KlimtOphile

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I'm hoping that in divulging my fears someone will reach out to me and shed some light on my current crisis!

I loved my psychiatry course, but struggled throughout most of medical school. I had terrible anxiety and procrastination, and a constant crippling insecurity about my intellectual abilities.
I managed to get through first and second year but not without remediating two classes and justifying myself to the phase 1 committee multiple times.

Now in third year, I find myself again debilitated by my fears of inadequacy. I'm doing my internal medicine rotation and am mortified that I won't be prepared to care for my own patients as an intern. I seem to have forgotten basic physiology or perhaps never learned it well enough the first time. My knowledge base seems grossly inept compared to my peers.

Unfortunately, I've come to resent allopathic medicine in general for the lack of emphasis on preventative care or the importance of lifestyle and nutrition in health maintenance. I loathe medications but realize their value in treating patients with acute illnesses. Still, my aversion to the approach of modern medicine combined with crippling anxiety and self-doubt has left me depressed, fearful and avoidant.

I'm terrified that I won't know enough internal medicine to practice as a psychiatrist! Am I being unrealistic? How can I resolve this?

:(
 

Chimed

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You may benefit from cognitive therapy.
 

Doctor Bagel

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On top of thoughts about therapy, have you tried to talk to your peers to see how they're feeling? It's very possible they feel as lost, confused and incompetent as you do. And if they don't act like it, they're probably faking. I'm on medicine right now and generally feel like an idiot daily who, yes, has forgotten every bit of pathophysiology I learned up to this date.

Parts of 3rd year just plain suck, so hang in there. But yeah, check out the mental health resources at your school because crippling anxiety is not a good thing.
 

marie337

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I felt exactly the same way for much of 3rd year. Somewhere around May of 3rd year things finally started to click. Just stick with it and realize that you probably know a lot more than you think you do.
 

2tall

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Yes, you're being a little unrealistic. First, stop comparing yourself to other people. No matter what it took you to get to third year...you're there. Some people don't make it that far and there are others who don't even make it into medical school. Be thankful.

You'd find more emphasis on preventive medicine in family medicine. Doing a couple months of inpatient medicine gives you a very skewed perspective health, healing, and all that jazz.

Remember, you're a third-year medical student. You've only just begun your training. You are inexperienced. With time and experience, you'll know more (God-willing).

Lastly, stop comparing yourself to other people.

P.S. I'm not sure any healthcare professional should loathe medications.
 

wolfvgang22

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I agree with those above whole-heartedly. You are NOT alone.
We've all felt like this at some point, and often still do to some degree. You are right to be wary of medications. You are right to highly value preventative medicine. You are not the only one to have ever re-taken a course or two in basic sciences. Your peers actually probably think you know a lot of things they don't know about medicine - if you listen they will probably tell you as much. None of us can know everything. You made it this far, that is a great accomplishment - don't let anyone tell you different!

Reach out to some good friend or classmate, an understanding preceptor, alum, or resident. Finally, cognitive therapy might be a good option as mentioned above, it really can change your life if you want. Don't give up until you get the support you need and deserve.
 
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KlimtOphile

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Thank you all very much for your feedback.

I feel a lot better....less isolated..and definitely want to try CBT.


Again, THANK YOU!!!! :)
 

whopper

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You are either doing much better than you think or you are correct. I can't tell because I don't know you.

The amount of data you have to know of IM for any doctor, psychiatrist or not is overwhelming.

I can't say your worries are unfounded. However I can say that worrying about it too much will make you you're own worst enemy.

In psychiatry, you still have to know internal medicine, though not as much as the IM residents or attendings.

In psychiatry, you have to know more IM if you're in inpatient vs outpatient. Reason why is several of your psychiatric inpatients will have medical disorders, and you just can't blow it off. Yes you will have an IM doctor working with you, but I've noticed they miss a lot of stuff.

In residency, the IM & ER doctors pretty much blew off most of their responsibilities with medical consults. A patient with 2 broken legs was medically cleared without any treatment on the person's legs, a punctured lung, BP over 220/110 for several hours, a patient in shock--oh yeah, they were all medically cleared with a written statement that the physical exam were completely normal & there were no problems.

It was a product of turfing & psychiatry attendings who did not remember their internal medicine so they felt they would not argue with the ER/IM doc doing the dump the job.

I've been in situations where I had to demand that the patient be placed back on the medical floor while arguing with the IM/ER attending, and hearing them feed me a line of bull that I knew was wrong, but they were expecting me to not know my stuff. E.g. I had a patient with a potassium level under 2.5 and the patient was refusing oral medications & has a history of heart problems. I asked that the patient be given an IV potassium before the patient be placed on the psyche unit, ironically, the patient would accept an IV (there's no IVs allowed in the psyche unit). The ER doc claimed that potassium takes weeks to be elevated, that there was no point to it and being that I'm a psychiatrist I don't know what I'm talking about.

I told that ER doctor to kindly document what he said, & he refused.

Now for me as an attending, the IM doctor working with me doesn't blow me or my patients off. The problem now is that the place I'm at has hundreds of psychiatry inpatients, & there's only 4 IM doctors. For that reason, those IM docs are overworked, & some of them are very behind on the latest data (a product of practicing for years without being in an IM institution that continues their education). I noticed the IM doctor did not order some of the labs appropriate for the IM problem my patient was facing. I had to remind them what labs to order.

Learn your IM well. Even if you do outpatient psychiatry where IM is not used as much, you will still need to remember it, you will get tested on it again in USMLE and you will see many cases where the IM pathology & the psychiatry pathology are mixed together.
 

chameleonknight

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Excellent post by Dr Whopper. :) One of my biggest pet peeves is when psychiatrists blow off IM and neuro 'stuff'
 

whopper

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In residency, there was a patient the surgeon was trying to turf to psychiatry, the patient was S/P 1 day after the surgery.

The psychiatry attending working with me did not do anything to double check the "medical clearance" of this patient. The inpatient psychiatrists hate it when the consult psychiatrist would just write an order to put them in the unit without double checking to make sure the patient was truly medically stable.

I double checked the patient's labs and there was a drop over over 2 pts in the hemoglobin, hematocrit also dropped significantly.

I told the attending there was probably a post surgical bleed and we should ask the surgeon to wait a day or 2 & there should be stable blood levels before we accept the patient (the surgeons were very uncooperative with consults to patients on the psyche unit).

The consult attending didn't seem to remember his stuff concerning bleeding, or didn't seem to care. I think it was more the latter. HE didn't do inpatient & often times facilitated dump jobs. Convenient for him too. The inpatient unit was in a different hospital about 20 minutes away. He didn't have to clean up the mess.