Does psych help patients?

[jakesaw]

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I am an MSIII interested in psych, although I have not done my psych rotation yet.

I have a very basic question: From experience, how much is psych able to meaningfully improve patients' lives? Also, are there any subpopulations of patients (ie addiction patients, those with higher/lower socioeconomic status, ...) that are more gratifying to work with than others (ie respond more positively to treatments)?

I realize in all fields of medicine there is often only so much you can do. However I get the impression (correctly or not) this is especially true of psych, and that often the cure can be worse than the disease.

I am not looking to save the world, however I couldn't live with just going through the motions of psychopharm that I think (correctly or not) goes on a lot today. If at the end of the day I truly believed I was facilitating at least some good/meaningful improvement in patients' lives I think I'd enjoy and be a good psychiatrist.

I know this is something I'll have to find out myself, but I'd be interested in any feedback on this.

 

[Milo]

If I buy a case of vitamins will you stop?

 

[jakesaw]

You can buy all the vitamins you want. Don't see what that has to do with my questions. Still would appreciate intelligent input.

 

[Milo]

Seriously, put me down for a case. What was that website again?

 

[Solideliquid]

Seriously, put me down for a case. What was that website again?

Me too. In fact put me down for a life-time supply, and please go bug the surgeons!

 

[jakesaw]

OK, now I get your sarcasm. A bit defensive, perhaps even paranoid but whatever. Just trying to get some feedback about how gratifying work as a psych is. If you don't want to respond to this milo, or question my sincerity, please ignore my post. I'm not going to waste my time trying to prove to you I'm not selling vitamins.

 

[Milo]

Don't you want to help people anymore?

 

[justcurious09]

Altough I'm only an MSI myself, I have worked as a Mental Health Counselor for several years, and I'll tell you that I think psychiatrists play a critical role in improving people's lives.

There is so much "it depends." If the patient is chronically ill, do they or their families have enough resources to pay for more than just psych care? That is, for therapists and social workers and others who can help them in their day to day lives? Will they keep taking their meds. Will they keep their appointments? I worked in a posh setting, where all these needs were provided for. Even with the best outside support, good psych treatment was the cornerstone that everything else could build off.

From what I've seen, some people don't improve much. Even the best responders have ups and downs. It's rarely perfect.

I really enjoyed working with people who've recently been diagnosed with bi-polar or schizo-affective. They often got a lot out of treatment. Working with people with addictions was satisfying only if they worked a good AA/NA program, b/c I think a lot of growth comes out of doing that. But addicts are addicts, and they will always be ups and downs there.

Good luck!

 

[jakesaw]

Thanks for your input justcurious.

 

[mdblue]

I am an MSIII interested in psych, although I have not done my psych rotation yet.

I have a very basic question: From experience, how much is psych able to meaningfully improve patients' lives? Also, are there any subpopulations of patients (ie addiction patients, those with higher/lower socioeconomic status, ...) that are more gratifying to work with than others (ie respond more positively to treatments)?

I realize in all fields of medicine there is often only so much you can do. However I get the impression (correctly or not) this is especially true of psych, and that often the cure can be worse than the disease.

I am not looking to save the world, however I couldn't live with just going through the motions of psychopharm that I think (correctly or not) goes on a lot today. If at the end of the day I truly believed I was facilitating at least some good/meaningful improvement in patients' lives I think I'd enjoy and be a good psychiatrist.

I know this is something I'll have to find out myself, but I'd be interested in any feedback on this.

As they say "it depends". If you are talking of a hebephrenic drinking his own urine, putting him on meds will make an difference. If you are talking of a 21 y/o college student who attributes his lack of motivation/laziness and failing grades to his ADHD, maybe meds may not be the best option. But you can offer him something else in form of indv therapy.
As for Addiction pts, if you understand that some of this pts do have some comorbid conditions which may/maynot be contributory to his SA, it makes your job a little easier. I always call them as patients and not clients/consumers- it works for me.
HTH

 

[willow212]

Hi jakesaw,

Before my psychiatry rotation in 3rd year, I wasn't interested in the field. It was the dramatic improvement of one geriatric patient with psychotic depression on my inpatient rotation that changed my mind. Her illness had made her such a different "person" (who sat in a dark room staring at the wall, not interacting, not eating, not sleeping) and after psychiatric treatment, she was a cheerful, happy, elegant grandmother. This is just one example of how psychiatry makes meaningful contributions in patient's lives.

That's not to say it's like surgery where you go in and take out a diseased organ, and things are all better.

In fact, in the emergency room where I am now, lots of people are repeat offenders and you wonder if they'll ever get better. But you also see people who are floridly manic or psychotic or depressed and suicidal come in, and even overnight, with some medications or therapeutic interviewing, you can see how they are on the path to getting better, at least temporarily.

I would recommend that you do several psychiatry rotations or spend some time in the psych ER, and you will get a better flavor for how much patient's improve and whether you are drawn to the patients and the field.

Best of luck!

 

[jakesaw]

Thanks for your advice and input, Willow212,

I too have witnessed a dramatic turnaround in one geriatric patient. She hadn't taken her meds in about a week and I was charged with taking her initial physical exam on admission. She was completely unreasonable; cursing attempting to hit me, refusing to eat/drink.

A few days later after she was back on her meds she was the most compliant patient...she told me what a wonderful person I was and thanked me so much for my help...amazing.

I'll take your advice to take several psych rotations to get a more broad exposure. I'm very curious. Thanks again.

 

[MJD503]

In my experience as a mental health therapist, it does depend. In a general sense, the obvious answer is yes. Prescribing/managing Medication is the only pre-req to practicing Psychiatry "effectively" today but you can make just as big of a difference in other ways too.

I have seen countless so called 'chronic' or 'refactory' psych patients get on effective meds, take the advice of the staff to heart and begin the self relaization needed to overcome psychiatric disorder. Never hear from them again after discharge which is usually a good sign. They clear up, get away from drugs or negative familial influences...etc and go on to live lives as you or I would.

In that aspect, I think many downplay the role of social worker (for lack of a better word) that Psychiatrists play. Helping patients see drug habits, familial influences or other negative aspects is very important. Or conversely, helping patients realize their potential, talents, assests and emphasising good personality traits is very important. Coming from someone who has suffered from a mental illness, when you become sick, you think your "sick in the head" or you have done something to your brain so it becomes important to help people see their positives to overcome this feeling. Psychiatrists should be leading in aspect because who else would a patient respect more then the MD? Nobody!!

You cannot become overly discourage by the many, many patients who take lots of time, energey and hard freakin' work to get well. Perseverence is key with these folks! The best of the best doctors I have encountered are always those who remains optimistict (not overly so) and have hope for EVERY patient, no matter how small or large that hope might be.

By and large, many of the patients I see on a state hosptial inpatient unit are those who have fallen through the cracks, not responded well to meds for whatever reason and/or just not reached the point where they were ready to dig deep into their hearts for courage to overcome the frightening effects of mental illness.

With that said, I have seen folks who appeared on deaths doorstep from not eating (while on the miracle meds for along time) or similar - respond to treatment either out of the blue or more likely because of a realtionship they formed, a new medication, ECT or even a good dose of orientation to where they were heading should this course continue. I know many say "this isn't the 50's, we are not doing reality orientation tactics". It takes a carefully planned amount of letting the patients know from one concerned person to another that they have to use every last resources avalible until they get themselves well.

Lastly, make no mistake, in almost all cases you and other MH professionals are in the care to help this person help themselves, at the most basic levels. Most patients WILL NOT get better should they not become able to realize this themselves. If a patient doesn't want to help themselves or doesn't know how or even more likely they have run out of resources/patience/optimisim, your job is to help them see the importance of helping themself. You could consider yourself a consultant/personal coach/motivator after the intial medication and treatment goals have been worked out.

OK, flame away! 😱