Doing Psych Residency but I don't like seeing patients

[Panama Red]

I'm a psychiatry resident and distressed to admit that I STRONGLY dislike seeing psych patients. Mostly, I find myself emotionally drained after a shift. I am feeling discouraged because I enjoy the theory of psych but I do not like the clinical management. I've learned that I am very much an introvert and a very concrete person, liking a quiet work space and definitive, precise diagnosis. Also, I realize that I like more to diagnose medical issues than necessarily treat them. Psych is too much of a revolving door, too ambiguous, and I'm not feeling happy anymore with my choice. This hurts my heart because, I had a guns-blazin' pro-psych demeanor all through med school and defended the specialty tooth and nail to any physican that bashed it. Ultimately, I respect psych but I'm realizing it is not for me.
Are there any psych residents out there who have felt the same. Did any of you switch specialties. I am now strongly considering specialties with more autonomy, diagnosis focus and less clinical patient management, like rads or path. Unfortunately, I did not have much exposure in medical schools to others specialties that may offer the same factors I desire. Is there anyone that could give me some advice? Thank you.

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[Faebinder]

I'm a psychiatry resident and distressed to admit that I STRONGLY dislike seeing psych patients. Mostly, I find myself emotionally drained after a shift. I am feeling discouraged because I enjoy the theory of psych but I do not like the clinical management. I've learned that I am very much an introvert and a very concrete person, liking a quiet work space and definitive, precise diagnosis. Also, I realize that I like more to diagnose medical issues than necessarily treat them. Psych is too much of a revolving door, too ambiguous, and I'm not feeling happy anymore with my choice. This hurts my heart because, I had a guns-blazin' pro-psych demeanor all through med school and defended the specialty tooth and nail to any physican that bashed it. Ultimately, I respect psych but I'm realizing it is not for me.
Are there any psych residents out there who have felt the same. Did any of you switch specialties. I am now strongly considering specialties with more autonomy, diagnosis focus and less clinical patient management, like rads or path. Unfortunately, I did not have much exposure in medical schools to others specialties that may offer the same factors I desire. Is there anyone that could give me some advice? Thank you.

Sounds like you hate the inpatient part and love the outpatient. Good news, third year is all outpatient and many electives dont need inpatient coverage. when you are done with residency go open your own office and all is well.

 

[HCE]

I'm a psychiatry resident and distressed to admit that I STRONGLY dislike seeing psych patients. Mostly, I find myself emotionally drained after a shift. I am feeling discouraged because I enjoy the theory of psych but I do not like the clinical management. I've learned that I am very much an introvert and a very concrete person, liking a quiet work space and definitive, precise diagnosis. Also, I realize that I like more to diagnose medical issues than necessarily treat them. Psych is too much of a revolving door, too ambiguous, and I'm not feeling happy anymore with my choice. This hurts my heart because, I had a guns-blazin' pro-psych demeanor all through med school and defended the specialty tooth and nail to any physican that bashed it. Ultimately, I respect psych but I'm realizing it is not for me.
Are there any psych residents out there who have felt the same. Did any of you switch specialties. I am now strongly considering specialties with more autonomy, diagnosis focus and less clinical patient management, like rads or path. Unfortunately, I did not have much exposure in medical schools to others specialties that may offer the same factors I desire. Is there anyone that could give me some advice? Thank you.

I know someone who was torn between Psych and Pathology. He also expressed an interest in diagnosing vs. treating, which was the attraction I believe to Pathology. He eventually went in to Psych, and hasn't looked back. I don't think that questioning whether you went in to the right field is all that unusual, especially with new interns. If after soul searching you are sure (and I wouldn't do anything unless you are sure about what you want to do) that Psych is not for you, talk to someone (do you have a good relationship with your PD or an Attending?). Perhaps some internal arrangement can be made in the hospital to give you exposure to another field.

 

[Panama Red]

What ultimately made your friend choose psych and not regret passing up path? For me, I'm finding incredible discomfort with psych's ambiguity as well as my personal desire to diagnose rather than treat.

 

[Anasazi23]

What ultimately made your friend choose psych and not regret passing up path? For me, I'm finding incredible discomfort with psych's ambiguity as well as my personal desire to diagnose rather than treat.

The ambiguity may decrease for you as your clinical skills improve. You could always do forensic work, or C/L. Those are more cut and dry diagnostically and relatively little treating compared to long term outpatients. Also, you can consider disability evals whereby you have no treatment relationship. This occurs also in forensics.

 

[Doc Samson]

The ambiguity may decrease for you as your clinical skills improve. You could always do forensic work, or C/L. Those are more cut and dry diagnostically and relatively little treating compared to long term outpatients. Also, you can consider disability evals whereby you have no treatment relationship. This occurs also in forensics.

I totally agree. Your description of an ideal career is essentially a description of forensic psychiatry. Diagnosis only, no treatment. Limited time with patients, lots of time writing your reports in a quiet workspace. You like the theory, which you'll get to espouse in court. Seems tailor-made. Just be aware that to get consistent work as an expert witness, there is some pressure to maintain your rep by publishing.

 

[OldPsychDoc]

I totally agree. Your description of an ideal career is essentially a description of forensic psychiatry. Diagnosis only, no treatment. Limited time with patients, lots of time writing your reports in a quiet workspace. You like the theory, which you'll get to espouse in court. Seems tailor-made. Just be aware that to get consistent work as an expert witness, there is some pressure to maintain your rep by publishing.

Possibly also the "dislike" of the patients may actually lend itself to his objectivity. I'm a bit more into building rapport and collaborating with patients, which made forensics very non-enjoyable for me.

Nevertheless, the OP might want to be re-exploring his rad and path options. If it really is about concrete diagnostics for him, he may well be happier there. We'll be sad to see you go (see how hard folks are trying to keep you in the fold?) but godspeed.

(Personally I did think hard about radiology--have a PhD in neuroanatomy--but I just liked the clinical interactions more. And for some reason I was lousy in pathology, though great in histology, and noticed how much the rads folks knew their path.)

 

[Doc Samson]

Possibly also the "dislike" of the patients may actually lend itself to his objectivity. I'm a bit more into building rapport and collaborating with patients, which made forensics very non-enjoyable for me.

My sense was that the "dislike" was due to the revolving door/recidivist aspects of practice rather than patients themselves. The enjoyment of rapport building and (more importantly) actually treating patients (I have to be doing something or else I get bored) made forensics a poor fit for me also.

Given the OPs enjoyment of the theory of psychopathology, I do actually think that forensics would provide more satisfaction than radar or path - although it's always sad to loose a jedi to the dark side.

 

[OldPsychDoc]

My sense was that the "dislike" was due to the revolving door/recidivist aspects of practice rather than patients themselves. The enjoyment of rapport building and (more importantly) actually treating patients (I have to be doing something or else I get bored) made forensics a poor fit for me also.

Given the OPs enjoyment of the theory of psychopathology, I do actually think that forensics would provide more satisfaction than radar or path - although it's always sad to loose a jedi to the dark side.

I thought WE were the Dark Side!

 

[Anasazi23]

I thought WE were the Dark Side!

 

[Solideliquid]

^ Classic

 

[Faebinder]

BEAUTIFUL!!