Cold Feet

[Red Beard]

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Agree with above: the bio vs. psychotherapy argument becomes a false dichotomy when you start to quantify the biological effects of psychotherapy. Psychology, psychotherapy, and psychopharmacology are all part of the same neurophysiology, whether we understand the exact mechanisms yet or not.

I went to a very interesting talk today on the neurobiology of early life trauma. Data suggesting that CBT induces measurable cortical and hippocampal growth and activity by CT and fMRI, while other data suggests psychopharmacologic benefits may be due to effects in the amygdala. This might explain why psychotherapy and drugs are often seen to work in a synergistic fashion. Drugs calm the aberrant arousal, allowing CBT to more easily act as a sort of 'cognitive weight lifting', essentially beefing up the brain's ability to cognate on stimuli rather than go straight to fight or flight.

The stuff about trauma causing lifelong arousal and its effects on health--insulin resistance, decreased immune function, etc.....very relevant and useful clinically.

This is what makes psychiatry such an interesting field to me right now, we are making huge leaps in our understanding of how all this stuff works, and I think some of the new tools like fMRI, transcranial magnetic stim, etc. could really open up amazing new doors, real cutting edge stuff to be a part of in the next decade or two. I suspect we are not far from having awesome new objective diagnostic tools for many psych illnesses that will really invigorate the field.

But anyway....getting late here, have a presentation to work on!

 

[nancysinatra]

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

Along those same lines, what about physical therapy? It's a huge part of inpatient and outpatient treatment plans on the surgery, neuro, medicine, ortho, pm&r services, etc., and you don't see those specialties going crazy debating its biological utility. If anything, you see them embracing it eagerly, because it moves patients out the door faster. Also it seems to be valued BECAUSE it's less reliant on drugs, which means less side effects, and leaves the patient more independent in the long run...

 

[YOOOUK09]

So I'm still having cold feet about going into psych. Again, this is in-line with my personality (freaked out before college, before med school, and not surprisingly now before residency). Psych seems like the best option - partly because I do actually like most of it, but also because it's the least objectionable (for me that means it has controllable hours, which is critical for me) . . . but there are so many options!! I'm also thinking EM, Heme/Onc, even hospitalist or neuro. . .

I've had interviews at some places I think I might like, and it seems the most realistic thing for me to do at this point is to go ahead and try psych and probably I'll like it. I've once had this explained: it's like you have an ice cream cone in each hand - one chocolate, one vanilla - and can't decide which to eat. Once you try either one you'll realize that you like it. You're just stuck in indecision. . . . and like the mule choosing between two bales of hay, I could be stuck in indecision long enough to starve! (that's a joke).

A second option for me at this point would be to "take a research year" and stop med school 1/2way through fourth year and get plugged into a research project at my school (people do this routinely so I don't think it'd be too difficult to work out), and re-apply next cycle. That would give me a few more months at least to sort things out (basically Psych, vs. EM, vs. IM). The advantage would be that I would be more confident in choosing my career path. And hopefully I'd avoid the dreaded switching residencies.

Should I go for psych or take a research year?

Thanks!

 

[masterofmonkeys]

I went to a very interesting talk today on the neurobiology of early life trauma. Data suggesting that CBT induces measurable cortical and hippocampal growth and activity by CT and fMRI, while other data suggests psychopharmacologic benefits may be due to effects in the amygdala. This might explain why psychotherapy and drugs are often seen to work in a synergistic fashion. Drugs calm the aberrant arousal, allowing CBT to more easily act as a sort of 'cognitive weight lifting', essentially beefing up the brain's ability to cognate on stimuli rather than go straight to fight or flight.

I've long argued that antidepressants and anxiolytics should best be viewed not as treatment but symptomatic management. *shrug*

 

[Doc Samson]

So I'm still having cold feet about going into psych. Again, this is in-line with my personality (freaked out before college, before med school, and not surprisingly now before residency). Psych seems like the best option - partly because I do actually like most of it, but also because it's the least objectionable (for me that means it has controllable hours, which is critical for me) . . . but there are so many options!! I'm also thinking EM, Heme/Onc, even hospitalist or neuro. . .

I've had interviews at some places I think I might like, and it seems the most realistic thing for me to do at this point is to go ahead and try psych and probably I'll like it. I've once had this explained: it's like you have an ice cream cone in each hand - one chocolate, one vanilla - and can't decide which to eat. Once you try either one you'll realize that you like it. You're just stuck in indecision. . . . and like the mule choosing between two bales of hay, I could be stuck in indecision long enough to starve! (that's a joke).

A second option for me at this point would be to "take a research year" and stop med school 1/2way through fourth year and get plugged into a research project at my school (people do this routinely so I don't think it'd be too difficult to work out), and re-apply next cycle. That would give me a few more months at least to sort things out (basically Psych, vs. EM, vs. IM). The advantage would be that I would be more confident in choosing my career path. And hopefully I'd avoid the dreaded switching residencies.

Should I go for psych or take a research year?

Thanks!

How will you be any more confident in choosing your career path? One thing to bear in mind is that Psychiatry PDs tend to be more supportive of their residents switching specialties than IM or ED (obviously there are exceptions on both sides, but that's the trend that I've seen).

 

[masterofmonkeys]

why not start psych? By the middle or end of your PGY1 you'll have experienced both internal med and ER at most programs as a resident rather than a student, if you decide you'd rather stick with psych, well then, there you go.

Sounds to me like you're leaning more toward psych than the others so it makes sense to go ahead and invest the time toward psych first, since a PGY1 year in psych actually would let you get real life experience in all three. And as doc samson said, psych PDs, by nature of being psych, tend to understand and support their residents who realize that psych isn't for them. If you really think there's a high probability of switching, it might be in your interest to go into a larger program, where there'll be less pressure for you to stay from a manpower standpoint.

Me, I dont have cold feet, but I've wished for a while that there was a psych/PM&R dual residency.

 

[YOOOUK09]

why not start psych? By the middle or end of your PGY1 you'll have experienced both internal med and ER at most programs as a resident rather than a student, if you decide you'd rather stick with psych, well then, there you go.

Sounds to me like you're leaning more toward psych than the others so it makes sense to go ahead and invest the time toward psych first, since a PGY1 year in psych actually would let you get real life experience in all three. And as doc samson said, psych PDs, by nature of being psych, tend to understand and support their residents who realize that psych isn't for them. If you really think there's a high probability of switching, it might be in your interest to go into a larger program, where there'll be less pressure for you to stay from a manpower standpoint.
quote]

I think you're right. I should probably just go ahead and do psych (for now!).

BTW - how many people per year is considered a "larger" program?

 

[OldPsychDoc]

...BTW - how many people per year is considered a "larger" program?

It's subjective, but I'd say 6 is the high end of "smaller"--so prob between 6 and 8?

 

[Faebinder]

RE: COLD FEET..


All fields have good and bad in them... if you want to go to ER.. go for it. There is no field in medicine where life does not suck and the hours don't blow.. unless you want to sit and make 80k a year for seeing 20 patients a week or something.

 

[YOOOUK09]

How will you be any more confident in choosing your career path? One thing to bear in mind is that Psychiatry PDs tend to be more supportive of their residents switching specialties than IM or ED (obviously there are exceptions on both sides, but that's the trend that I've seen).

I'm definitely leaning towards psych and am thinking of going for it. However, I know that if one is going to switch it's better to do so sooner rather than later.

I've looked for info about switching specialties and haven't found much out there.

Is there a "best way" to switch? In terms of timing, and who to talk to first. (e.g., If I wanted to switch from psych to IM in the same hospital, would I talk to the IM PD first and only later the Psych PD, etc). What kinds of letters would one need? Does one apply through ERAS?

 

[rpkall]

I think what you're describing (the old PGY-1 switcheroo) is easier at your home institution, where people know you as a decent student and you have connections with both departments. My understanding is that you can switch, but you may have to repeat all or part of your intern year, depending on whether each departments' PGY2 class is full or not. Repeating intern year is probably more common when switching from psych to something else, seeing as most rotations from PGY-1 of other specialties would probably count towards your "6 months of medicine" requirement in psych.

I would talk to your (trusted) mentors from both departments at your home school about it, and ask whether they think the program directors would be amenable to sitting down with you and discussing the options openly without letting it affect your chances of matching in either. Some PD's would be totally fine with this, others might be like, "Hm. Why would I want to hire someone who can't guarantee me they'll be here past PGY-1?"

But the bottom line is, some of us need guidance that goes beyond the traditional "party line" stuff that's posted on websites or that comes out of official academic departments. Someone you've met in your travels should be able to help without judging.