I don't feel like a 'doctor' :(

[digitlnoize]

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I picked psych for the same reason a lot of people pick psych: evaluating abgs or FeNA or whatever was uninterssting, surgery/procedures were not appealing, and the hours in psych seemed pretty good.

The mystery has been solved. I'm curious how many people go into psych for these reasons.

I went into it because I enjoy talking to people, I find the theory and pharmacology very interesting, and I think the field is the last "undiscovered country" in medicine with huge leaps to be made in knowledge over the course of my career, and finally...because I think I can be truly good at it.

I do like the hours, though

I think a popular concept of a physician is someone who treats physical illness with medications and/or procedures/surgery. Under this definition diagnostic radiologists and pathologists count because they provide answers about the dx of illness which then leads to treatment.

I think the popular concept of a physician has little to do with any of those things and more to do with the uniform and experience. Hence the success of mid-levels recently. Patients usually don't know or care if they're being seen by a "doctor" or "NP" or "Joe-Bob from the Corner" if that provider can make them feel better. Because THAT is what a doctor does. Makes people feel better.

 

[MrJiggles]

On the number of people who find it a "joke", I'll guess we will have to just disagree. Like I said, tour the sdn lounges and you will find a variety of opinions on the matter. The reality is that there is a HUGE gulf between "a joke" and "100% the real thing".....most people certainly fall somewhere in between. So no, most people don't find psychiatry to be a complete joke.

I think alot of it has to do with the caliber of programs. Since Psych is not a competitive specialty, there is going to be a wide variation in quality of both the programs and the residents therein. In the more academic program I've seen with a highly developed consult department, doctors in the hospital across specialties seem to have a lot more respect for psych. In the crappy program I've seen with crappy residents and a crappy consult team, the other doctors see a bunch of fools in the psychiatry department and think that all psychiatrists are bums.

And yeah I agree that psych is a popular specialty to switch into for reasons of competitiveness, but also because of some jadedness with medicine. I mean, have you read "House of God"? I think I'm in the same boat as Sam Shem in plugging psych. I did not come into medicine thinking that I would go into Psych, but while I loved the stimulatin of medicine, my psych rotation was one of the only times I felt that I was actually helping people. I imagine many actual doctors feel the same.

 

[surftheiop]

The mystery has been solved. I'm curious how many people go into psych for these reasons.

I went into it because I enjoy talking to people, I find the theory and pharmacology very interesting, and I think the field is the last "undiscovered country" in medicine with huge leaps to be made in knowledge over the course of my career, and finally...because I think I can be truly good at it.

I do like the hours, though



I think the popular concept of a physician has little to do with any of those things and more to do with the uniform and experience. Hence the success of mid-levels recently. Patients usually don't know or care if they're being seen by a "doctor" or "NP" or "Joe-Bob from the Corner" if that provider can make them feel better. Because THAT is what a doctor does. Makes people feel better.

I always find it intersting how the fact that psychiatric illness isn't well understood gets two such diverging reactions from people. A lot of folks say "psych isnt intellectual because you can't order a test to prove something".

But to you (and me) it seems like being in a field where you can't order a test to 100% confirm a diagnosis would be more exciting intellectually, and who knows maybe you will be the one to invent that test or make the next great breakthrough.

 

[vistaril]

I think alot of it has to do with the caliber of programs. Since Psych is not a competitive specialty, there is going to be a wide variation in quality of both the programs and the residents therein. In the more academic program I've seen with a highly developed consult department, doctors in the hospital across specialties seem to have a lot more respect for psych. In the crappy program I've seen with crappy residents and a crappy consult team, the other doctors see a bunch of fools in the psychiatry department and think that all psychiatrists are bums.

I agree with this.....at some of the crappier programs, I'd actually say some derm residents could do a better job on psych rotations than the psych residents. That's because the derm residents at even lower caliber programs are all superstars, whereas the psych residents at some of those same training places are truly scary.......

the other thing though is that at some truly "top" places, although the quality of the psych people does improve, the quality of the medicine and surgery people is truly elite. So while the average psych resident at Duke is a good bit better than the average psych resident at East Carolina(just to pick two north carolina examples), the average medicine resident at duke is a hell of a lot more with it too.......so that impacts their perspective on how they observe psych.

 

[vistaril]

I always find it intersting how the fact that psychiatric illness isn't well understood gets two such diverging reactions from people. A lot of folks say "psych isnt intellectual because you can't order a test to prove something".

But to you (and me) it seems like being in a field where you can't order a test to 100% confirm a diagnosis would be more exciting intellectually, and who knows maybe you will be the one to invent that test or make the next great breakthrough.

unfortunately though, those same issues also allow lots of incompetents to practice in our field....

 

[jettavr6]

We are paid(or going to be paid for those of you who havent started actually working for real money yet) to do psychiatry.....not to do psychiatry and function at 40% the abilities of a good internist.

Actually, this is going to be the major issue going forward in healthcare. What value as psychiatrists, let alone physicians, are we going to bring to the table. Even if we think it's BS and unsafe, the corporatocracy will replace us with NPs at the drop of a hat if it will save (make them) money. What does this mean? We may end up having to do a little bit of medical management in the future whether we like it or not. We have to adapt to the changing landscape of medicine and try to predict the best we can, starting now, where things are headed. One example in the future could be the following: Patient who we are treating for depression also has a "minor" sore throat or a UTI, I can see this is being a case where a trial of an anti-biotic could be considered reasonable. This could potentially save the "system" by not having the patient see two different physicians.

 

[diagonal]

Actually, this is going to be the major issue going forward in healthcare. What value as psychiatrists, let alone physicians, are we going to bring to the table. Even if we think it's BS and unsafe, the corporatocracy will replace us with NPs at the drop of a hat if it will save (make them) money. What does this mean? We may end up having to do a little bit of medical management in the future whether we like it or not. We have to adapt to the changing landscape of medicine and try to predict the best we can, starting now, where things are headed. One example in the future could be the following: Patient who we are treating for depression also has a "minor" sore throat or a UTI, I can see this is being a case where a trial of an anti-biotic could be considered reasonable. This could potentially save the "system" by not having the patient see two different physicians.

I think the 80 yr old with sacral decubs getting an ECHO and being put on dialysis is a more likely target than having a psychiatrist treat UTIs.

"Alright sir, now that we've got your anxiety sorted out, let's see that dick."

 

[jettavr6]

I think the 80 yr old with sacral decubs getting an ECHO and being put on dialysis is a more likely target than having a psychiatrist treat UTIs.

I think you missed my point... In a nutshell, how are we going to prevent ourselves from being replaced by NP's and APRN's? In some way we might need to be more medically involved.

80 year old with sacral decubitus ulcers falls under the spectrum of surgery.... Surgery is protected in that regard.

 

[diagonal]

I think you missed my point... In a nutshell, how are we going to prevent ourselves from being replaced by NP's and APRN's? In some way we might need to be more medically involved.

80 year old with sacral decubitus ulcers falls under the spectrum of surgery.... Surgery is protected in that regard.

We don't take insurance. Pretty simple. If you're an English speaking doc with the ability to talk intelligently and connect with a patient, you'll be a hot commodity. Mental health, for all that it's ignored in medicine, is the #1 thing people care about, in reality. And people with resources will always seek out a physician to help them through their problems.

 

[OldPsychDoc]

I think you missed my point... In a nutshell, how are we going to prevent ourselves from being replaced by NP's and APRN's? In some way we might need to be more medically involved.

80 year old with sacral decubitus ulcers falls under the spectrum of surgery.... Surgery is protected in that regard.

Don't count on it--there are places right now where the day to day management of this stuff is being delegated to mid-levels, and with reimbursements likely to fall more percentage-wise in the procedural areas, you'll probably see fewer openings in surgical jobs for MDs. (Or possibly more openings, paying less well.)

 

[jettavr6]

We don't take insurance. Pretty simple. If you're an English speaking doc with the ability to talk intelligently and connect with a patient, you'll be a hot commodity. Mental health, for all that it's ignored in medicine, is the #1 thing people care about, in reality. And people with resources will always seek out a physician to help them through their problems.

That's becoming an even more rare commodity these days. Unless you practice in a wealthy area, it's becoming more and more difficult to get cash paying patients.

 

[splik]

We don't take insurance. Pretty simple. If you're an English speaking doc with the ability to talk intelligently and connect with a patient, you'll be a hot commodity. Mental health, for all that it's ignored in medicine, is the #1 thing people care about, in reality. And people with resources will always seek out a physician to help them through their problems.

???!!!!!

 

[nancysinatra]

It's like those guys saying synchronized swimming is not a sport. It is one, but yeah, okay, it doesn't meet the guy's visceral reaction of what he thinks is a sport.

I thought synchronized swimming was an art, aka "water ballet."

 

[vistaril]

I think you missed my point... In a nutshell, how are we going to prevent ourselves from being replaced by NP's and APRN's? In some way we might need to be more medically involved.

80 year old with sacral decubitus ulcers falls under the spectrum of surgery.... Surgery is protected in that regard.

the key to protect ourself from mid levels isn't to be able to manage basic medical issues....heck, midlevels can do that themselves. Stating you can treat upper respiratory infections "almost as good as a PA" isn't exactly a ringing endorsement for psychiatry......

 

[Mattchiavelli]

just my 2c as a PGY2 neurology resident who thinks a psychiatrist is a real doctor therefore I skipped that part of the thread, but to the OPs problem-

Psych medications are real medications and need to be taken on and off as such in a reasonable manner as they have effects on the autonomic nervous system as well - lots of kids with psych problems on a2 blockers for instance and I don't know if peds is different, but based on my medicine intern year on the adult side the medicine people are very unfamiliar with psych meds especially as many new ones and new uses for them came out after people doing IM in hospitals as attendings were doing their MS2 pharmacology lectures. If you stay interested in medicine you can make a very talented C/L psychiatrist, and they are worth their weight in gold. However, I don't know how much $$ that is because I usually do adult and am not used to weight based dosing~

 

[vistaril]

I can honestly say that I have very little idea what any of the above post meant.

 

[slowbee]

Thank you for all of your posts. I think I do miss kids mostly. I actually really disliked my pediatrics rotation becuase I didn't like the medicine of it, but was able to stand it because the kids are so darn cute... and I hated all other rotations even more. I chose psychiatry because it was the only field I enjoyed, and I think I am now getting cold feet (is it too late for cold feet?) because I'm missing the kids... There's no way I'd switch to any field right now, I kept a diary of my third year rotations and upon referencing that, I see I was quite disappointed with pediatrics overall.

i'm in a similar boat only i'm still in a position to be deciding bw the two. i'm wondering if things are better with everything getting underway? i'd really like to hear your thoughts on your decision/doubts/cold feet if you'd like to PM me.

 

[Sharpie1]

i'm in a similar boat only i'm still in a position to be deciding bw the two. i'm wondering if things are better with everything getting underway? i'd really like to hear your thoughts on your decision/doubts/cold feet if you'd like to PM me.

Well it's only been like a week since I posted... things aren't very different at this point. Sorry I can't help you more!

 

[pre med 2014]

Sometimes I really miss real medicine... I'm only a couple of weeks into intern year and I know I'd hate it if I were doing anything else... but I was between psychiatry and pediatrics and some moments I just wish I chose pediatrics! Does anyone else have these feelings?

This is completely normal, since psychiatry is an impersonation of medicine, not an actual field of science or medicine.

 

[Leo Aquarius]

This is completely normal, since psychiatry is an impersonation of medicine, not an actual field of science or medicine.

Tell this to all the schizophrenic, majorly depressed, psychotic, borderline, and suicidal people in our society who would be otherwise dead if it weren't for psychiatrists. Then tell this to their families and see what response they give you. I'm serious. Try it.

It will open your eyes.

(As an aside, I once thought ObGyn was a bunch of hot air because all you had to do was stand there and help the baby out of the womb. People have been delivering babies for thousands of years without ObGyn doctors, so they obviously are useless and it's just a trumped up field. Well, my glaring foolishness and short-sighted opinion was quickly dispelled when I actually got to med school.)

 

[GOINGDUMB]

Meanwhile in another thread I read...

CC: Anxiety, ADHD, Depression

HPI: 25 y/o otherwise healthy MWF with a history of panic attacks, bipolar (type II) depression, generalized anxiety, and ADHD. She meets individual DSM criteria, at separate times, for all. However, currently suffering from all at the same time. No history of substance abuse. Currently on Klonopin (1mg TID) and Lamictal (400mg daily on estrogen based OCP's). Main problem is anxiety and ADHD symptoms. Klonopin exacerbates ADHD symptoms and psychostimulants have exacerbated anxiety and destabilized mood. Seroquel showed promise but caused significant weight gain. Adequate trial of Strattera of no benefit for ADHD and antidepressants of no benefit for anxiety, while on mood stabilizer. Patient reluctant of lithium. We are In the same situation as we were six months ago. Debilitating anxiety and panic attacks. Unable to function at work as an upper level school administrator d/t anxiety and ADHD symptoms. Depression minimal but fluctuates with anxiety and ADHD symptoms. No recent hypomanic episodes.

ROS otherwise unremarkable, no significant medical problems, and recent labs WNL

I understand the pathophysiology of each disorder and the mechanism of action of each drug, and how they can exacerbate each other.

Hmmmm that sounds like doctorese to me with complexity comparable to IM and judicious hypothesis extension potential far beyond the day to day IM reasoning. But I'm not a psychiatrist, just a spectator at this point.

 

[digitlnoize]

This is completely normal, since psychiatry is an impersonation of medicine, not an actual field of science or medicine.

Tell that to the C-L docs and see what happens. Delirium management feels pretty "doctor-y" to me. Tell that to the guy whose depression and anxiety was a manifestation of his undiagnosed hemochromatosis. Good thing I doctorly diagnosed that or he would have died of Liver Cancer.

Suicide is one of the top 10 leading causes of death. Working to prevent it sounds pretty doctor like. Depression is one of the LEADING causes of debilitation and decreased productivity in the world. It's too bad there aren't any doctors to treat it...

 

[notdeadyet]

This is completely normal, since psychiatry is an impersonation of medicine, not an actual field of science or medicine.

You resurrected a 2 month old thread for this weak jab?

And nothing personal, sport, but listening to premeds talk about medicine is a little like hearing the nuns opine about sex.

 

[vistaril]

You resurrected a 2 month old thread for this weak jab?

And nothing personal, sport, but listening to premeds talk about medicine is a little like hearing the nuns opine about sex.

Interestingly, I've talked to a number of med students(mostly really good ones) who had a much higher opinion of psychiatry(at least the medical model version) before going to med school and doing their core psychiatry clerkship.

After many finish the clerkship, they feel that psychiatry fits in the medical model a lot less well than their previous conception was.

 

[vistaril]

Meanwhile in another thread I read...




Hmmmm that sounds like doctorese to me with complexity comparable to IM and judicious hypothesis extension potential far beyond the day to day IM reasoning. But I'm not a psychiatrist, just a spectator at this point.

honestly, it sounds like mostly nonsense to me and I wouldnt neccessarily have confidence in any of those dx. Furthermore, the idea that(in this pt) they are all separate pathologies neccessitating individualized treatments is ludicrous.....

 

[SixStringPsych]

Of course most med students will have a lesser view of Psychiatry after clerkships and whatnot. What looks more like "medicine" to you: the patient who lives because of a kidney transplant or the schizophrenic who gets only a little better after a dose of Haldol? The simple fact of the matter is that Psychiatry is medicine. If there were no visible need for mental health treatment it wouldn't have it's own accredited programs and it wouldn't be a specialization. I love when people argue that it's "not medicine" because it just goes to prove how many unskilled doctors or future doctors we have.

If you don't like the idea of practicing Psychiatry as your main career, that's fine, no one cares. But at least respect the field and pay attention to what it can tell you about your patients because mental health is NOT something to overlook just because you can't regulate it with Simvastatin or something.

Yeah I'm a lowly pre-med so my opinion probably holds no weight here but I don't care. Truth is Psychiatry is a profession for a very different breed of physician, or so I have seen from the many different physicians I have met.

 

[drno31]

Yea, I'm pretty sure the guy who resurrected this thread is just trolling.

 

[pre med 2014]

Of course most med students will have a lesser view of Psychiatry after clerkships and whatnot. What looks more like "medicine" to you: the patient who lives because of a kidney transplant or the schizophrenic who gets only a little better after a dose of Haldol? The simple fact of the matter is that Psychiatry is medicine. If there were no visible need for mental health treatment it wouldn't have it's own accredited programs and it wouldn't be a specialization. I love when people argue that it's "not medicine" because it just goes to prove how many unskilled doctors or future doctors we have.

If you don't like the idea of practicing Psychiatry as your main career, that's fine, no one cares. But at least respect the field and pay attention to what it can tell you about your patients because mental health is NOT something to overlook just because you can't regulate it with Simvastatin or something.

Yeah I'm a lowly pre-med so my opinion probably holds no weight here but I don't care. Truth is Psychiatry is a profession for a very different breed of physician, or so I have seen from the many different physicians I have met.

I don't disagree that mental problems exist. But it is shortsighted to focus only on the voluntary portions and ignore the elephant in the room. That is psychiatry is a field plagued by unfalsifiable subjective value judgements. Typhoid fever is a disease, that diagnosis can be falsified. But spring fever is not a disease, it is an unfalsifiable condition, just like every psychiatric condition. An any time a real disease is found it is given to real doctors to be treated with medicines discovered using science. Like when psychiatrists discovered syphilis in the mental wards.

Mental problems exist just like pretty sunsets exist. You can use science to determine the sunset is red, but if you say this sunset is pretty you can't falsify that it's pretty. That to me is the number one problem that has always plagued psychiatry and always will. Falsifiability is the hallmark test for a scientific theory.

 

[splik]

most of medicine deals with non-disease. most of primary care is not about diagnosis. rheumatologist and allergists/immunologists deal are the experts in non-diseases and often just make up diagnoses with antibodies and other biomarkers flimsily supporting the diagnosis in a patient who is psychiatrically ill. The diagnostic criteria for many things is subjective and arbitrary, take SLE, multiple sclerosis, rheumatoid arthritis for example. That is not to mention fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. Even the cut off points for what constitutes diabetes and hypertension are shifting continuously, and based partly on subjective norms of what constitutes physiological and what is pathological.

Many criticisms of psychiatry are based on a romanticized view of medicine, and that doctors deal with 'diseases'. Well the medical model isn't all that great for many patients, which is why 40% of ER visits for abdominal pain and chest pain do not result in a diagnosis, and one of the reasons why alternative medicine has grown in popularity in recent years. At least psychiatry confronts uncertainty rather than ignoring it, takes the biomedical model as one perspective, but has behavioral, cognitive, dynamic, existential, systemic, and sociocultural frameworks to help understand the patient and their problems where the biomedical model fails. Even then that medical model pretty well helps me explain my delirious patient, or methamphetamine-induced psychotic patient, or the prominent psychosis in my patient with Parkinson's disease on Levodopa.

Anyone who has this naive view of medicine being falsifiable dealing with 'real' pathology doesn't know anything about medicine. Anyone who thinks medicine should be the aim of psychiatry and not the starting point, doesn't know anything about psychiatry.

 

[splik]

Don't even get my started on the role of coercion in medicine. In psychiatry, coercion is explicit, it is something talked about, fret over, a source of unease and anxiety. In much of the rest of medicine, coercion is implicit, insidious, pernicious, never acknowledged. The acutely ill patient is often the passive recipient of care, decisions made which they would not want, things done in the name of treatment that constitute battery. Whist I don't want to downplay the effects of coercion in psychiatric hospitalization, patients are often a lot more traumatized from being in the MICU than from being on a psych unit.

 

[BS81]

most of medicine deals with non-disease. most of primary care is not about diagnosis. rheumatologist and allergists/immunologists deal are the experts in non-diseases and often just make up diagnoses with antibodies and other biomarkers flimsily supporting the diagnosis in a patient who is psychiatrically ill. The diagnostic criteria for many things is subjective and arbitrary, take SLE, multiple sclerosis, rheumatoid arthritis for example. That is not to mention fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. Even the cut off points for what constitutes diabetes and hypertension are shifting continuously, and based partly on subjective norms of what constitutes physiological and what is pathological.

Many criticisms of psychiatry are based on a romanticized view of medicine, and that doctors deal with 'diseases'. Well the medical model isn't all that great for many patients, which is why 40% of ER visits for abdominal pain and chest pain do not result in a diagnosis, and one of the reasons why alternative medicine has grown in popularity in recent years. At least psychiatry confronts uncertainty rather than ignoring it, takes the biomedical model as one perspective, but has behavioral, cognitive, dynamic, existential, systemic, and sociocultural frameworks to help understand the patient and their problems where the biomedical model fails. Even then that medical model pretty well helps me explain my delirious patient, or methamphetamine-induced psychotic patient, or the prominent psychosis in my patient with Parkinson's disease on Levodopa.

Anyone who has this naive view of medicine being falsifiable dealing with 'real' pathology doesn't know anything about medicine. Anyone who thinks medicine should be the aim of psychiatry and not the starting point, doesn't know anything about psychiatry.

Not to mention interstitial cystitis, chronic pelvic pain, chronic back pain, vulvodynia, complex regional pain syndrome, insomnia, whiplash, tension headaches, migraine headaches, TMJ disorder, and the numerous more pain syndromes that are out there. Just finishing a CAM elective and the type of stuff these specialists have put these patients through no wonder they go to alternative approaches.

 

[splik]

since my special interest is medically unexplained symptoms (especially neurological symptoms) does that mean I'm a non-doctor? Or does it just mean I'm a doctor of non-diseases?

 

[pre med 2014]

You resurrected a 2 month old thread for this weak jab?

And nothing personal, sport, but listening to premeds talk about medicine is a little like hearing the nuns opine about sex.

I was on my phone and this thread was on the top Of the list under psychiatry in my search function, I had no idea I was replying to old thread. I just assumed it was new.

 

[diagonal]

I don't disagree that mental problems exist. But it is shortsighted to focus only on the voluntary portions and ignore the elephant in the room. That is psychiatry is a field plagued by unfalsifiable subjective value judgements. Typhoid fever is a disease, that diagnosis can be falsified. But spring fever is not a disease, it is an unfalsifiable condition, just like every psychiatric condition. An any time a real disease is found it is given to real doctors to be treated with medicines discovered using science. Like when psychiatrists discovered syphilis in the mental wards.

Mental problems exist just like pretty sunsets exist. You can use science to determine the sunset is red, but if you say this sunset is pretty you can't falsify that it's pretty. That to me is the number one problem that has always plagued psychiatry and always will. Falsifiability is the hallmark test for a scientific theory.

You sound like a community college grad that just finished his first bio class and now wants to preach on the mountain your newfound razor-sharp scientific prowess. Psychiatric illness is the #1 cause of disability in America. Because it can't be diagnosed with an x-ray or eradicated with a scalpel doesn't make it any less of a specialty. It is, in fact, a specialty. I'm not surprised the ambiguity of it bothers you. Most science-minded people aren't good with grays. So study hard, get into that Ivy League med school, memorize a lot of things, and become a brain surgeon. As far as I'm concerned, the only real doctors are brain surgeons. Who cares that most of the patients they operate on are old and feeble. Who cares that many die anyway. Who cares that they come out of surgery with a million other problems that remain, and their quality of life changes not one iota. I should correct myself: in fact, their quality of life is often worse because now they get to live the remainder of their days in a hospital. Then they get to get an infection, and those badass ID docs come in and pump them with antibiotics, which sometimes don't work. Then they go back to the ICU to be intubated. Then they die. It's a beautiful system. But hey, at least they got to live another day!

Psychiatry is unique in that we place value on quality of life. I'm don't get morning wood over making a senile 90yr old live an extra week. I do get mildly tumescent when a 25yr old overcomes a life-crippling addiction and goes on to live a productive and rich life for another 50 yrs, thanks to the intervention of a fake doctor.

 

[pre med 2014]

most of medicine deals with non-disease. most of primary care is not about diagnosis. rheumatologist and allergists/immunologists deal are the experts in non-diseases and often just make up diagnoses with antibodies and other biomarkers flimsily supporting the diagnosis in a patient who is psychiatrically ill. The diagnostic criteria for many things is subjective and arbitrary, take SLE, multiple sclerosis, rheumatoid arthritis for example. That is not to mention fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. Even the cut off points for what constitutes diabetes and hypertension are shifting continuously, and based partly on subjective norms of what constitutes physiological and what is pathological.

Many criticisms of psychiatry are based on a romanticized view of medicine, and that doctors deal with 'diseases'. Well the medical model isn't all that great for many patients, which is why 40% of ER visits for abdominal pain and chest pain do not result in a diagnosis, and one of the reasons why alternative medicine has grown in popularity in recent years. At least psychiatry confronts uncertainty rather than ignoring it, takes the biomedical model as one perspective, but has behavioral, cognitive, dynamic, existential, systemic, and sociocultural frameworks to help understand the patient and their problems where the biomedical model fails. Even then that medical model pretty well helps me explain my delirious patient, or methamphetamine-induced psychotic patient, or the prominent psychosis in my patient with Parkinson's disease on Levodopa.

Anyone who has this naive view of medicine being falsifiable dealing with 'real' pathology doesn't know anything about medicine. Anyone who thinks medicine should be the aim of psychiatry and not the starting point, doesn't know anything about psychiatry.

I do not believe psychiatrists confront uncertainty. They could say they do but they don't act like it by treating patients against their will. And yes, other fields of medicine are subjective but only psychiatrists treat people against their will based on subjective evaluation.

They cannot admit that their diagnosis is uncertain because that is inconsistent with a justification to hold a person against their will and give them dangerous drugs they don't want. Also, psychiatrists are unique to other doctors because they cannot undo a diagnosis without also admitting the diagnosis was made as punishment. Whereas a doctor only risks the status of his competence by admitting to a misdiagnosis a psychiatrist risks the exposing their punitive motive. The best example of this is when the Federation of Soviet Psychiatrists had to resign from WPO, because once it was socially accepted their diagnosis' were punishment they could no longer survive as a credible medical organization.

 

[diagonal]

I do not believe psychiatrists confront uncertainty. They could say they do but they don't act like it by treating patients against their will. And yes, other fields of medicine are subjective but only psychiatrists treat people against their will based on subjective evaluation.

They cannot admit that their diagnosis is uncertain because that is inconsistent with a justification to hold a person against their will and give them dangerous drugs they don't want. Also, psychiatrists are unique to other doctors because they cannot undo a diagnosis without also admitting the diagnosis was made as punishment. Whereas a doctor only risks the status of his competence by admitting to a misdiagnosis a psychiatrist risks the exposing their punitive motive. The best example of this is when the Federation of Soviet Psychiatrists had to resign from WPO, because once it was socially accepted their diagnosis' were punishment they could no longer survive as a credible medical organization.

You've clearly never seen a psychotic patient in your life. Nor have you ever seen a suicidal one. Or a homicidal one. All you know you watch on TV and gleen from popular culture. People don't get involuntarily admitted to a hospital because they farted in their shrinks office, or voted for the opposing party. Funny thing is, you don't realize how ignorant you sound. You don't know what you're talking about.

 

[drno31]

You've clearly never seen a psychotic patient in your life. Nor have you ever seen a suicidal one. Or a homicidal one. All you know you watch on TV and gleen from popular culture. People don't get involuntarily admitted to a hospital because they farted in their shrinks office, or voted for the opposing party. Funny thing is, you don't realize how ignorant you sound. You don't know what you're talking about.

Please stop feeding the trolls. This person is a premed. They have never had any patient before, let alone a psychiatric patient. His opinion should not matter: even if he came here with glowing praise of the field, it would be based on nothing.

 

[pre med 2014]

Don't even get my started on the role of coercion in medicine. In psychiatry, coercion is explicit, it is something talked about, fret over, a source of unease and anxiety. In much of the rest of medicine, coercion is implicit, insidious, pernicious, never acknowledged. The acutely ill patient is often the passive recipient of care, decisions made which they would not want, things done in the name of treatment that constitute battery. Whist I don't want to downplay the effects of coercion in psychiatric hospitalization, patients are often a lot more traumatized from being in the MICU than from being on a psych unit.

Psychiatry includes a great deal of implicit coercion as well as explicit. I don't know how they get away with the straightforward stuff. I think the implicit force is the truly evil portion of the field.

 

[pre med 2014]

Please stop feeding the trolls. This person is a premed. They have never had any patient before, let alone a psychiatric patient. His opinion should not matter: even if he came here with glowing praise of the field, it would be based on nothing.

so what? Thomas Szasz entered psychiatry with the intention of delegitimizing it. You could never do that with pathology.

 

[Salpingo]

They cannot admit that their diagnosis is uncertain because that is inconsistent with a justification to hold a person against their will and give them dangerous drugs they don't want.

No one uses a diagnosis as a basis for holding a patient against their will. For example, if you get into medical school, you'll see a disturbing number of patients in physical restraints (mostly on medicine/surgery; they are extremely rare in psychiatry). There will probably also be a couple of consults to see if a patient has capacity to sign out AMA. Danger to self or others has absolutely nothing to do with diagnosis.

 

[OldPsychDoc]

Please stop feeding the trolls. This person is a premed. They have never had any patient before, let alone a psychiatric patient. His opinion should not matter: even if he came here with glowing praise of the field, it would be based on nothing.

If that...

 

[pre med 2014]

Psychiatry is unique in that we place value on quality of life. I'm don't get morning wood over making a senile 90yr old live an extra week. I do get mildly tumescent when a 25yr old overcomes a life-crippling addiction and goes on to live a productive and rich life for another 50 yrs, thanks to the intervention of a fake doctor.

Just so long as the psychiatrists point of view of what constitutes a good quality of life is consistent with the patients perspective that's great.

I don't think the survivors of psychiatry would say their quality of life is better. Many ex patients are physically and emotionally damaged for life.

 

[diagonal]

Just so long as the psychiatrists point of view of what constitutes a good quality of life is consistent with the patients perspective that's great.

I don't think the survivors of psychiatry would say their quality of life is better. Many ex patients are physically and emotionally damaged for life.

With this post, you're officially an idiot. diagonal, out.

 

[GOINGDUMB]

Furthermore, the idea that(in this pt) they are all separate pathologies neccessitating individualized treatments is ludicrous.....

See what I mean, doctor? You have insight into some sort of pathology that you can say that.

I troll, I troll.

 

[Leo Aquarius]

 

[Leo Aquarius]

Don't feed the troll. Pre med 2014 is a rather unintelligent troll with no understanding of what the troll is talking about. Don't feed the troll.

 

[Ron Mexico]

i prefer being in psych and learning medicine on an academic level. managing medical patients was never my interest but i read on medical/surgical issues and try to learn as much as i can. my only gripe is the lack of procedures...but at least right now in my intern year on my ER and medicine rotations, i am getting do some.

 

[shan564]

Don't feed the troll. Pre med 2014 is a rather unintelligent troll with no understanding of what the troll is talking about. Don't feed the troll.

This.

I'm surprised that this single comment has sparked as much discussion as it has.

 

[pre med 2014]

I assure you all I'm not a troll. I am genuinely concerned about the use of force in psychiatry and the lack of any scientific justification to do so.

 

[pre med 2014]

I don't know how any of you can support the misuse of psychiatry.

Try explaining your research to a person handicapped in a wheelchair because they were given drugs against their will just because they said a metaphor or recited the lyrics of a song.