Do You Ever Feel Like You're Not a Doctor?

[yanks26dmb]

Not trolling and mean no disrespect with my question. Midway through M3, psychiatry is in fact at the top of my short list of specialty to pursue. The time to start choosing 4th year rotations is nearing and the sooner I can figure out the rest of my life, the better.

I really love the mental aspect of health, talking to patients about their problems, etc. I'm fascinated by mental illness. That said, I really really love doing hands on things, high intensity, and really thrived in the OR during my surgery rotation. That said, I have a family and I don't want to spend the bulk of my life working and not seeing them. Surgery is out. Anesthesia and EM are also high on my list. The thought of doing an emergency chest tube or intubation brings me joy.

Do any of you ever miss the more physical aspects of medicine? Ever feel like you're more of a therapist than a doctor (this is my biggest fear)? Think there can be middle ground for someone like myself; perhaps pursuing a pain fellowship or something else? Thanks for your help.

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[hamstergang]

Ever feel like you're more of a therapist than a doctor (this is my biggest fear)?

No. Though I was always more of a thinker than a toucher, so you may feel differently.

 

[Shikima]

Yeah, I hate those days where I'm not a real doctor by picking up on a lacunar stroke and sending them immediately to the ER from clinic.

 

[technopoly]

Do any of you ever miss the more physical aspects of medicine? Ever feel like you're more of a therapist than a doctor (this is my biggest fear)? Think there can be middle ground for someone like myself; perhaps pursuing a pain fellowship or something else? Thanks for your help.

I am in a residency program of which the entire intern year is inpatient medicine and neurology, including ICU time. I manage many basic medical problems in my inpatients before consulting other specialties, and feel comfortable taking outpatients with complex medical problems. Psychiatrists are physicians, and I think if you want to "feel like a physician" then you can seek out more rigorous medical and CLS psychiatry experiences for training.

 

[Gavanshir]

Yes, absolutely. Psychiatry is very different from the rest of medicine and we don't use most of what we learned in medical school. I do sometimes feel like a therapist, but then I look at the letters after my name, the enormous responsibility that I have to my patients to take care of ALL of their needs including medical since no else on the team is trained to do so, and the size of my paycheque which remind me that I am indeed a physician. It's then that I realize just how brain I washed we are about what it means to be a stereotypical doctor that two years into residency I still sometimes don't feel like a "doctor".

I am certain other specialties like pathology, derm, PM&R, pal care and rads have the same complexes to some extent.

 

[DD214_DOC]

The unnecessary administrative burden and never-ending deluge of paperwork makes it impossible to not feel like a doctor.

 

[splik]

Ever feel like you're more of a therapist than a doctor (this is my biggest fear)? Think there can be middle ground for someone like myself; perhaps pursuing a pain fellowship or something else? Thanks for your help.

If this is fear for you, then psychiatry is probably not a good fit. Psychiatry is not a procedural specialty. You don't get to use your hands. Most psychiatrists don't spent the bulk of their time doing therapy though. I don't currently do any therapy technically but find myself slipping into therapist mode occasionally (which I shouldn't be doing as a forensic psychiatrist) but I can tell you that is when I make the most difference and when my residents and students are the most impressed with my skillz. Psychotherapy is a special sort of procedure that in its own way can be just as invasive as surgery, but we use our words instead of our hands. You might find that psychotherapy is something you actually enjoy and find integral to the identity of psychiatrists. Personally I hate it when people call psychiatrists "prescribers" or talk about "medication management" which makes us sound like pharmacists. I do miss the satisfaction of doing procedures, but there are other satisfactions of this kind of work and I frequently use my medical knowledge to make diagnoses others have missed.

But if you actually have to do procedures that involve using your hands you shouldn't go into psychiatry.

 

[yanks26dmb]

If this is fear for you, then psychiatry is probably not a good fit. Psychiatry is not a procedural specialty. You don't get to use your hands. Most psychiatrists don't spent the bulk of their time doing therapy though. I don't currently do any therapy technically but find myself slipping into therapist mode occasionally (which I shouldn't be doing as a forensic psychiatrist) but I can tell you that is when I make the most difference and when my residents and students are the most impressed with my skillz. Psychotherapy is a special sort of procedure that in its own way can be just as invasive as surgery, but we use our words instead of our hands. You might find that psychotherapy is something you actually enjoy and find integral to the identity of psychiatrists. Personally I hate it when people call psychiatrists "prescribers" or talk about "medication management" which makes us sound like pharmacists. I do miss the satisfaction of doing procedures, but there are other satisfactions of this kind of work and I frequently use my medical knowledge to make diagnoses others have missed.

But if you actually have to do procedures that involve using your hands you shouldn't go into psychiatry.

It's tough because I really love sitting and talking to patients. I enjoy hearing their problems and trying to offer solutions. I imagine after training in psychotherapy my ability to tackle their real problems would be much greater.

I just worry I'll regret never being able to do some of the higher acuity stuff you'd see in a trauma ed, or while someone is flat lining in the OR.

 

[wolfvgang22]

You won't regret having less expensive malpractice insurance and a lower likelihood of being sued.

 

[hamstergang]

I enjoy hearing their problems and trying to offer solutions.

Offering solutions isn't really psychotherapy.

 

[yanks26dmb]

Offering solutions isn't really psychotherapy.

Of course not. I hope I didn't imply I thought I was providing psychotherapy, that would be crazy of me.

 

[Shikima]

I just want to provide psycho...

 

[hamstergang]

Of course not. I hope I didn't imply I thought I was providing psychotherapy, that would be crazy of me.

You didn't imply that at all.

Many people feel that psychiatrists and therapists give patients advice (in fact, you implied this was what you liked about the field). That's not really the purpose of therapy nor very helpful. I'm not saying this should factor into your decision as you would obviously learn about psychotherapy, but I was just correcting what seemed to be a common misconception in your post.

 

[NickNaylor]

I will freely admit that this is a concern that I had when ultimately choosing my field. I didn’t like the situation of “most of what I just spent the last 3-4 years doing isn’t going to be directly applicable to what I’m doing.” Also a little bit of “wtf do I actually do.”

You are very much a physician, and you are expected to think like such. Are you going to be doing emergent, life-saving procedures in high-stress situations a la the ICU? No, probably not, but that doesn’t somehow mean that you aren’t doing the basic work of a physician. You just do so using different skills and an approach with different foci than most other physicians.

 

[TexasPhysician]

Every field outside of FM and maybe EM will lose some of the skills taught in medical school and therefore not always feel like a true physician.

Anesthesia could be described as surgical support. Outside of managing an airway and sedation, they may not actually treat anything.

Radiology is repetition of scans in a dark room without even seeing a patient. Prescription pad? Haha

Please don’t flame me for the above anesthesia/rads generalizations. They are great fields that are essential to medicine just like psychiatry. I have complete respect for them - just pointing out unfair generalizations similar to psychiatrist = therapist.

Specialists all lose some medical skills to focus on their specialty. They all have some negative stereotypes.

Psychiatry is no different. If you want to be able to do a procedure, stay involved in ECT, TMS, etc. Ketamine and Botox May be on the horizon.

 

[futuredo32]

It's a loss of most of what you learned in med school and I feel like a Dr but regret choosing psych. I am going to apply for a second residency in FP next year, doubtful I will match. I like psychotherapy, many jobs I have worked as a locums want you to be a prescription writing factory which bores me to no end. I just miss the rest of medicine.

 

[birchswing]

Botox

This interested me so I looked at the study to see how they did the control. The control was a saline injection. The thing about Botox is that you know almost immediately that it has taken effect, and you would know if it hasn't (at the muscular level affecting the dermis, not psychologically). It's hard to see how you could have a true placebo control when whether you've had the treatment or not is so obvious. Having had your wrinkles flattened could convey a sense of having entered the upper class. There are a lot of other tests that would be interesting to try to suss out what about the Botox caused improvement. Like trying it on areas of the body where visible improvement is less obvious such as the scalp. Or using a different anti-wrinkle approach versus saline versus Botox. It's interesting that it helps, but it could be from the same reasons people already use Botox.

 

[yanks26dmb]

Thanks all for your opinions. Glad to know these worries aren't bothering the majority of you in practice. Will keep it all in mind as I figure this out.