Feeling discouraged as a psychiatrist, switch field?

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I really enjoyed this thread and the input many of you wise folks have provided.

I'll provide a naive, bushy-tailed intern perspective that perhaps might take you back to what got you into psych or at least a narrative born from inexperience.

Thinking back on my experience as a medical student and when I first did my psychiatry rotation, a lot has changed. I think one of the coolest aspects of our job is to confront things that are very frequently stigmatized and "too uncomfortable to talk about" head-on. I remember being uncomfortable asking someone about suicide, trauma-related stuff, and psychosis. It was weird and felt intrusive. Now, it's something I do without a passing thought. We deal with issues that people are often uncomfortable talking about with others - hell, the patients themselves may not even be able to confront these things - and provide an outlet to begin processing and dealing with these issues, whether that be with psychopharm, psychotherapy, or other interventions. No, this isn't something I think about on a daily basis, but in retrospect with a sufficiently global perspective, it is kind of a cool thing. There is nothing special about psychiatrists being able to ask these questions - anyone can do it - but it forms such an integral part of our daily practice that we actually develop comfort with these issues to the point that we can talk about them tacitly and in an environment that provides a sufficient degree of comfort to the patient while perhaps providing the treatment that can enable those folks to begin dealing with those very painful things. Good luck getting a surgeon to have an in-depth discussion on suicidality, why a patient's cheating wife launched him into a florid period of substance use, or any other "cliche" story we've probably seen a hundred times. Further, good luck to the surgeon should they attempt to have a meaningful discussion on these issues to help a patient develop insight into what's going on, convince them to accept treatment, or any other numerous basic tasks that we perform.

On consults, even the frustrating ones can be interesting or helpful to the consulting service, especially, as others have said, if you're able to decode the actual issue(s) behind a useless consult question like "homeless" or "tearful." No, you may not be able to solve those problems when the patient is being discharged the next day, but in your discussion of why a patient is homeless you may happen upon some substantial issues that have never been discussed before and open the door for treatment that up to that point hasn't been opened. I like the more medically-intensive, psychopharm heavy cases too, but even in the absence of those skills I think there are still things we are able to offer other teams that we probably take for granted without a passing thought.

I tire just as much as anyone of the patient who is on his/her 20th admission for substance-induced issues, but I've found that digging deep with many of these patients can bring to the surface some interesting and even actionable nuggets, sometimes seemingly unrelated to the presenting issue at hand. I think part of the practice is getting so much exposure to people that we can somewhat intuitively detect weirdness and know when to start probing to understand things that, prima facie, may not appear to require further investigation. Just as a medical student may not pick up on small, seemingly insignificant things in the history that have substantial importance to psychiatric management, so too with our consulting services.

I'm not entirely optimistic about the field. There are certainly plenty of negative things that go on with our daily practice. There are things about it that I can't stand. Sometimes I get bored. But just as cardiologists are experts of the heart, dermatologists experts of the skin, etc. - and, by the way, they very likely get bored with pacemaker placements, stent deployments, shave biopsies, and all of the other technical procedures we've developed - we also have our field of expertise. I think we may more liable to take those skills for granted because compared to, say, the more technical solutions to other medical problems, they seem pretty basic. But I think it's important to not lose sight of the fact that there are unique skills that we provide to both our patients and services that ask for our input. Sure, a lot of that is psychopharmacology, a lot of that is related to diagnosis, but I think just as much - if not more - is simply because we're comfortable dealing with issues that may make other folks, including physicians, extremely uncomfortable. That comfort allows us to get to the point of being able to even offer psychopharmacological solutions to problems. It allows us to attempt to separate the wheat from chaff - or at least make an attempt at doing so - so that we can try and prioritize an often-times long list of concurrent issues that many of our patients come with. That experience comes from years of seeing the spectrum of human behavior, the spectrum of determinants that play a role in that behavior, and attempting to identify slight variations on themes we've seen an innumerable number of times before.

These are soft skills, sure, but that doesn't in and of itself reduce their value, utility to our practice, or importance when doing something even as "basic" as routine depression management. It also doesn't make us any less experts in our own little world. The medical treatments we offer may be fairly straightforward (at least to those that demean the field), the diagnostic process apparently subjective and uncomplicated ("hold on, let me check the DSM and make sure I have a sufficient number of boxes checked"), and the task of talking with someone "so easy a caveman can do it," and yet plenty of people are so incompetent at these things that it's laughable.

Now those things may not be suited to your interests or what kind of work you envision doing. That's a completely different question and issue. But I do think it's important to recognize that we do offer expertise, that expertise takes significant time and experience to develop, and while it may not be "respected," it isn't, ergo, useless or unimportant.
Thanks. Insightful.

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I started this thread and have been excited to read everyone's response. I finally started to feel the spark of psychiatry again and then got that same response of disappointment today when someone asked me what kind off doctor I am (someone else had introduced me as a doctor.. Not me) an when i responded psychiatrist they responded with a disappointed "oh" and the conversation ended. I LOVE the job we do and things we see, but I'd be completely lying if I said it didn't bother me when people have this reaction. I also do still miss being able to feel like your doing something "tangible" for patients where they see a physical result. I feel bad saying those thoughts out loud but I do believe in trying to look within and being honest with how you feel. I'm glad everyone's been able to share a different perspective of their experience. I'll try to do some soul searching to figure out why it matters to me what people think...
 
Speaking of switching fields, my last official day as a psychiatrist was yesterday! I'm still doing some moonlighting, but no longer must I be identified among the general public as a weirdo whose job is to ask people questions in response to questions!
Mind sharing which field you switched to?
 
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Maybe you're just running in some pretty ****ty circles. I'm even more naive than NickNaylor because I start intern year in a few weeks but I too am entering Psych because of my interest in C/L work and was entertaining a number of other fields before finally making my mind. This stuff bothered me a lot, at times it still does, but most of the people I've met who aren't in medicine seem to be genuinely grateful and appreciative that I'm entering Psychiatry (a lot of "We need more good psychiatrists" or they share an anecdote from their life). I get more judgement from people in medicine who know how well I've done in medical school (because it seems like "a waste" to them) but when I ask those individuals if they'd like to manage the psych issues themselves, they promptly shut up.

It was mentioned back on page 1 but it really sounds like you need a nice, long vacation before starting work, and in general work-life balance might be something for you to evaluate. I get that this is what we do day in and out, and it's harder for us to make career shifts than non-medical peers, but I don't look at my future job as a psychiatrist as something that defines who I am. Neither should you. It's a part of what I do, sure, but it's still just a job. It's a job that, despite what some may say, pays pretty well for the hours worked, and isn't as stressful or demanding as other specialties (though we have our own problems to be sure). It will let me travel, afford a nice standard of living, and hopefully also be rewarding. No, it's not derm in any of these respects, but few things are. If I wanted to do derm or ophtho or anesthesia or ent, I could have, ditto for you and most others on this board.

Also, think back to your medical school rotations. Do you remember treating the same patient for COPD or CHF exacerbations multiple times in the same month on your IM service? Admits for emergent dialysis? Patients dying in front of you in the ED shock rooms only to walk back into the acute area to have two more insult and threaten you, and every service you consult complaining about the "lack of workup" done while you've just assessed 8 patients in the past hour and there's full waiting room that needs evaluation? Keep talking to other specialties, everybody feels shat on, everybody. You may feel the grass is greener on the other side but it's probably the same shade of brown everywhere.

I'd re-evaluate in a year, after taking a few months off to travel and reconnect with the things and people you like, and settling into a new job.
 
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I started this thread and have been excited to read everyone's response. I finally started to feel the spark of psychiatry again and then got that same response of disappointment today when someone asked me what kind off doctor I am (someone else had introduced me as a doctor.. Not me) an when i responded psychiatrist they responded with a disappointed "oh" and the conversation ended. I LOVE the job we do and things we see, but I'd be completely lying if I said it didn't bother me when people have this reaction. I also do still miss being able to feel like your doing something "tangible" for patients where they see a physical result. I feel bad saying those thoughts out loud but I do believe in trying to look within and being honest with how you feel. I'm glad everyone's been able to share a different perspective of their experience. I'll try to do some soul searching to figure out why it matters to me what people think...

I understand, but would still encourage you to view this as your job, and not YOU. You are not your job. Too much delusion of the opposite is not healthy for you or anyone around you.
 
and then got that same response of disappointment today when someone asked me what kind off doctor I am (someone else had introduced me as a doctor.. Not me) an when i responded psychiatrist they responded with a disappointed "oh" and the conversation ended.
Like I said earlier, be glad when they stop talking, it is worse when they will not stop talking. Maybe we should go look at the Proctology blog and see what they are saying about this.
 
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