How much medical knowledge do you use/maintain?

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As a practicing psychiatrist, do you lose all you "medical" knowledge? Or is some of it being used/maintained in the work?

One fear I have about psychiatry is that I'll be a "doctor", yet I won't know anything "doctorly", from the perspective of a layman at a cocktail party...if that makes any sense.

 

[BobA]

As a practicing psychiatrist, do you lose all you "medical" knowledge? Or is some of it being used/maintained in the work?

One fear I have about psychiatry is that I'll be a "doctor", yet I won't know anything "doctorly", from the perspective of a layman at a cocktail party...if that makes any sense.

Having gone through med school, you'll know more than enough to sound like a doc at a cocktail party.

But it's important for med students to know that psychiatry is actually a very broad field. If you do Consult work, Emergency Psych, Pain, Sleep, etc you may continue to use your medical knowledge.

However, I bet most outpatient general psychiatrists don't use medical knowledge much.
In fact, I once heard a famous psychiatrist say that after 20+ years of doing outpatient psychiatry he "barely felt comfortable prescribing chapstick." That was a joke, but it's got a kernel of truth.

How much "doctorly" knowledge does a pathologist, dermatologist, ophthalmologist know? After years of practice, I bet most sub-specialists don't feel competent with primary care stuff. Not just psychiatrists.

 

[Shufflin]

A seasoned orthopedic surgeon once told me that he's forgotten medical knowledge and only knows how to use a saw and hammer. He was partly joking, emphasis on partly.

 

[peppy]

Any good psychiatrist should maintain some medical knowledge since we're prescribing meds that have real potential side effects. You have to know how to recognize it when a patient you have on antipsychotics develops hyperprolactinemia or when your bipolar patient has an elevated ammonia from depakote (I once caught that a patients' bizarre behavior was from that, not from his mental illness, when the ER didn't seem to take notice of it). I've seen at least one case of clinically significant hyponatremia which appeared to be from an SSRI.Oh, and let's not forget QT prolongation, hyperlipidemia, and other metabolic effects...not to mention the possible psych symptoms that can result from hypothyroidism and seizure disorders.

 

[notdeadyet]

A seasoned orthopedic surgeon once told me that he's forgotten medical knowledge and only knows how to use a saw and hammer. He was partly joking, emphasis on partly.

True. In psychiatry, you'll lose more general medical knowledge than most specialties, but this is true no matter what you go into.

Just for fun, ask an ER doc antibiotic questions: most are limited to about eight and they'll google/epic rates the rest. Ask a surgeon about managing diabetes or hypertension.

Psychiatrists, like many physicians, are specialists. That means we get better and better in our field while our skills in other fields atrophy. The Ortho guy will be more capable to answer someone's question of "why does it hurt when I do this?" but you'll be better able to answer someone's questions about their mom's alzheimer's.

By the way, if you're really interested in up keeping your knowledge in general medicine for the sake of protecting all that study you've done and to be able to answer the questions of friends and family, there's absolutely nothing stopping you from keeping up with your reading or doing gen med CME, if you want.

 

[freaker]

I find myself applying medical knowlege on a regular basis. For my geriatric patients, I'm routinely finding UTIs and very much aware of the side-effects and interactions of medications. I routinely check heights and weights of my adolescents, monitor blood pressures in my adults.

I don't always prescribe medications for these conditions, but a lot of times I'll suggest CAM methods, many of which I've used myself. It's a grade motivator to get patients to exercise, which will improve their mood, as wel, in addition to recomending that they follow-up with their PCP. Hibiscus tea works great for blood pressure. I've caught more than a few patients with low energy on statins or with CHF and had them start taking CoQ10, and suddenly they're feeling better again. I routinely recommend fish oil for my patients as the research seems to be showing mood stabilizing benefits, aid with anxiety, and improvements in lipid panels and weight with it. I routinely catch abnormal thyroid function and also check for low testosterone. I find many PCPs will miss low testosterone in young vets who have had TBIs, but I find it rather routinely.

It's hard at times to practice as an outpatient provider because you don't want to step on someone else's toes. No, you won't be prescribing the medicines an internist prescribes because that's not your job, that's their field of expertise, and really, the experts should be prescribing those sorts of medications. That doesn't mean you ignore the medical illness.

As for my stethoscope, well, that's collecting dust somewhere. You simply won't have time to use it much except on doing consults.

If you're looking at going into psychiatry and keeping abreast of medical knowlege, go ahead and subscribe to the American Family Physician Journal. I find their journal to be the most digestable and relevant to clinical practice of any that I've seen.

 

[PikminOC]

I did a full prelim medicine year with 2 months in the ICU. I use my medical knowledge every day in outpatient, inpatient, and CL work. My indigent patients appreciate this as they have a hard time getting to multiple docs. I call their PCP and let them know of any concerns.

And medical and substance induced conditions must be considered when making psychiatric diagnoses so that keeps me on my toes too.

 

[zenman]

I'm an psych NP and I'm glad I had a lot of ED, ICU experience. Many of our referrals from ED are not thoroughly checked out if the patient has a psych diagnosis, but rapidly sluffed over to us. We've actually sent a few right back to the ED. My psychiatrist med director recently picked up internal bleeding while consulting on a 10 yr old kid thrown out of a car. That was embarrassing to the pediatrician. Kid's mother died in the accident.

 

[whopper]

I'm currently working on a geriatric psychiatric unit among other responsibilities and general medical knowledge is much more needed in this situation. Virtually every patient I have has multiple medical problems and several of them are within months of dying.

How much medical knowledge you retain is going to be based on how often you use it, keep up with it, or choose to relearn it.

Doing a year of forensic psychiatry as a fellow greatly removed me from the practice of non-psychiatric medicine. In fact it greatly removed me from even psychiatric treatment because I spent a tremendous amount of time doing evaluations without treating patients much while having to memorize law cases.

I remember I wanted to have a few hard-core patients where no one was able to get them better in fellowship. I relish being able to have a very tough case, then spending a lot of time on that one case. While doing several evaluations, seeing the patient no where near as improved as they should be, then being forced to not do anything about it other than report to the court what was going on while seeing the treating psychiatrist continue to sit on their butt and do even less than what should've been the bare minimum in terms of standard care.