How much medicine do you really have to know

[Brainhurts]

So I recently graduated med school and have always known that I wanted to go into psych. Med school has been tough bc I have no interest in general medicine and frankly I'm not too good at it either. I know this sounds bad but i tried my best to stay out of spotlight during my clinical rotations and wasnt very hands on with patient care (except for my psych rotation which i rocked). I did just pass step 3 but I'm scared as hell about intern year. ****, I can barely read an EKG! I know there's 4 months of IM and 2 months of neuro. How tough is it going to be for a psych resident? After those core months, are we expected to keep up our general medicine knowledge? How are things once you graduate and go into private practice? I just really want nothing to do with general medicine ever and look forward to just treating mental illness. Obviously, I know there will be some overlap between psych and IM and I'm totally okay with screening for things like thyroid disorder, seizure d/o, head injury etc. but that's as much as I would like to do. I'm hoping after intern year, I can say goodbye to general medicine.

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[LimbicResponse]

Most medicine interns know very little medicine, it's all about being organized, taking orders, working hard. A positive attitude goes a long way. Being a psych intern in medicine, your resident will be aware of your background and hopefully either be supportive and help you or just give you stable patients with dispo issues to care for.

 

[whopper]

You don't have to know IM well but I recommend you know at least enough medicine to deal with PCP stuff. EKGs? You don't have to know it as well as a cardiologist but several psychotropics do adversely affect the heard. QT prolongation is a good thing to always be able to measure. You will also get cases from time to time where you'll need to read up on it, just to stay sharp and see where the interface with medicine and psychiatry is.

Your enjoyment with IM may improve when you're not responsible to know as much information. I hope it does because IMHO you need to know it more than to the degree than you're currently willing to use it.

And this is not an attack on you. I'm suspecting you likely know medicine decently as most medical students do. I think all medical students feel ovewhelmed on some level. I've found medicine more enjoyable given that I had to know less of the details and more of the fundamentals vs several of my colleagues outside the field.

But rest assured, if you don't want to know medicine, you can get away with it. I hate saying that because there's so many bad psychiatrists out there whose lack of medicine skills contribute to all psychiatrists being viewed with suspicion. I recall attendings I had as a resident freaking out with a BP of 135/89. I don't respect attendings whose knowledge is to that degree. I don't think you're like that and hope you'll agree with me this is pathetic. I also hope that by seeing this, you might realize your comfort level with IM would put you at a level far above those attendings.

 

[Brainhurts]

Thanks for the reassuring words. Whopper, you must be a great psychiatrist bc you nailed it on the spot. It's not that I hate medicine, I'm just overwhelmed with how much there is to know. If there wasn't so much pressure and sleep deprivation involved, it would be enjoyable. I've worked along side too many "gunner" IM students and I feel so incompetent compared to them...I get bad anxiety! But when it comes to bedside manners, soft skills, and psych issues, I definitely have them beat in that respect.

 

[whopper]

Medical school's pace is like getting 100 hot dogs and telling a guy he has one day to eat them all. Eat em once a week, you're fine, in fact you'll likely even enjoy them.

That's what it was like for me. I actually like reading up on the IM stuff now and then, and I consider myself to actually know more than several of my psychiatric colleagues in medicine simply because I know how to correctly diagnose HTN, and order lithium labs before the lithium is started, and actually spend some time considering the patient's metabolic status when ordering meds Medical students already have the foundation in their head. Maintaining it isn't as much work. You could like it at that pace. I hope you do.

I mentioned this in another thread but I had a patient with what I believe is a lupus anticoagulant induced psychosis. Did I remember everything about it when I had this patient? No. I had to read up on it again. No problem. What we had here was an older man in his 60s with no prior psychosis, showing very odd symptoms (he wanted to keep a bag of urine on him at all times), being very paranoid and telling me he respected me because he knew I was a Princeton U. grad (I'm not and don't know WTF he got this notion). The only abnormal lab he had was a lupus anticoagulant that he did not have before. Every single other lab you could think of that could explain a later psychotic episode was negative. Just using common sense I used that as a first step, read up on it and went from there, googled "lupus anticoagulant" and "psychosis." Then I read up on any articles that shed light on it. It wasn't that I'm some medical genius.

I actually enjoyed that because I didn't have to read it as if I had a gun to my head like I did in medschool. I ended up knowing about this stuff in a few days better than the IM doctor working with me.