Deciding on psychiatry, but unsure about becoming an MD?

[katymarie]

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Hi all,

Recently I've had a change of heart and decided I want to go into psychiatry. I've always loved learning about science and the brain so I'm sure medicine would interest me too, to an extent.

I completely understand why medical school is the foundation to psychiatry and it is essential that I learn how to be a doctor first. However, I've never found myself wanting to be a doctor, or doctor-material. I'm too introverted to be performing all the physical duties of a doctor… rectal exams? pelvic exams? physicals on patients. I'm not sure if I'm cut out for any of that. It's not so much the gross factor as it is the fear of doing something wrong. I wholeheartedly believe that the road to psychiatry is worth it though if I were to decide to seriously go that route.

So, how much of medical school has actual patient contact where you must perform something on them? Are you "tested" on this? Do you have to spend your residency practicing as an MD? Anyone go through a similar situation?

 

[hamstergang]

Yes, you will have to perform invasive exams on patients, and you will be tested on it. And at least at my medical school, but I imagine many others if not most or all, you even get to practice on non-patients.

I'm rather introverted and lacking in confidence in general, but I have no problem doing any part of the physical exam on any patient (though we aren't doing rectal or pelvic exams on our psych patients). Interacting with a patient is different than interacting with people in other situations. We do get enough practice as well. What also helps is portraying confidence -- if you act like you know what you're doing and that you're in charge, the patient will let you do anything to them and they will let you ask them anything. If you start acting nervous instead, then it becomes awkward for everyone involved.

I think this is something many people can get over. However, there was at least 1 student in my med school class that was, imo, too socially inept for this field (well, you can be in medicine without patient contact if you choose the right specialty).

What is it about psychiatry that so attracts you? If you say you don't want to be a doctor, then maybe there is a field related to psychiatry that still holds those qualities that attracted you here?

 

[surftheiop]

Hi all,

Recently I've had a change of heart and decided I want to go into psychiatry. I've always loved learning about science and the brain so I'm sure medicine would interest me too, to an extent.

I completely understand why medical school is the foundation to psychiatry and it is essential that I learn how to be a doctor first. However, I've never found myself wanting to be a doctor, or doctor-material. I'm too introverted to be performing all the physical duties of a doctor… rectal exams? pelvic exams? physicals on patients. I'm not sure if I'm cut out for any of that. It's not so much the gross factor as it is the fear of doing something wrong. I wholeheartedly believe that the road to psychiatry is worth it though if I were to decide to seriously go that route.

So, how much of medical school has actual patient contact where you must perform something on them? Are you "tested" on this? Do you have to spend your residency practicing as an MD? Anyone go through a similar situation?

You obviously need to be comfortable with people to be a medstudent, but they dont expect you to already be a doctor when you come in!

All of us (well almost all of us*) come into medschool pretty worried anytime we touch a patient that we are going to accidentally kill them. Heck, the first time I took someone's BP in our clinical skills class I was sure I was going to break their arm or something.

On one of my early pre-clinical hospital visits the attending told me to examine this patient with pancreatitis and I was super worried and said something like "Is it dangerous to palpate his abdomen, could the pancreas like explode or something?" The attending burst out laughing and from his smile I could tell he remembered what it was like to examine a patient for the first time.

* Of my classmates, as MS2's the only ones who are super confident all the time when it comes to physical exam findings are the ones who I think are most likely to end up causing harm at some point because they are just generally careless in all areas of life and have no real understanding of their own limits.

 

[tobi44]

I can answer for med school expectations about physical exams. I'm in second year right now and clinical skills are not really the focus. Students are expected to practice mostly on each other and once a year we are tested by having an attending watch us do a physical on an actor on a pass fail basis. On these watched exams there is no pelvic or testicular or breast exam, though we do get the chance to practice these on actors once a year with no grading.

I think that third year we would be expected to do focused physical exams on our rotations and then present our findings to the medical team. But I haven't gotten there yet so I don't know. As for how much physical exam skills we need in psychiatry residency and psychiatry practice, I'll have to defer to someone else. I'm interested in that answer to that too....I'd would imagine that physical exam skills would be used a lot less in psychiatry.

 

[imp3tigo]

As for how much physical exam skills we need in psychiatry residency and psychiatry practice, I'll have to defer to someone else.

None.

 

[peppy]

Since psychiatry is only a small part of the curriculum at most med schools, the majority of your time in med school will focus on other specialties and most other specialties do put a lot of emphasis on physical exams and/or procedures. It will definitely be a lot more tolerable if you can find something to like about other specialties of medicine.
You will get a lot of practice doing procedures and physical exams during med school. You're not expected to know how to do it or be good at it when you start. You get used to things.
Does anyone actually like doing a rectal exam? I don't think so, but it's one of those things you just have to put up with. A lot of medical school is like that...just enduring various unpleasant hurdles to get to the goal at the end of a long road.

My experience has been that physical exams are not often emphasized in outpatient psych, beyond checking for the abnormal movements that can come from the medications we use as well as monitoring for weight gain/metabolic side effects from such medications.
Inpatient psych and psych consults can be a different story. If someone on the inpatient unit has a medical problem, you'll probably have to examine them even if it's only so that you can discuss the problem intelligently with the consultant (if it's a problem you can't manage on your own and need to call in another doctor to guide treatment of the problem). Recently I have had situations on consults such as checking for clonus on someone with serotonin syndrome or checking for waxy flexibility on someone with catatonia. In certain situations like when you're seeing a patient only for psychotherapy it's probably not appropriate to do a physical exam, but since we are physicians, we need to be prepared to do an exam if the situation calls for it.

If you really dislike other specialties of medicine and really don't want to touch patients, becoming a psychologist or social worker might be closer to what you would want to do.

 

[shan564]

Since psychiatry is only a small part of the curriculum at most med schools, the majority of your time in med school will focus on other specialties and most other specialties do put a lot of emphasis on physical exams and/or procedures. It will definitely be a lot more tolerable if you can find something to like about other specialties of medicine.
You will get a lot of practice doing procedures and physical exams during med school. You're not expected to know how to do it or be good at it when you start. You get used to things.
Does anyone actually like doing a rectal exam? I don't think so, but it's one of those things you just have to put up with. A lot of medical school is like that...just enduring various unpleasant hurdles to get to the goal at the end of a long road.

My experience has been that physical exams are not often emphasized in outpatient psych, beyond checking for the abnormal movements that can come from the medications we use as well as monitoring for weight gain/metabolic side effects from such medications.
Inpatient psych and psych consults can be a different story. If someone on the inpatient unit has a medical problem, you'll probably have to examine them even if it's only so that you can discuss the problem intelligently with the consultant (if it's a problem you can't manage on your own and need to call in another doctor to guide treatment of the problem). Recently I have had situations on consults such as checking for clonus on someone with serotonin syndrome or checking for waxy flexibility on someone with catatonia. In certain situations like when you're seeing a patient only for psychotherapy it's probably not appropriate to do a physical exam, but since we are physicians, we need to be prepared to do an exam if the situation calls for it.

If you really dislike other specialties of medicine and really don't want to touch patients, becoming a psychologist or social worker might be closer to what you would want to do.

+1.

When I first started med school, I was pretty sure that I had an idea of which specialty I wanted to choose. This was a specialty that is much more thoroughly covered in med school than psychiatry, but not one that involves a lot of clinical examination and the like. By going into med school with that mentality, I started to disregard a lot of the clinical examination and procedural teaching. As a result, I think I did myself a real disservice.

During third year, I started to become much more interested in psychiatry and internal medicine. By being open to different specialties, my learning experience was amplified massively. I finally ended up deciding on psychiatry, but if I had gone in with a different perspective, my med school experience would have been much less fruitful. And as a result, I probably wouldn't have made a very good psychiatrist.

 

[surftheiop]

None.

Don't most inpatient psychiatrists do physical exams when admitting patients to the psych floor?

I dont know if its typical, but an attending I did a research project with said he routinely finds pretty serious medical conditions in his inpatients because they on average get so little medical care and do a lot of "hard living". Granted he's not the one who ends up treating the serious stuff, but if he didn't know how to do a physical exam then medicine/surgery wouldn't have gotten consulted until who knows when.

 

[michaelrack]

None.

I recently covered an inpt psych unit (as a psychiatrist) over the weekend. Physicals were required on the admissions that didn't come through the ER (during the week, there is some type of primary care provider available to do physicals).

 

[BobA]

Hi all,

Recently I've had a change of heart and decided I want to go into psychiatry. I've always loved learning about science and the brain so I'm sure medicine would interest me too, to an extent.

I completely understand why medical school is the foundation to psychiatry and it is essential that I learn how to be a doctor first. However, I've never found myself wanting to be a doctor, or doctor-material. I'm too introverted to be performing all the physical duties of a doctor… rectal exams? pelvic exams? physicals on patients. I'm not sure if I'm cut out for any of that. It's not so much the gross factor as it is the fear of doing something wrong. I wholeheartedly believe that the road to psychiatry is worth it though if I were to decide to seriously go that route.

So, how much of medical school has actual patient contact where you must perform something on them? Are you "tested" on this? Do you have to spend your residency practicing as an MD? Anyone go through a similar situation?

I couldn't imagine getting through medical school and internship without actually enjoying doing more hands-on medicine. There's a lot of it and if you don't like it it'll be at 2-3 years of doing stuff you don't really like. For me, life's too short for that. Also, if you don't enjoy it you might not be good at it and that would be reflected in your performance which would make things that much more stressful.

Why not become a psychologist? or a psych NP (who still go through general medical training, just not as much)?

Life's too short to spend it doing things you won't like.

 

[zenman]

I recently covered an inpt psych unit (as a psychiatrist) over the weekend. Physicals were required on the admissions that didn't come through the ER (during the week, there is some type of primary care provider available to do physicals).

I recently finished working at a hospital. We had to do short PEs on patients even if they came through the ER, not so if they had been admitted to medical floor and hospitalists had seen them. Now, in outpt setting, no PEs 👍

Ever think about being a neuropsychologist?

 

[katymarie]

Thank you for your responses.

Initally I was interested in doing clinical psychology but my interests started venturing off into science-related fields like neuroscience. I've considered pharmacy at one point as well, I am very interested in psychotherapy, so all of these things sort of lead me to deciding in psychiatry. My dream has always been to help people in the mental health field, it is fascinating to me just as it is rewarding. I come from a not-so-well-off family financially, so I can't lie - the salary is also a major advantage versus clinical psychology. I would be the first one in my family who holds a MD title, so it is worthwhile having that opportunity and the ability to take advantage of my education that no one else really has had.

I think it's a matter of getting used to envisioning myself as a doctor, and the rest will follow.

During third year, I started to become much more interested in psychiatry and internal medicine. By being open to different specialties, my learning experience was amplified massively. I finally ended up deciding on psychiatry, but if I had gone in with a different perspective, my med school experience would have been much less fruitful. And as a result, I probably wouldn't have made a very good psychiatrist.

Does anyone actually like doing a rectal exam? I don't think so, but it's one of those things you just have to put up with. A lot of medical school is like that...just enduring various unpleasant hurdles to get to the goal at the end of a long road.

Very insightful, medical school is much like a journey... personally and educationally...

Also, I think the more I gain hospital-patient based volunteering experience will either get me fully comfortable with it or it will be one of those things that helps me decide whether or not it's right for me. I think the key is to focus on becoming/being successful as a medical doctor first rather than a psychiatrist.

 

[hamstergang]

As for how much physical exam skills we need in psychiatry residency and psychiatry practice, I'll have to defer to someone else.

None.

I'll join the dogpile in disagreeing. Physical exams get done on every patient that gets admitted to the main psych hospital I'm at. And when on the inpatient psych units, if any patient has a complaint, it's up to us to examine them in order to determine the best course of action (this includes on the C/A unit, so it's not just adults).

However, I have never done a rectal/pelvic/breast exam on a psych rotation yet, and I don't expect to. If it's emergent, then I can't treat it anyway, so get them to the ER or other part of the hospital. If it's not emergent, then do it as an outpatient. There are issues with boundaries that need to be respected.

 

[Neroli]

I came into med school interested more in the intellectual side and mind-body-lifestyle or biopsychosocial aspects. I had many of the same fears you do, especially regarding procedures and god forbid surgery. Medschool has done a superb job at reconditioning and desensitizing me to the awkwardness, gross out factor, and anxiety. This happens mostly gently and progressively, but there are also those moments where you take a leap over a chasm such that you will never be the same naive kid again. It starts with things like photos of a wrestler with an acute explosive prolapsed rectum and doing blood a blood draw on a classmate first year and you just don't have that knee jerk gross out and awkwardness any more after that. Despite the anxieties and moments of asking why you are trudging through months of "irrelevant" material, it all comes together in rewarding ways and is worth it if you have a deep interest in the workings of human beings on various levels.