Considering Psychiatry - when did you know? Why did you choose?

[nope80]

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Hi guys,

I'm currently a second yr considering psychiatry. I wasn wondering when everybody "knew" that this was the field they wanted to go into - was it third yr elective, 4th yr, beginning of med school? What was the process you went about choosing this field over others? In the end, are you happy with your decision? Was it what you expected?

Also, did most of you do research specifically in psychiatry?

Thanks for the help! Sorry so many questions..😛

 

[Doc Samson]

Hi guys,

I'm currently a second yr considering psychiatry. I wasn wondering when everybody "knew" that this was the field they wanted to go into - was it third yr elective, 4th yr, beginning of med school? What was the process you went about choosing this field over others? In the end, are you happy with your decision? Was it what you expected?

Also, did most of you do research specifically in psychiatry?

Thanks for the help! Sorry so many questions..😛

4th year on my CL elective - finally figured out I could see medically ill folks in the general hospital AND have time to talk to them vs. having to chase labs/rads all day. Liked that the physical and mental status exam were important vs. technological diagnosis. Continue to love my career - wouldn't change it for the world.

My research in med school was on cancer genetics and epidemiology.

 

[OldPsychDoc]

Hi guys,

I'm currently a second yr considering psychiatry. I wasn wondering when everybody "knew" that this was the field they wanted to go into - was it third yr elective, 4th yr, beginning of med school? What was the process you went about choosing this field over others? In the end, are you happy with your decision? Was it what you expected?

Also, did most of you do research specifically in psychiatry?

Thanks for the help! Sorry so many questions..😛

I was pretty sure once I started med school that it was the direction I was headed, thanks to a rather zealous research mentor who had the audacity to suggest that the BRAIN was involved in psychopathology!

I entered the 3rd year clerkship concerned that a) I might not like the patients, and b) that there wouldn't be enough "real" medicine involved. Like Doc Samson, I was reassured on both counts. It was cool to see people actually get better because of what I was doing with them! I flirted with radiology (neuroimaging) and internal medicine, but ruled them out--felt psych made a greater impact, and had a better lifestyle, too. I also liked the attendings in psych more--they were interesting, well-rounded people, most of whom appeared to have "a life". I liked my IM sub-I a lot, and folks were encouraging me to do IM--but unfortunately for them I had the opportunity to compare and contrast the lifestyle of a senior IM resident to a senior psych resident, and that was the final coin to drop.

Because of my basic research (neuroscience) background, I pursued residency looking for academic programs--but once I got rolling, I found I preferred the clinical side. I've found that far better than I expected. There are still days I do just kind of want to get through my schedule and go home. Many other days I have to remind myself that it IS work and I actually get PAID to do this stuff. I like going to work overall, I love my teammates, and I love making a difference with my patients.

 

[chemist157]

I was pretty sure once I started med school that it was the direction I was headed, thanks to a rather zealous research mentor who had the audacity to suggest that the BRAIN was involved in psychopathology!

I entered the 3rd year clerkship concerned that a) I might not like the patients, and b) that there wouldn't be enough "real" medicine involved. Like Doc Samson, I was reassured on both counts. It was cool to see people actually get better because of what I was doing with them! I flirted with radiology (neuroimaging) and internal medicine, but ruled them out--felt psych made a greater impact, and had a better lifestyle, too. I also liked the attendings in psych more--they were interesting, well-rounded people, most of whom appeared to have "a life". I liked my IM sub-I a lot, and folks were encouraging me to do IM--but unfortunately for them I had the opportunity to compare and contrast the lifestyle of a senior IM resident to a senior psych resident, and that was the final coin to drop.

Because of my basic research (neuroscience) background, I pursued residency looking for academic programs--but once I got rolling, I found I preferred the clinical side. I've found that far better than I expected. There are still days I do just kind of want to get through my schedule and go home. Many other days I have to remind myself that it IS work and I actually get PAID to do this stuff. I like going to work overall, I love my teammates, and I love making a difference with my patients.

Mind sharing how you were assured on there being enough "real" medicine? I haven't done my clerkship yet but this is one of my concerns. I don't know if I can "hang up my stethoscope", so to speak.

 

[billypilgrim37]

Mind sharing how you were assured on there being enough "real" medicine? I haven't done my clerkship yet but this is one of my concerns. I don't know if I can "hang up my stethoscope", so to speak.

We seriously need to dispel the myth of the stethoscope.

Has any piece of metal and tubing ever been so overrated as a medical instrument? Unless you're in emergency medicine and actually have to make decisions quickly, it's use is pretty limited:

It's uses include seeing if kids are going to die from sudden death, seeing if a patient is in a funky rhythm while the nurse gets the EKG machine, seeing if you can hear something funny while you wait for the echo to get scheduled, and something for cardiologists to demean you about.

It also lets you know if somebody is taking their asthma meds or whether you can trust the x-ray you're going to order anyway. Oh yeah, and do they need more Lasix or not.

And is their gut working--as if listening tells you so much they couldn't have told you on history? And does that wooshy sound agree with the carotid dopplers you're going to get anyway?*

Compare this to the mental status exam, which has no rival. MRIs don't tell you about mental status, unless their frontal lobe is gone, which does tell you that. And if their EEG shows burst suppression, well yeah. But for the vast vast majority of psychiatry patients, your excellent history and your mental status exam are both forces for which there are no proxies. They are skills that take at least as long to become proficient at as does internal medicine.

You have to give up a lot of what you do in medical school to do any specialty. Surgeons rarely carry around stethoscopes, and can take awfully brief, focused histories. Internal Medicine docs lance a boil and convince themselves they get to do all these awesome procedures when they really just want to play surgeon. OBs don't see dudes. Pediatricians don't see people who can vote.

These are all wonderful specialties, but all require you to give up a large part of the skill set you begin to develop in medical school. Nobody talks about giving up their stethoscope when they go to ophthalmology residency, even though my friends doing ophthy probably won't use their stethoscopes as much as I will in the next four years.

*I'm being entirely facetious. Entirely. Be clear. Not actually knocking medicine. Medicine is awesome, like psychiatry is awesome. But medicine is not awesome the way psychiatry isn't, either.

 

[masterofmonkeys]

I decided before I started medical school. That said, med/psych, family/psych, and PM&R were all considerations, although none were considered all that seriously.

I took my first college psych class when I was still in HS. Did a lot of neuroscience stuff too. Majored in neurobio and took a lot of psych classes in college. The brain is the final frontier. And I am fascinated by adaptive aspects of biology, which are most visible, clinically, and practically relevant with regard to muscle, metabolism, and the mind. And I want to study the intersection of the three.

That said, PM&R continues to strongly pull at me, but I remain most fascinated by the psychological side of rehabilitation and neuromusculoskeletal disease. Not to mention the fact that I am a walking demonstration of counter-transference issues with respect to PM&R issues.

My third year clerkship was simply a validation of my interest.

As for research, I am an active researcher in primatology, have some public health research, and am working on a couple of psych review papers.

MS4 by the way.

 

[Regnvejr]

I decided in my 3rd year rotation.

Now I'm 2.5 years out of residency in one of those dry, mountanous, sparsely populated western states at a community health center and love it.

Oh, and by the way, we need a lot more psychiatrists out this way

 

[DD214_DOC]

I thought I wanted to do psych until my first third-year core clerkship. It wasn't a very good experience. I decided the material interested me enough that I really wanted to do it again and re-evaluate. I decided to do my third-year elective on a child/adolescent crisis stabilization unit.

I think I'm gonna do psych. The material is really interesting, I think you actually get to dramatically effect the quality of life of your patients with a demonstrable improvement (rather than just a number like blood glucose that means nothing to the pt), and the lifestyle seems pretty good. I have no idea what the pay is like but I'm sure it can't be bad.

Now I just have to decide which fellowship I want and if I should try to get a combined neuro/psych program. C-L seems pretty interesting.

 

[peppy]

I thought I wanted to do psych until my first third-year core clerkship. It wasn't a very good experience.

I think this is a common reason for why psychiatry isn't more popular. It seems like many people have very uninspiring core rotations in psych. I had a really fun, interesting psych rotation with an intelligent psychiatrist who wanted to teach (oh, and who also approached patients from a medical perspective). It really helped dispel my concerns about choosing the field.

 

[BobA]

I think this is a common reason for why psychiatry isn't more popular. It seems like many people have very uninspiring core rotations in psych. I had a really fun, interesting psych rotation with an intelligent psychiatrist who wanted to teach (oh, and who also approached patients from a medical perspective). It really helped dispel my concerns about choosing the field.

I agree. If I hadn't had experience working with a good psychiatrist prior to med school in a *nice* setting I wouldn't even consider psychiatry. Many of the attendings at my institution aren't just bad psychiatrists, they're frightening! One can't speak English well enough to understand their patients. Another is a paid Abilify speaker and literally puts every single patient on Abilify no matter what the diagnosis. There are some really bad psychiatrists out there who make the field look bad.

On the FLIPSIDE, their are some great psychiatrists who make a huge difference in patient's lives and who are really inspiring. It just depends who you end up with.

Also, my school doesn't do a good job of exposing students to the diversity available in psychiatry. Outpatient, CL, Child, Forensics, etc - you have to go out of your way to get these experiences at my school.

So I choose psychiatry prior to med school.

 

[diosa428]

I actually didn't choose psychiatry until I did my clinical rotations. I thought I would hate it (mostly because of the "not practicing real medicine" thing), but then realized that that was a bunch of crap. I was a neuroscience major in undergrad and love the brain and behavior, so it ended up being a really good fit for me. It was one of my first rotations, so everything after I compared to psych and found that psych was the best for me. I then confirmed my suspicions with an elective (child psych) and was sold.

Interestingly, my school must have a great psych team because even though very few of my classmates are planning on going into psych, when I tell them that's what I'm doing, a lot of them say "oh that's great, I really liked psych".