years, and b) run screaming to you for help with their seriously disturbed patients. (Right, Doc Samson?)
2) Surround yourself with like-minded people. We know the world out there doesn't "get" us--but you're going to share this experience with a lot of other people who are like you.
3) Cultivate interests outside of medicine--sports, hobbies, start a rock band in your garage, whatever floats your boat. This will enhance your own sanity.
4) Nurture relationships with people who care about you--not your profession.

Others?

Yup... just this morning got called to see an unresponsive "encephalopathic" guy that had already had the (probably literally) million dollar neuro work-up. Within 1 minute, I said "yup, that's catatonia." 15 minutes and a couple of miligrams of IV Ativan later he was sitting up and chatting away, asking for lunch. Team and nurses appropriately awestruck. No stigma here, I prove my worth in cases like these way too often for anyone to turn their nose up at my specialty.

 

[OldPsychDoc]

Yup... just this morning got called to see an unresponsive "encephalopathic" guy that had already had the (probably literally) million dollar neuro work-up. Within 1 minute, I said "yup, that's catatonia." 15 minutes and a couple of miligrams of IV Ativan later he was sitting up and chatting away, asking for lunch. Team and nurses appropriately awestruck. No stigma here, I prove my worth in cases like these way too often for anyone to turn their nose up at my specialty.

Doc Samson brings healing!

 

[Chimed]

I know this will sound corny, but every day (...most every day ) I get to do a job that I love and feel like I'm (usually ) making a positive impact on others. This by itself is enough for me to not give a crap about what others think about psychiatry. Also, the more suffering I see with mental health disorders, the more aware I am of the importance of our field. So, when I go home knowing I was part of a team who helped someone stop being terrified of voices who claim they want to kill my patient or helped alleviate the depression of an 18 year-old girl who wanted to end her life before treatment, I really don't give a rat's ass what others think about psychiatry.

 

[illusenjester]

A lot of people- When* they ask what physician I'd like to be- look down upon my answer in a way. It's kind of embarrasing to tell people I'm interested in psychiatry, because I know immediatly people will think Psychiatry is a freak job/depressing, etc.
So in a way I know how you feel like.

 

[masterofmonkeys]

1. I do get told by a lot of people that most of the shrinks they know are crazy. Whatever.

2. I'm often told I'm 'too smart' or 'too competitive' to go into psychiatry. Sometimes I just chuckle and say thanks. Other times I say that the brain is the most complex and difficult to understand structure in the body. The only thing in the body whose physiology even comes close is the heart. Just because the best and brightest don't necessarily go into psychiatry doesn't mean it's not the most potentially intellectually challenging aspect of medicine.

 

[BobA]

Welcome to the team.

1) Keep in mind that most of the nay-sayers are imaginary.
In reality, your colleagues in other fields will a) envy you for your regular hours in 2 years, and b) run screaming to you for help with their seriously disturbed patients. (Right, Doc Samson?)
2) Surround yourself with like-minded people. We know the world out there doesn't "get" us--but you're going to share this experience with a lot of other people who are like you.
3) Cultivate interests outside of medicine--sports, hobbies, start a rock band in your garage, whatever floats your boat. This will enhance your own sanity.
4) Nurture relationships with people who care about you--not your profession.

Others?

This is awesome advice!

 

[marie337]

1. I do get told by a lot of people that most of the shrinks they know are crazy. Whatever.

2. I'm often told I'm 'too smart' or 'too competitive' to go into psychiatry. Sometimes I just chuckle and say thanks. Other times I say that the brain is the most complex and difficult to understand structure in the body. The only thing in the body whose physiology even comes close is the heart. Just because the best and brightest don't necessarily go into psychiatry doesn't mean it's not the most potentially intellectually challenging aspect of medicine.

Yes, I too have been told that I'm too smart for psychiatry. I think this is the most absurd thing to say! They'll be the first people paging me to take care of their psychotic patients.

 

[whopper]

Just because the best and brightest don't necessarily go into psychiatry doesn't mean it's not the most potentially intellectually challenging aspect of medicine.

Its true that there are fields that only accept the best & brightest medstudents, & psychiatry is not one of them--E.g. Dermatology, and the appeal to many there is simply the pay & lifestyle, not an interest in the skin, or a choice to advance the field.

If you go into a field because you love it, want to advance it & want to sincerely treat patients as part of your Hippocratic Oath, that trumps anything else.

Yes, I too have been told that I'm too smart for psychiatry. I think this is the most absurd thing to say!

Tell that to Eric Kandell--Nobel prize winning Psychiatrist.
I bet the person who told you that you are too smart don't hold a candle to Kandell.

I do get told by a lot of people that most of the shrinks they know are crazy. Whatever.

Truth be told the demographic doctor that I find with the most amount of people finding personality faults with them are surgeons & Ob-Gyn doctors.
And while I do not know of any hard data that can support a theory as to why, I have my own. They work very demanding hours. Almost every surgeon & Ob-Gyn doctor I've seen worked hours that would make anyone have a very thin patience. (anticipating getting a surgery or Ob-Gyn attending or resident being upset with my statement)

 

[BlondeDocteur]

Fyi it's not like that everywhere-- at Columbia psychiatry is extremely well-respected. We send 10-12 students in every year and usually at least 2-3 are AOA and among the most impressive people in the class. The psychiatrists we work with are brilliant, compassionate people and every medical student is wowed by the rotation; the residents/docs in the hospital who interface with the C-L service are equally impressed. I'm sure New York in general, and Columbia specifically, is a special case (since the stigma against psychiatric treatment is basically non-existant for the upper middle class and upper class), but I just wanted to give you all hope.

 

[OldPsychDoc]

Its true that there are fields that only accept the best & brightest medstudents, & psychiatry is not one of them--

"Best and brightest" in what way? MCATs and USMLE scores--well maybe, if you are into reducing people to numbers on a standardized scale, we aren't on the same level as derm or neurosurg. But there's way more to being "best" I think, and I've certainly known many docs with "numerical brightness" who have proven themselves to be flat-out dumb in clinical judgment. One might argue that the personality problems with many ob-gyns and surgeons reflects the selection of those who excel "by the numbers" without valuing (and sometimes actively discouraging) the human aspects of medicine.

I played the pre-med GPA game long enough. My wife thinks I'm the best , my patients think I'm pretty smart, my friends respect what I do. That makes for a pretty good day at the office, I think.

 

[Spiderwoman]

In my case, I decided to apply to psych just because it is the best choice for me and I have what it takes to be a good psychiatrist( after lots of training). Which is knowledge and true care. I am coming from another residency. In my experience, comparing attendings, and residents in psych with attending and residents of other fields ( family practice, pediatric, and OB GYN ), You see more balanced, intelligent, polite, and professional people in psych. I don't know which one came first: psychiatry training or well rounded, highly intellectual charactristics! That is enough for me. I don't care what other people say about my choice of career. They don't live my life. That may be easy for me to say, since my family supported my choice. I have very nice scores too, but I am more than those numbers! This is a real life experience: Do what you enjoy!

 

[YOOOUK09]

These are all great points. I like the notion that most of the naysayers are imaginary - that's probably very true. Actually, just the fact that I care about a stigma probably says more about my own competitive nature than other peoples!!

Any perceived "stigma" might also be extra fuel to go the extra mile in patient care. That's really the ultimate yardstick of performance.

 

[masterofmonkeys]

I will say that although I've known psychiatry was one of two or three things I'd go into since I was in high school (and the only medical specialty I've ever really considered), it was only a few months ago that I stopped considering triple-board or med/psych.

I am very good at 'real' medicine/peds and I really really love it. Never considered going into anything but psych all the same, but I enjoy being competent in the stuff. So perhaps the hardest thing about going psych for me, stigma-wise, is the idea that people wouldn't trust my opinion on general medical issues.

I enjoy the 'student consults' and even the questions I get from residents and attendings as to what *I* would do for a patient medically.

I finally decided that I didn't need a board certification and extra training to validate the knowledge that I already have and will continue to develop throughout my career. Gyn-Oncs aren't boarded in medicine and at least at my institution they are respected for their ability and desire to treat medical issues themselves.

If I don't consult Medicine every time someone's blood sugars are out of control, they develop trace edema, or have decreased breath sounds in the right lower lung field, then that's all I need. Like the time I was on psych wards and a patient's CBC revealed teardrop cells and I knew to get a peripheral blood smear and if indicated by the hematopathologist, get hem/onc to consult for a bone marrow biopsy. Instead of 'consult medicine' which was the residents' plan.

 

[Still Kickin]

Awhile back someone said something along these lines to me: "But you could go into any specialty that you want... Why are you going into Psychiatry?" (This was in the context of a "you're too smart for Psychiatry" type conversation.)

I simply smiled and said, "Yes, that's right. I can go into whatever I want. And what I want to go into is Psychiatry."
(That shut them up!)

 

[whopper]

"Best and brightest" in what way? MCATs and USMLE scores--well maybe, if you are into reducing people to numbers on a standardized scale, we aren't on the same level as derm or neurosurg

Yes-exactly in that way.

Reducing people into those scores I agree too is not anywhere a close measure to the quality of a doctor. I've seen people score extremely well on MCATs & USMLEs & had poor clinical skills.

However & its unfortunate, several of the more competitive & more respected institutions completely break it down into these factors.

IMHO, the USMLE is a poor method to test someone. I scored in the highest percentage one could possibly score in the CSA section of Step III and didn't do so hot on the multiple choice questions. That CSA section didn't exist some time ago. If the USMLE is such a good & valid exam, well the older format & the newer format would've had me scoring very differently.

I was in Psi Chi-National Honor Society for Psychology, among several other honors as a psychology undergrad-& scored the lowest one could possibly score in the behavioral section of USMLE Step I, but scored in the highest section one could score in Pulmonology. Go figure. I didn't think I knew anything about pulmonology more than the next medstudent but though I knew much more in the behavioral sciences.

Anyway, sorry for the rant.

 

[GATORANALYST]

Anyone else having (or had) cold feet about choosing psychiatry? (I'm not going to change my mind - my aps are in).

I didn't make this choice rashly - I worked as a psych aid for several years prior to med school. And I enjoyed both my 3rd year and 4th year rotations in psych - more so than other areas of medicine.

Cold Feet are probably natural with any major life decision. However, it seems particularly acute with psych b/c of the stigma that everyone's gonna think I'm crazy myself, or that I'm not smart enough to practice real medicine (when I'm actually in the top 1/2 of my class and have better than average board scores).

How do other applicants and more experienced practitioners deal with this stigma when they face it?

If your so worried about stigma's then go for ER, PMR, or GAS. There is always going to be a stigma with psych so it may be tough for you to deal with.
I love my job and was never worried about the "stigma" associated with psych.

 

[michaelrack]

Although attracted to psychiatry, I was worried about the stigma and didn't want to lose my general medicine skills. I therefore did a med/psych residency. I became interested in sleep during residency, and did a sleep followship afterwards.

If med/psych wasn't available, I probably would've done a medicine residency alone and would now be a burnt-out primary care doc.

 

[EFesta77]

I'm in the surgery clerkship right now, and when they ask us what we want to do with our lives, I always tell them the truth and say psych. Then you get that look, and they tell you "oh, that's interesting." My chief resident actually asked me if I was going to "waste my grades and step scores on psych?"
I normally just nod and say nothing. They act like they are so happy to be in surgery, but I can see in their faces they are miserable most of the time. But people have to defend their choices....
I always hear about residents switching our of surgery to psych...but never the other way around

 

[masterofmonkeys]

one of my attendings on surgery was by far the most encouraging and supportive attending i told. Was pretty funny since I was the only one who told teh truth anddidn't claim I was thinking about doing surgery. And was the only one who didn't get yelled at.

 

[billypilgrim37]

When I told the surgeons I was thinking about psych or OB, they made fun of OB much more than psych.

There's always something worse

 

[whopper]

When I told the surgeons I was thinking about psych or OB, they made fun of OB much more than psych.

I've seen every field knocked by others.

The IM docs knock the surgeons for simply just cutting & sewing up people. Where I've worked the surgeons would always put down the wrong orders when the patient was stepped down from surgery to IM. That always ticked off the IM docs. The psychiatrists would complain about the surgeons who "medically cleared" patients from surgery who were still internally bleeding but since it is the surgeon, not the psyche doc who determined medical clearance, the psychiatrist had to order a consult & wait 24 hrs until that bleeding patient got seen again by a surgeon or use the nuclear option & call risk management which ticks off everybody in that chain of command.

The inpatient doctors made fun of the outpatient doctors for too easily referring to inpatient. The outpatient doctors knocked the inpatient doctors for discharging the patient too readily & not providing them with good histories.

Most of the OB-Gyn docs I've worked with were concerned with malpractice to the point where it was almost a daily rant, they worked crazy hours & several of them were real easy to set off. I actually competely sympathized with them because I agree that their hours are crazy & the malpractice situation in that field is unfair--yet it did create a pattern of negative behavior often seen by them (at least at the hospital I was at).

 

[marie337]

I went to my first big family function yesterday since officially deciding on psychiatry. I have to say the reception has been amusing. Most people just want to make sure I'll take their insurance . Then they ask me to tell them more about the field and what I enjoy about it. I've been pleasantly surprised by the lack of stupid comments.

 

[silenthunder]

the stigma is a terrible, terrible thing. but as far as I can see its always going to be there...

I'm an MS4 applying to psychiatry this year.

I would like to say I've heard it all - but I'm pretty sure I'll hear different variations on the stigma for the rest of my life.

I still get from my parents : "you wanna deal with those CRAZY people for the rest of your life!?!"

I got from the superintendant of a state psychiatry facility: " be prepared for a number of people to tell you that you are NOT a real doctor"

I got from a non-medical friend of mine: " oh I wouldn't expect you to know about my moms hypertension meds because you want to be a psychiatrist"

got from an IM resident (this one almost made me laugh, just because of how really, really dumb it was): "don't ask him about strokes - he just wants to go into psychiatry "

One thing I don't think alot of people realise about psychiatry is that the lifestyle is good.

as for the OP : 'cold feet'

yeah I've had thoughts that run along the lines of 'cold feet'. Funny how alot of it involves some of the same stuff that is involved in the stigma afflicting psych. one of the ones I've voiced out loud was :

" I went through 4 years of med school, to be followed by 4 years of residence, just so that I can be seen as HALF a doctor!!! "

I used to think I was in a tough bind, not knowing if I really, really want to do psych. Now I'm of the mind that I'll hopefully land a residence in it, and if I hate it, then I'll have to figure it out at that point. (please don't confuse this with me just taking a spot to land ANY residence spot. I like psych - and I really do want to make a go of it. but how can we REALLY know what its like until we're actually DOing it?)

sorry to ramble like this,

Cheers,

Silenthunder

 

[fotolilith]

"Best and brightest" in what way? MCATs and USMLE scores--well maybe, if you are into reducing people to numbers on a standardized scale, we aren't on the same level as derm or neurosurg. But there's way more to being "best" I think, and I've certainly known many docs with "numerical brightness" who have proven themselves to be flat-out dumb in clinical judgment. One might argue that the personality problems with many ob-gyns and surgeons reflects the selection of those who excel "by the numbers" without valuing (and sometimes actively discouraging) the human aspects of medicine.

I played the pre-med GPA game long enough. My wife thinks I'm the best , my patients think I'm pretty smart, my friends respect what I do. That makes for a pretty good day at the office, I think.

Wait, your friends respect you? MY HERO!

 

[OldPsychDoc]

Wait, your friends respect you? MY HERO!

Yeah, I just wish my kids did, though...

 

[marie337]

I have to say, I've recently had several attendings (neurosurgery, radiology) ask me what I want to do when I grow up. I've had surprisingly good feedback from them when I tell them I'm going into psychiatry. I keep waiting for them to roll their eyes or make a snide comment. I actually had a deep conversation with a radiologist about the genetic basis of psychiatric illness and one neurosurgeon asked me my opinion about how he handles patients who are opioid dependent. I've been pleasantly surprised!

 

[BobA]

That's funny just a few days ago a family friend who's a neurosurgeon was genuinely trying to offer me heartfelt advice about why I shouldn't enter psych:

"you know I don't think you'll ever cure anyone" he said.

I'm not sure if he's been on his own service's rounds lately or what (most neurosurgery patient here look pretty bleak).

He also had to add some snide comment about how shrinks are as crazy as their patients. . .

. . . but without getting into it, he's not exactly someone who I'd let dictate my life.

 

[nancysinatra]

That's funny just a few days ago a family friend who's a neurosurgeon was genuinely trying to offer me heartfelt advice about why I shouldn't enter psych:

"you know I don't think you'll ever cure anyone" he said.

I'm not sure if he's been on his own service's rounds lately or what (most neurosurgery patient here look pretty bleak).

He also had to add some snide comment about how shrinks are as crazy as their patients. . .

. . . but without getting into it, he's not exactly someone who I'd let dictate my life.

Whoa, in my hospital, neurosurgery is WAY below psychiatry on the totem pole of inter-departmental ridicule. I even heard some plastics guys complaining once about the poor social skills and general unavailability of the neurosurgeons. And their handwriting is, of course, totally deplorable. When plastics is complaining that way, you know that's bad!

Maybe it is different at other hospitals. I'm picturing these really well adjusted, friendly neurosurgeons walking around, being nice to all the families and to the patients for the .00001 seconds they are reputed to see them, and writing nice lovely notes that actually tell you what they did. Ahhh...

 

[BobA]

Whoa, in my hospital, neurosurgery is WAY below psychiatry on the totem pole of inter-departmental ridicule. I even heard some plastics guys complaining once about the poor social skills and general unavailability of the neurosurgeons. And their handwriting is, of course, totally deplorable. When plastics is complaining that way, you know that's bad!

Maybe it is different at other hospitals. I'm picturing these really well adjusted, friendly neurosurgeons walking around, being nice to all the families and to the patients for the .00001 seconds they are reputed to see them, and writing nice lovely notes that actually tell you what they did. Ahhh...

I guess some things are different at different hospitals. Here plastics are super nice (they don't carry a large service, esp compared to neurosurgery).

But neurosurgery certainly doesn't take any time to explain anything to anyone - in all fairness they work extremely hard carrying a huge census and operating 12hrs a day.

Getting back to the OP, I wish people could just respect psych as a worthy profession. . . .

sometimes when I encounter the naysayers I have the fear that they know something that I don't. That psych is in reality some horrible profession I should let them save me from. But that's not true at all. Stigma has ignorance at it's root. The psych naysayers are operating out of ignorance and fear and the truth is that I know something they don't.

 

[marie337]

sometimes when I encounter the naysayers I have the fear that they know something that I don't. That psych is in reality some horrible profession I should let them save me from. But that's not true at all. Stigma has ignorance at it's root. The psych naysayers are operating out of ignorance and fear and the truth is that I know something they don't.

You will run into naysayers about every field. It seemed like every rotation in 3rd year was spent discussing why every other rotation was a waste of time. Every one thinks they're chosen specialty is the best. I guess this is good. It means people like their jobs. I do agree that people who knock psychiatry probably don't really understand what the specialty is all about.

I've decided that when I'm an attending and someone I meet asks me casually what I do, I will say "I'm a physician." Then they can ask me to clarify and we'll have a discussion. I'm already a little tired of explaining the difference between psychologists and psychiatrists. I think the 2 specialties should have titles that are more differentiable to lay people.

 

[Faebinder]

Some of the stigma of psychiatry can be fixed by first giving ECT a different name... since we no longer do ECT without anesthesia and muscle relaxants.. it has become a much much much gentler procedure. We should call it.. ENCT (electro non-convulsive therapy). That way people watching bad old movies like One flew over the Kukou's nest, they will stop associating psychiatrists with old practices. Most people who watch it will not register in their mind that in that same old time they used to do surgeries with little anesthesia and barely any antibiotics...

Anyhow.. regarding the notority of psychiatry... it's the whole reason why psychiatry has a solid position in the medical field and a nice life style.. Not too many want to do it... otherwise we'd find people dying to get into it. In other words, your job is guaranteed... Schizophrenics/Bipolars and the rest of Axis I disorders are just not going to go away.

 

[marshmallows]

You will run into naysayers about every field. It seemed like every rotation in 3rd year was spent discussing why every other rotation was a waste of time. Every one thinks they're chosen specialty is the best. I guess this is good. It means people like their jobs. I do agree that people who knock psychiatry probably don't really understand what the specialty is all about.

I've decided that when I'm an attending and someone I meet asks me casually what I do, I will say "I'm a physician." Then they can ask me to clarify and we'll have a discussion. I'm already a little tired of explaining the difference between psychologists and psychiatrists. I think the 2 specialties should have titles that are more differentiable to lay people.

i feel the same way when people ask me, oh whats the diff between psychology and psych.. unfortunately due to the Hx of psych laypeople often don't know that psych docs go med school and do 4 years residency,(1 more than more than the other primary care specialties).. once they hear all that or know it, or i explain it to them, they usually go, oohh.. and then change their stance. but i really think most of Psych/s stigma is due to a sometimes unfortunate misrepresented mainstream hx of it..

 

[masterofmonkeys]

fear of what we don't understand often breeds ridicule.

 

[notdeadyet]

fear of what we don't understand often breeds ridicule.

Do you really think?

I'm sure there are some pretty ignorant med students/doctors out there. But I think most people who turn their nose up at Psychiatry do that because it's just not for them.

I know that when someone mentions they're a surgeon, my instinct is to say, "Ugh, why?" because it's not for me. I don't because of experience and manners.

I think the folks who say, "Ugh, psychiatry???" are more guilty of bad manners than ignorance.

 

[BobA]

Do you really think?

I'm sure there are some pretty ignorant med students/doctors out there. But I think most people who turn their nose up at Psychiatry do that because it's just not for them.

I know that when someone mentions they're a surgeon, my instinct is to say, "Ugh, why?" because it's not for me. I don't because of experience and manners.

I think the folks who say, "Ugh, psychiatry???" are more guilty of bad manners than ignorance.

As a junior PA consulting my seasoned ID attending said today, "I respectfully disagree." He left her something like 35 recommendations after that. A good learning point for me - don't disagree with your consultants, either learn from them, or communicate better with them. (In the PA's case she hadn't explained the situation well).

I think people are genuinely freaked out by some of psych - Freud, for example, was pretty strange. And old-style ECT. . . Historically there's some freaky stuff about psych. I think Big-Pharma's influence on research is even creepy now (since psych meds are mind (soul?) altering medications). . . I think the ignorance that it's somewhat beyond that - more biological now and less Fruedian, for example - causes people to attach a stigma to psych.

If it were just bad manners, why do people only react that way to psych? Most people who react negatively when I tell them I'm going into psych would react much more positively if I said I was going to be a rectal surgeon, or nephrologist (which to me is about as "eww" as I could imagine). I think there's something specifically about psych that they don't like, and it might be related to psych's admittedly creepy past (and present)

 

[Doc Samson]

As a junior PA consulting my seasoned ID attending said today, "I respectfully disagree." He left her something like 35 recommendations after that. A good learning point for me - don't disagree with your consultants, either learn from them, or communicate better with them. (In the PA's case she hadn't explained the situation well).

I think people are genuinely freaked out by some of psych - Freud, for example, was pretty strange. And old-style ECT. . . Historically there's some freaky stuff about psych. I think Big-Pharma's influence on research is even creepy now (since psych meds are mind (soul?) altering medications). . . I think the ignorance that it's somewhat beyond that - more biological now and less Fruedian, for example - causes people to attach a stigma to psych.

If it were just bad manners, why do people only react that way to psych? Most people who react negatively when I tell them I'm going into psych would react much more positively if I said I was going to be a rectal surgeon, or nephrologist (which to me is about as "eww" as I could imagine). I think there's something specifically about psych that they don't like, and it might be related to psych's admittedly creepy past (and present)

This is true of all of medicine - surgery without anesthesia, leeches, poultices - they're all pretty creepy.

While advances in the biological underpinnings of psychiatry are important, we shouldn't be distancing ourselves from psychodynamic theory just to enhance our image as "real" doctors. Psychotherapy is "real" medicine.

 

[masterofmonkeys]

This is true of all of medicine - surgery without anesthesia, leeches, poultices - they're all pretty creepy.

While advances in the biological underpinnings of psychiatry are important, we shouldn't be distancing ourselves from psychodynamic theory just to enhance our image as "real" doctors. Psychotherapy is "real" medicine.

smooches.

It's time to get rid of mind-brain dualism.

 

[BobA]

This is true of all of medicine - surgery without anesthesia, leeches, poultices - they're all pretty creepy.

While advances in the biological underpinnings of psychiatry are important, we shouldn't be distancing ourselves from psychodynamic theory just to enhance our image as "real" doctors. Psychotherapy is "real" medicine.

I agree - I'm not pushing a biologic agenda.

I actually don't understand why there's such a big debate between biologic vs. psychodynamic anyway.

Some injuries are best healed one way, some another. Sometimes my old injured joints need surgery, sometimes they need PT, sometimes they need both. It's not an argument - just different treatment modalities for different ills.

I had happened to have caught a biography of Freud on A&E yesterday, and he was pretty creepy so it was on my mind. I shouldn't free-associate on the boards.

 

[whopper]

Stigma has ignorance at it's root.

I've seen bad psychiatrists, but I've also seen bad ER doctors, surgeons, IM docs, what have you.

I remember one of my IM attendings during medschool told me not to go into psychiatry because he said the field would be dead in 1 year, claiming that there was going to be some type of advance in meds that would cure all mental illness.

Geez-now there's a delusional statement. Awfully unprofessional for an attending to say something that was not true, with no basis for it, and there's nothing even close that he could've mistaken it for.

I've noticed that many of the attendings I've seen who have criticized psychiatry don't know what they're talking about.

Besides, I've also seen people cut up other medical fields. Just as medical students, your exposure is mostly to IM. From my experience, Family Practice & Ob/Gyn docs I've seen love the psychiatrists that work with them, because in these fields there's plenty of mental health issues, & the psychiatrist knows more about it than the other 2 fields. Those docs are very appreciative to have one working with them.

 

[BabyPsychDoc]

Yeah, I just wish my kids did, though...

as long as they don't hate you, you can count yourself lucky

 

[BabyPsychDoc]

I actually don't understand why there's such a big debate between biologic vs. psychodynamic anyway.

Money and influence.

 

[nancysinatra]

I actually don't understand why there's such a big debate between biologic vs. psychodynamic anyway.

Here is what I think is funny--as far as "biologic" psychiatry--what exactly IS it? Does it mean using drugs instead of psychotherapy? Well then, would someone please tell me, in a very specific chemical way, how all those psych meds work? Of all the specialties I've rotated through in med school, it's in psychiatry that I've gotten the least "biological" sense of what causes the illnesses and how medications actually treat them, and this applies to the drugs as much as it does to psychotherapy. Right now I am doing neurology, and there there is no doubt what "biological" means. It means you do a physical exam and a mental status exam, and you look up on an MRI or some other test what's wrong in the patient's nervous system, and then you fix that particular part OF the nervous system with a specific treatment whose mechanism is either known or unknown. If it's unknown, then research is geared toward discovering its mechanism, not toward discrediting it! It seems to me that in psychiatry, similarly, we should be devoting our time to figuring out how both drugs and psychotherapy actually work.

Now I am just wondering--are there ANY psych meds whose mechanism, from beginning to end, is completely understood? I was going to say benzos--since we know their receptor mechanism. But how do they actually reduce anxiety? Maybe I'm blanking right now, but I can't think of any psych drugs that are so well understood they could clearly be hailed as that much more "biological" than psychotherapy! Unless the definition of biological is "goes in the mouth" as opposed to non-biological being "goes in the ear." Because beyond that, what do we actually know scientifically about these treatments?

More "effective" I could understand--if indeed it is true. But if I'm correct that's not exactly been proven either. These turf wars seem like a distraction from science and from patient care to me. I just don't see this going on in other areas of medicine--like in surgery, you don't see them saying, let's STOP doing open surgeries now just because we CAN do laparoscopic now. They do them both, sometimes in combination, depending on what's best for the patient. It's not like the whole field had to go out and have an identity crisis over the matter.

 

[Faebinder]

There is definately inta-specialty issues... I feel that in the future the biological aspect of the field will sooner or later overwhelm the psychodynamic aspect. The psychodynamic goes well for Axis II but is no way near enough for Axis I... vica versa for biological with Axis I and Axis II.

 

[Doc Samson]

There is definately inta-specialty issues... I feel that in the future the biological aspect of the field will sooner or later overwhelm the psychodynamic aspect. The psychodynamic goes well for Axis II but is no way near enough for Axis I... vica versa for biological with Axis I and Axis II.

Depends on what you're listing on axis I. Schizophrenia? Then I agree. Generalized anxiety? Probably equal. Conversion DO? I'd opt for therapy.

Meds will only "overwhelm" psychotherapy in terms of our practice if we are complicit in allowing it to happen.

 

[Faebinder]

Depends on what you're listing on axis I. Schizophrenia? Then I agree. Generalized anxiety? Probably equal. Conversion DO? I'd opt for therapy.

Meds will only "overwhelm" psychotherapy in terms of our practice if we are complicit in allowing it to happen.

Until we find none addictive drugs that can put down general anxiety and have high efficacy. Pharm companies are working on it i am sure....

IMO Conversion DO and Malingering should go to Axis II but i am sure we wont do that due to reimburisement.

 

[marshmallows]

Here is what I think is funny--as far as "biologic" psychiatry--what exactly IS it? Does it mean using drugs instead of psychotherapy? Well then, would someone please tell me, in a very specific chemical way, how all those psych meds work? Of all the specialties I've rotated through in med school, it's in psychiatry that I've gotten the least "biological" sense of what causes the illnesses and how medications actually treat them, and this applies to the drugs as much as it does to psychotherapy. Right now I am doing neurology, and there there is no doubt what "biological" means. It means you do a physical exam and a mental status exam, and you look up on an MRI or some other test what's wrong in the patient's nervous system, and then you fix that particular part OF the nervous system with a specific treatment whose mechanism is either known or unknown. If it's unknown, then research is geared toward discovering its mechanism, not toward discrediting it! It seems to me that in psychiatry, similarly, we should be devoting our time to figuring out how both drugs and psychotherapy actually work.

Now I am just wondering--are there ANY psych meds whose mechanism, from beginning to end, is completely understood? I was going to say benzos--since we know their receptor mechanism. But how do they actually reduce anxiety? Maybe I'm blanking right now, but I can't think of any psych drugs that are so well understood they could clearly be hailed as that much more "biological" than psychotherapy! Unless the definition of biological is "goes in the mouth" as opposed to non-biological being "goes in the ear." Because beyond that, what do we actually know scientifically about these treatments?

More "effective" I could understand--if indeed it is true. But if I'm correct that's not exactly been proven either. These turf wars seem like a distraction from science and from patient care to me. I just don't see this going on in other areas of medicine--like in surgery, you don't see them saying, let's STOP doing open surgeries now just because we CAN do laparoscopic now. They do them both, sometimes in combination, depending on what's best for the patient. It's not like the whole field had to go out and have an identity crisis over the matter.

i agree, and think a lot of the identity crisis is due to the misrepresntation of psych by other specialties mostly based on ignorance. there are alot of medicine drugs whom we don;t know the exact mechanism of action. i mean we know a lot of why some antihypertensive control someones HTN well enough.. but when the same medicine may have less of an effect on someone else (assuming the same age, sex, stress, compliance, exercise, diet etc..) and that person has to have additional meds, to control their disease you dont have people debating the History of the specialty and the medication; as they do in psych when the meds and therapy do work or help...we still have many people who lov to attack and criticize psych based largely on their lack of experience and knowledge of it.

 

[masterofmonkeys]

Depends on what you're listing on axis I. Schizophrenia? Then I agree. Generalized anxiety? Probably equal. Conversion DO? I'd opt for therapy.

Meds will only "overwhelm" psychotherapy in terms of our practice if we are complicit in allowing it to happen.

And you know, greater efficacy for depression, preferred in adjustment, EXTREMELY helpful in reducing the use of acute sedative/anxiolytics for anxiety/panic, and having a reduction effect on cardiovascular morbidity than any psych drug can even begin to touch.

Thoughts and emotions are chemical phenomena. Psychotherapy is ultimately about strengthening certain synaptic connections and weakening others.

To give a very valid analogy given that they're both electrically active tissues that unlike other biologic systems use a combination of negative AND POSITIVE feedback, would anyone argue that anabolic steroid, mTOR inhibitors, or selective cortisol receptor modifiers to build muscle are 'biological' while weight-lifting is not?

If we allow the 'biologic' perspective to overwhelm the 'psychotherapy' perspective we do our patients a huge disservice, in that we tell them that they lay hostage to their brains.

 

[Still Kickin]

would anyone argue that anabolic steroid, mTOR inhibitors, or selective cortisol receptor modifiers to build muscle are 'biological' while weight-lifting is not?

This is a TERRIFIC analogy! (I'll have to remember this one for future reference...)