I focus too much on psychological issues during my rotation.

[bGMx]

Not really sure what to make of this in the context of my career goals; I've been told on each rotation so far that I focus too much on the psychological issues in my patients. I've been this way since childhood and intend to go into psychiatry. So far my clinical grades have been excellent, haven't had my psychiatry rotation yet. I don't get excited about the medical issues like I get excited about the psychological and social factors at play. Is this a problem or do I just need to keep grinding until I make it through to the other side of rotations?

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[deleted849476]

You’ve been focusing too much on the psychological issues of your patients since childhood?

At least when you go to residency interviews and they ask you why you’re interested in psych you can say, “it all started when I was born.”

 

[bGMx]

I mean in the sense that I like to know *about* people since childhood; my critique has been that I focus too much on these *unsolvable* issues. Something akin to I spend too much time on eliciting and then describing the patient's circumstances.

 

[deleted849476]

Sounds like you just like psych, I don’t think it’s a problem. Worst case scenario the preceptors might be round-aboutly telling you to chill on the psych side and focus on their specialty during their rotation, but this is just a guess. If your grades/evals are fine that says it all to me.

 

[Celexa]

It is unlikely this will be a problem if the feedback is coming from non psych rotations.

 

[TexasPhysician]

Keep in mind that the goal of these rotations is to help you be a well-rounded general physician. On ob/gyn, focus on learning ob/gyn.

That said, I find my Gen Surg “paragraph” on my dean’s letter or whatever they call it now entertaining. Gen Surg paragraph was a single sentence that stated something like “Student is too empathetic for surgery”.

At first I thought about appealing the veiled insult by surgery, but I realized it could work to my advantage in psych. It was a fun talking point on interviews.

 

[TheRightMedication]

Sounds like you focus too much on the psychological issues of your patients.

Once you're in a psych program, get yourself a good therapist / supervisor. Once you figure out what needs of yours are met by this or otherwise why you do it, you'll be far more useful to your patients.

Failure to figure it out could be trouble.

 

[bGMx]

Always down for introspection. I just don't find asthma vs pneumonia the most stimulating. This is a matter of non-psychiatrists hearing me talk about behavioral health issues. Just a little disheartening.

 

[painballer27]

Just do what you're supposed to do and learn the stuff you're supposed to learn for each rotation. You can focus on the things you want to later

 

[hamstergang]

I just don't find asthma vs pneumonia the most stimulating.

But that's your job right now. You should try to do it well because you get graded on it, you never know what connections you might take advantage of in the future, and unless you plan to exclusively practice psychotherapy it is valuable to have a good understanding of how the human body works in terms of illnesses and medications.

 

[ObsequiousAplomb]

Always down for introspection. I just don't find asthma vs pneumonia the most stimulating. This is a matter of non-psychiatrists hearing me talk about behavioral health issues. Just a little disheartening.

You don't find it interesting to understand the biological, medical, and functional underpinnings of what would differentiate a chronic respiratory condition with acute attacks from a simple infection? If you can't find that interesting, are you really all that more interested in the psychological components of their problems?

Knowing why someone has this or that breathing problem and how living with the condition and how the treatments affect their lives is equally psychological and medical. If you can't get yourself to focus on the simple things your medical mentors are wanting you to focus on - acute treatment of asthma attack, preventative treatments of asthma attacks, acute treatment of pneumonia, indications for hospitalization, etc - then how are you going to ever really understand the resistances the patients have to these labels / treatments? Knowing the adverse effects of these treatments is critical. Knowing why the benefits medically outweigh the risks is absolutely critical. Then you can think about why the patient disagrees with that balance (consciously or unconsciously, denial vs rationalization, etc).

You're lying to yourself if you think that you can understand the psychological from a psychiatrist's perspective without a foundational understanding of the other specialties.

 

[Monocles]

You don't find it interesting to understand the biological, medical, and functional underpinnings of what would differentiate a chronic respiratory condition with acute attacks from a simple infection? If you can't find that interesting, are you really all that more interested in the psychological components of their problems?

Let's be real, I can't even name more than two antibiotics off the top of my head, but that does not make me an incompetent psychiatrist.

The fact is, many psychiatrists do not like medicine and that is why we are not internists or surgeons. I think at minimum if you can pass step 3 and know when to place a reasonable consult for medicine, that should be enough for psych (unless you are CL or geri). From the other side, you would be surprised at how often pediatricians will send an "urgent" consult asking "pt got better so they stopped SSRI, now depressed again what do"

 

[ObsequiousAplomb]

Let's be real, I can't even name more than two antibiotics off the top of my head, but that does not make me an incompetent psychiatrist.

The fact is, many psychiatrists do not like medicine and that is why we are not internists or surgeons. I think at minimum if you can pass step 3 and know when to place a reasonable consult for medicine, that should be enough for psych (unless you are CL or geri). From the other side, you would be surprised at how often pediatricians will send an "urgent" consult asking "pt got better so they stopped SSRI, now depressed again what do"

as an attending you don't need to know antibiotics the way you do as a student first learning about the suffering of patients. You know enough to understand the patient's experience with a chronic illness. That's the part you don't forget. Learning the details is something everyone forgets quickly. You still know when to send an outpatient to a hospital based on their breathing problems. When someone says they get really anxious after taking their albuterol, you know why.

Also, you're definitely exaggerating on not knowing more than two antibiotics off the top of your head.

 

[Merovinge]

Let's be real, I can't even name more than two antibiotics off the top of my head, but that does not make me an incompetent psychiatrist.

I hope that's hyperbole. PCN, Amoxicillin, Cefadil, Ceftrixaone, Gentamycin, Arythromycin, levoquin, other floroquinolones that blow out your leg tendons, tmp-sulfa, yadda yadda 4th-7th gen cepholosporins, +super broad spectrum stuff they put the really sick patients on that started coming out a decade or two ago whos names escape me. I did generally mediocre to bad on medicine and haven't set foot on a medicine floor in a decade but we are still doctors...

Edit: Penems, it came to me!

 

[comp1]

People's stories get kinda...similar the longer you do this, unless you have some amazingly diverse patient panel. For mine, there's usually childhood abuse, often sexual, sometimes just physical. The slight variation is the timing of when the abuse began and that leads to the relative severity of presentation. Regardless, it leads to substance abuse and a small group of other severely maladaptive coping strategies (often surrounding self harm) by late adolescence/early adulthood. This got labeled schizoaffective disorder or bipolar disorder because it was easier for the clinician as well as the patient and in turn they've been through many, many medication trials that just don't seem to make much of a change. Honestly, their medical comorbidities often show greater differences.

 

[clausewitz2]

I hope that's hyperbole. PCN, Amoxicillin, Cefadil, Ceftrixaone, Gentamycin, Arythromycin, levoquin, other floroquinolones that blow out your leg tendons, tmp-sulfa, yadda yadda 4th-7th gen cepholosporins, +super broad spectrum stuff they put the really sick patients on that started coming out a decade or two ago whos names escape me. I did generally mediocre to bad on medicine and haven't set foot on a medicine floor in a decade but we are still doctors...

Why remember any of that boring stuff when you have Vancopime?

 

[FlowRate]

I think a lot of us do naturally focus on patients' psychosocial needs and it's part of how we realize that we want to do psych.

However, if you're not keeping up with your peers on medical knowledge/clinical abilities, it could also be a symptom of focusing on something that comes more easily to you and requires less of that crystallized book learning. (You didn't say you weren't keeping up, I'm just pointing out one way this can arise.)

We did a pretty good deal of managing patient medical issues while they were on our unit and also needed independent medical knowledge to assess the sloppy/absent workups done by the ED at one of the hospitals we admitted from. It's also helpful to have some understanding of what's going on medically when you do CL. Psychiatrists are medical doctors, not just therapists.

 

[Bartelby]

If you have been told that on each rotation then the attendings and residents are probably frustrated that you hone in on the information that is of interest to you rather than the information the team needs to gather. You'll have plenty of time to explore patient's psyches starting in residency! For now, when on another service try to learn how they think and what's important to *them*.

 

[painballer27]

You need to learn everything. It's important for several reasons. One being your grades/evals/step scores depend on a broad knowledge base, and this is important for getting into the residency of your choosing. It's also important for being a good doctor in general. You never know when in the future you may pick up on something no one else did because you had that knowledge. It also is fun knowing things that other people don't know about a lot of different things, it helps with attracting women, etc.

 

[bGMx]

Thanks all; I'm getting great feedback and have been doing well on rotations. My medical knowledge is above average at least as others perceive it; the comments have been more so about my focus. I work up asthma and then spend time talking with patients and educating patients; then report on the psychosocial aspects of my patients that I believe are important; then I get the feedback that those things are not important-- this is followed up with me improving and adjusting appropriately. Bartleby and FlowRate reiterated what I'm seeing best. Thanks for all feedback!

 

[forchinet121]

You don't find it interesting to understand the biological, medical, and functional underpinnings of what would differentiate a chronic respiratory condition with acute attacks from a simple infection? If you can't find that interesting, are you really all that more interested in the psychological components of their problems?

Knowing why someone has this or that breathing problem and how living with the condition and how the treatments affect their lives is equally psychological and medical. If you can't get yourself to focus on the simple things your medical mentors are wanting you to focus on - acute treatment of asthma attack, preventative treatments of asthma attacks, acute treatment of pneumonia, indications for hospitalization, etc - then how are you going to ever really understand the resistances the patients have to these labels / treatments? Knowing the adverse effects of these treatments is critical. Knowing why the benefits medically outweigh the risks is absolutely critical. Then you can think about why the patient disagrees with that balance (consciously or unconsciously, denial vs rationalization, etc).

You're lying to yourself if you think that you can understand the psychological from a psychiatrist's perspective without a foundational understanding of the other specialties.

This may be a tad much..