I love psych... But, am I going to miss medicine?

[Mariafe]

Hello guys, I'm just another med student trying to decide what would be the next step...

I'm seriously cosidering psych. I've taken almost all of the electives in psych and I simply love it... My only concern at this point is that sometimes it doesn't feel like real medicine, usually when I read an article I focus on the neurology rather than on the psychiatry itself... How do you deal with this? I'm worried about going into an specialty that isn't in real contact with science.

As for the different programs, which ones do you consider that are more focused into biologic psychiatry rather than psychotherapy???

any comments appreciated!!!

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[F0nzie]

Got what you don't like about psych. What do you like about it?

 

[nitemagi]

http://apm.org

 

[hamstergang]

usually when I read an article I focus on the neurology rather than on the psychiatry itself... How do you deal with this? I'm worried about going into an specialty that isn't in real contact with science.

I don't think I understand. You read scientific articles about psychiatry, but then say that psychiatry isn't in real contact with science?

 

[peppy]

Washington University and University of Iowa tend to be viewed as some of the most biological programs.

My own opinion on psychiatry is that if you don't feel like you're using medical skills or "real science" then you're doing it wrong. A decent psychiatrist will monitor for medication side effects and take into consideration comorbid conditions/special situations (i.e., factoring in their condition when you decide to prescribe for someone who is pregnant, has a seizure disorder, Parkinson disease, renal insufficiency, HIV, cancer, etc.) rather than just always writing for sertraline and risperdal because those are their "favorites" (something I've seen happen). They will also use the scientific literature to make a rational decision about what to do in treatment-resistent cases and stay in touch with the newest developments.

The thing about psychiatry is that it is a very diverse field. You have psychosomatic and neuropsychiatry subspecialists who deal in the more "medical" side of psychiatry every day, and then you have psychodynamic people who often don't really want to be involved in the medical side of things much (in general). However, all decent psychiatrists should be interested in medicine to the degree mentioned above in my opinion.

 

[OldPsychDoc]

Washington University and University of Iowa tend to be viewed as some of the most biological programs.
...

One keeps hearing these things--they were said back when I was on the interview trail as well. (NO--not in a covered wagon!)

Having talked with many of my fellow PDs around the country, I think that we are all closer to the middle. We're all practicing and training in a biologically-dominated medical paradigm, and we all have to teach and train to the same psychotherapeutic competencies. There may be gradations of emphasis--but let's put this biological vs psychological dichotomous stereotyping to bed soon, please.

 

[shan564]

I'm seriously cosidering psych. I've taken almost all of the electives in psych and I simply love it... My only concern at this point is that sometimes it doesn't feel like real medicine, usually when I read an article I focus on the neurology rather than on the psychiatry itself... How do you deal with this?

If you love psych, you'll be happy with your life in the absence of medicine. But if you're really itching to get more medicine involved in your life as a psychiatrist, there are many ways to do it. Psychiatrists can practice C/L, addictions, pain medicine, sleep medicine, clinical neurophysiology, neuropsychiatry, and a variety of other things. And if you're comfortable looking after the basic medical needs of your psychiatric inpatients, you're licensed to do that. You can also get involved in procedural psych and do things like ECT and TMS, and play some part in VNS and DBS procedures.

I'm worried about going into an specialty that isn't in real contact with science.

There are some places where psych isn't in real contact with science, but there are also places where psych is deeply rooted in science. There's a lot of research going on with things like psychiatric genomics, neuroimaging (read: Human Connectome Project), DBS, cell signaling, and pretty much anything else that you can imagine. I hear that people at Hopkins have been assassinated for mentioning the word "psychodynamic."

As for the different programs, which ones do you consider that are more focused into biologic psychiatry rather than psychotherapy???

There may be gradations of emphasis--but let's put this biological vs psychological dichotomous stereotyping to bed soon, please.

OPD makes a good point, as always. But to answer your question of which programs are on which side of the gradation...

Splik made a couple of notorious threads to answer this question last year:
http://forums.studentdoctor.net/showthread.php?t=887723
http://forums.studentdoctor.net/showthread.php?t=887721

Personally, I'm mostly on the biological side, so I interviewed at a lot of programs on splik's "biological" list. The ones he mentions (in order from #1 to #10) are WashU, Hopkins, Pitt, UCLA, U.Washington, Duke, MGH/McLean, Cleveland Clinic, Miami, and Mayo. While it's impossible to actually rank places with any level of accuracy, I think that's a fair characterization of 10 of the top places to learn biological psychiatry.

But I'd probably also add a few places to that list - Iowa, Indiana, Florida, UIC, Vanderbilt, Cincinnati, Emory, MUSC, Brown, Harvard Longwood, and UCSD are all strong programs with a biological slant. I'm sure that I'm probably forgetting some, but I figured that this should be a good enough list to prove that biological psychiatry is certainly going strong. There are also many programs that are very strong on both sides, so they aren't known for being "biological" programs, but are definitely great places to learn biological psych - that might include Yale, Baylor, Penn, Michigan, UCSF, Maryland-Sheppard Pratt, UTSW, Mt. Sinai, and many more.

Of these programs, I interviewed at WashU, Cleveland Clinic, Mayo, Indiana, Iowa, and Florida. All of those places will provide oodles of opportunities to develop as a researcher and a biological psychiatrist. I would have been very happy at any of those programs, but I was lucky enough to get my top choice.

 

[digitlnoize]

Hello guys, I'm just another med student trying to decide what would be the next step...

I'm seriously cosidering psych. I've taken almost all of the electives in psych and I simply love it... My only concern at this point is that sometimes it doesn't feel like real medicine, usually when I read an article I focus on the neurology rather than on the psychiatry itself... How do you deal with this? I'm worried about going into an specialty that isn't in real contact with science.

As for the different programs, which ones do you consider that are more focused into biologic psychiatry rather than psychotherapy???

any comments appreciated!!!

You won't miss medicine. I get to do a LOT of it constantly.

Just THIS WEEK on the wards I have diagnosed Stiff Person Syndrome (150 cases in the last 25 years) most likely neoplastic variant and am currently digging for the cancer, am working on diagnosing an endocrine abnormality making this girl look like a adolescent boy who is psychotic and paranoid she is being poisoned so drinks so much water she got hyponatremic to 126, most likely an adrenal tumor of some kind at this point), am managing severe rheumatoid arthritis, and have a severe anorexic who recently had a hemoglobin of 2.8. And I'm only carrying 5 patients.

Psych patient are among the sickest medical patients you will have. To make matters worse, they get marginalized much of the time by the "Medicine" doctors, who TEND to attribute all of their problems to their psychiatric disorders. Here are some absurd things I have seen:

1. A 65 year old lady with a history of schizophrenia who fell, hit her head, with LOC, then came into the ED with AMS. Guess what? No head CT. Admitted to medicine for electrolyte derangement, then psych consult. Psych consult ordered a Head CT, turns out she had a freaking stroke. What 65 yo head injury, fall, LOC, with AMS doesn't get a head CT?!? The one with a history of schizophrenia. Because THAT'S why she's altered. Of course. 🙄 Proud to say this was NOT at my hospital. Our ER docs are actually pretty good about psych patients generally.

2. A elderly lady (> 70yo) with no past psychiatric history at all, who has waxing and waning mental status and a dirty urine with a pending culture. Medicine DEMANDS transfer to psych going all the way up to the top of the hospital food chain, because she must have Schizophrenia "because when they gave her Haldol, she got better." Fail.

3. A 64 yo male with a GFR of 12 on dialysis who gets altered on his non-dialysis days. No past psych history. IM again demands psych admit because his altered MS is due to, again, schizophrenia, which he does not have. Refuse to believe that it could be do to his poor renal function. We're taking care of him instead.

Hope that eases your mind. You will still do PLENTY of medicine as a psychiatrist. Even more if you decide to do Psych Consults after residency.

 

[dl2dp2]

One keeps hearing these things--they were said back when I was on the interview trail as well. (NO--not in a covered wagon!)

Having talked with many of my fellow PDs around the country, I think that we are all closer to the middle. We're all practicing and training in a biologically-dominated medical paradigm, and we all have to teach and train to the same psychotherapeutic competencies. There may be gradations of emphasis--but let's put this biological vs psychological dichotomous stereotyping to bed soon, please.

I actually think this "dichotomy" might become more pronounced, if anything, as "biologically" oriented therapy gets more complicated and involved, with infusion protocols, biologicals, stimulators, medication assisted therapy, imaging etc. should they become more prevalent in 50 years.

At that point, psychiatry will split into two fields, one does "medical" stuff, and the other deals with "medical humanities", including some other various sundries, like ethics consults, etc.

For instance, the idea that psychiatrists need to learn and do therapy might eventually be dispensed--http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1139&context=jeffjpsychiatry

To me this is fairly similar to how a PM&R or a ortho don't do physical therapy. Of course they are taught how physical therapy works and when to refer. This is already occurring in some aspects. Very few psychiatrists, for instance, know how to do DBT or family therapy, and they almost invariably get referred out. And across the country most of what psychiatrists do is psychopharm, even right now. In my opinion, the reality the practice of a psychiatrist today is not very different from that of a neurologist or internist. This can be interpreted in a variety of ways of course, either good or bad.

 

[F0nzie]

For instance, the idea that psychiatrists need to learn and do therapy might eventually be dispensed

I'm making a stand and starting a psychotherapy practice on the side. I just got a part-time job dispensing meds because I have to make a living. If psychotherapy was removed from clinical practice, I would most definitely quit the field.

 

[vistaril]

I actually think this "dichotomy" might become more pronounced, if anything, as "biologically" oriented therapy gets more complicated and involved, with infusion protocols, biologicals, stimulators, medication assisted therapy, imaging etc. should they become more prevalent in 50 years.
.

first, 'biologically'(ie throwing pills at patients) getting 'more complicated' is just a euphimism for it becoming more and more a cluster****.

Not once have I ever looked at a med list containing Seroquel, Topomax, Paxil, Lamictal, Abilify, Effexor and Klonopin and said "my oh my that's some real fine tuned sophisticated evidence based biological psychiatry right there"....

that sort of psychiatry is what is bound to get us less and less respect in the future from other fields. A neurologist or internist looks at that med list and (rightfully) assumes the psychiatrist is just aimlessly picking different psychotropic drugs to throw at the problem. They know that there isn't a single paper out there that suggests the above combination has any better efficacy than say...the above combination minus Abilify + Lithium. Wanting to push the field more and more in that direction(without anything to support it) would be the wrong move.

 

[vistaril]

Hello guys, I'm just another med student trying to decide what would be the next step...

I'm seriously cosidering psych. I've taken almost all of the electives in psych and I simply love it... My only concern at this point is that sometimes it doesn't feel like real medicine, usually when I read an article I focus on the neurology rather than on the psychiatry itself... How do you deal with this? I'm worried about going into an specialty that isn't in real contact with science.

As for the different programs, which ones do you consider that are more focused into biologic psychiatry rather than psychotherapy???

any comments appreciated!!!

ummm...that's what a lot of us *like* about psychiatry. That it isn't medicine. If I wanted to do something 'more medical' I would have....done so.

 

[Jorje286]

"Medicine" is a bit overrated anyhow. I thought in psychiatry there's more opportunity to actually ponder and really think through issues, whereas in other fields the reasoning is more like a series of quick thoughts whose content you have managed to memorize.

 

[Leo Aquarius]

Haha wait until you do your internal medicine month(s) and then let us know how much you miss medicine.

Medicine doctors (in residency and in practice) are worked to the bone. You'll be so glad you're in psych - will be my guess.

 

[peppy]

Not once have I ever looked at a med list containing Seroquel, Topomax, Paxil, Lamictal, Abilify, Effexor and Klonopin and said "my oh my that's some real fine tuned sophisticated evidence based biological psychiatry right there"....

that sort of psychiatry is what is bound to get us less and less respect in the future from other fields. A neurologist or internist looks at that med list and (rightfully) assumes the psychiatrist is just aimlessly picking different psychotropic drugs to throw at the problem.

And is that how your residency is teaching you to prescribe? If it is, then my sympathies on going to a horrible residency program.
Decent psychiatrists will also recognize that is a terrible regimen. Just because there are a lot of poor educated or lazy psychiatrists out there doesn't mean that psychiatry as a whole doesn't have sophisticated and evidence based biological treatment.

 

[dl2dp2]

I'm making a stand and starting a psychotherapy practice on the side. I just got a part-time job dispensing meds because I have to make a living. If psychotherapy was removed from clinical practice, I would most definitely quit the field.

This is not what I'm saying. I think in my mind's eye, the field is moving in a certain direction, and may potentially split into two fields. You don't have to "quit the field". You'll just become a subspecialist. For future medical students interested in therapy, they may enter into a different residency training track altogether and the label psychiatry may not even exist in 50 years. Right now the training is integrated, you come out of the residency able to do both therapy and meds, but this may become too time inefficient to be feasible in the future.

Also I don't think what I'm saying is very controversial. You do some individual therapy, but you are not a comprehensive therapist who does sex therapy, family and couples therapy, group therapy, psychoanalytic therapy, DBT, etc. For these services you refer out. All I'm saying is that likely more and more of these services will be referred out, and psychiatry will become more like rheumatology or rehab medicine. There will be several kinds of "psychiatrists", some certified to do mostly meds, some therapy, though those people would have to compete with other therapists.

Another thought is I think complex psychosocial management could be one of the subspecialties of behavioral health. I.e. a track that aims to train sort of a MBA for social work kind of a job.

If you look at the history of medicine, splitting is much more common than merging. As knowledge expand, larger fields split into smaller fields and develop more efficient training tracks. We are just at a much much early stage of that in psychiatry.

And is that how your residency is teaching you to prescribe? If it is, then my sympathies on going to a horrible residency program.
Decent psychiatrists will also recognize that is a terrible regimen. Just because there are a lot of poor educated or lazy psychiatrists out there doesn't mean that psychiatry as a whole doesn't have sophisticated and evidence based biological treatment.

This is also what I believe.

 

[dl2dp2]

Wanting to push the field more and more in that direction(without anything to support it) would be the wrong move.

Except the mainstream (NIH, APA, etc.) doesn't agree with you. Your opinion is mostly on the fringe side of things. The current trend both in research and in practice is to increasingly place psychiatry solidly within the rubric of evidence based medical practice. The evidence isn't even close to complete, of course, but we are NOT going back to the 60s when the senior analysts spill some wisdom and the trainees swoon, which appears to be the kind of backward system that you would like to endorse.

Also, given that psychologists and social workers can do therapy much cheaper, I just don't see how it's going to be feasible to argue for paying a bunch more money for psychiatrists to do therapy as time goes on.

 

[vistaril]

Except the mainstream (NIH, APA, etc.) doesn't agree with you. Your opinion is mostly on the fringe side of things. The current trend both in research and in practice is to increasingly place psychiatry solidly within the rubric of evidence based medical practice. The evidence isn't even close to complete, of course, but we are NOT going back to the 60s when the senior analysts spill some wisdom and the trainees swoon, which appears to be the kind of backward system that you would like to endorse.

Also, given that psychologists and social workers can do therapy much cheaper, I just don't see how it's going to be feasible to argue for paying a bunch more money for psychiatrists to do therapy as time goes on.

where you and I disagree is on what the evidence says....the main reason in psychiatry you so often see *different* polypharmacy between practitioners(and experienced ones with good reps) is because there isn't great evidence for doing one thing over the other from a pharm standpoint. Trying to make it more sophisticated/complicated doesn't make any sense when there is no evidence such a strategy will work....for patients I mean. Over the last 5+ years we've seen increasing emergence of those(inside and out of medicine) who are skeptical of the efficacy of psychotropics in general. And I'm not talking about scientology types.

As to your second point, you could say the exact same thing about psych nurse practitioners and pharmacotherapy....

 

[vistaril]

Haha wait until you do your internal medicine month(s) and then let us know how much you miss medicine.

Medicine doctors (in residency and in practice) are worked to the bone. You'll be so glad you're in psych - will be my guess.

not always....medicine hospitalists work 7 on/7 off typically, and even though the 7 on is technically a 12 hr shift a lot can leave sooner in many systems.

 

[dl2dp2]

As to your second point, you could say the exact same thing about psych nurse practitioners and pharmacotherapy....

That's true. You've got a point there. Although I suspect that the risk for that isn't as great as the risk for therapy providers as there are way more of them.

I'm not sure what to say. Neither of us has a crystal ball. The question is if psychiatry is going to be more or less medical in the future. My gut is more. But maybe you are right. Maybe in 50 years the job won't exist anymore--i.e. psychiatry may be ENTIRELY out of medicine altogether. The whatever is medical in psychiatry today will be subsumed under neurology as a fellowship, and the rest will be farmed out to allied professionals.

 

[nitemagi]

That's true. You've got a point there. Although I suspect that the risk for that isn't as great as the risk for therapy providers as there are way more of them.

I'm not sure what to say. Neither of us has a crystal ball. The question is if psychiatry is going to be more or less medical in the future. My gut is more. But maybe you are right. Maybe in 50 years the job won't exist anymore--i.e. psychiatry may be ENTIRELY out of medicine altogether. The whatever is medical in psychiatry today will be subsumed under neurology as a fellowship, and the rest will be farmed out to allied professionals.

Any actual evidence to back up these extreme forecasts?

I make it a point to do therapy in my private practice, and everyone I meet here says to me "oh, you will be in high demand." Given my practice is young, but the point being there is a very viable niche for this, and as far as I'm concerned zero indication it will disappear.

As long as people are willing to pay for that expertise, it will continue to exist. Why do they seek it? Because they want people they can trust who can offer them Options. Options to offer therapy, and to offer meds when/as needed, but not turn to one tool only because they don't know anything else.

 

[splik]

This is not what I'm saying. I think in my mind's eye, the field is moving in a certain direction, and may potentially split into two fields.

Actually in the UK psychiatry is 'split' like this, 'medical psychotherapy' is a subspecialty of psychiatry. If you are a medical psychotherapist you will not prescribe medications, and with some exceptions if you are general adult psychiatrist, you will not be doing therapy though some occasionally have a CBT clinic 1 day a week, or have a psychoanalytic private practice this is rare. The psychotherapy requirments for core psychiatric training there are very minimal and it is precisely because it is not cost-effective for psychiatrists to be doing therapy. In fact most of these medically trained psychotherapists (who subspecialize in either psychoanalytic, cognitive-behavioral, or systemic therapy), spend v little time doing therapy and instead lead services, teach, supervise etc.

 

[BobA]

Hello guys, I'm just another med student trying to decide what would be the next step...

I'm seriously cosidering psych. I've taken almost all of the electives in psych and I simply love it... My only concern at this point is that sometimes it doesn't feel like real medicine, usually when I read an article I focus on the neurology rather than on the psychiatry itself... How do you deal with this? I'm worried about going into an specialty that isn't in real contact with science.

As for the different programs, which ones do you consider that are more focused into biologic psychiatry rather than psychotherapy???

any comments appreciated!!!

I like medicine and psychiatry. I don't miss chronic disease management (which is what much of general medicine is), since there is plenty of that in psych. I do sometimes wish I had a more clear sense of the pathophysiology of what I'm treating (like in ID or cardiology).

I really like psychiatry. I feel I'm sometimes making a big difference in improving patient's quality of life. It's gratifying.

There's a good chance that you'd be happy either way!

 

[shan564]

Actually in the UK psychiatry is 'split' like this, 'medical psychotherapy' is a subspecialty of psychiatry. If you are a medical psychotherapist you will not prescribe medications, and with some exceptions if you are general adult psychiatrist, you will not be doing therapy though some occasionally have a CBT clinic 1 day a week, or have a psychoanalytic private practice this is rare. The psychotherapy requirments for core psychiatric training there are very minimal and it is precisely because it is not cost-effective for psychiatrists to be doing therapy. In fact most of these medically trained psychotherapists (who subspecialize in either psychoanalytic, cognitive-behavioral, or systemic therapy), spend v little time doing therapy and instead lead services, teach, supervise etc.

I think the NHS is a great example of a medical system that has finally started to thrive on the model of choosing to provide the most cost-effective care in situations when there is little evidence to support the use of the more expensive treatment. One excellent example of that is your description of how psychiatry training has evolved there. But even Australia and Canada are still far from using that model, so I'd be surprised if we see anything like that in the US within our lifetimes.

 

[vistaril]

That's true. You've got a point there. Although I suspect that the risk for that isn't as great as the risk for therapy providers as there are way more of them.
QUOTE]

but the difference is that therapy(well good therapy with tough patients) is HARDER. Your examples of how orthopods interact with physical therapists(ie the orthopod isn't the one manually doing PT) aren't really comparable because manually doing PT is easier and less skilled than doing a rotator cuff surgery. Whereas therapy in many cases is much more difficult(and requires much more expertise) than pharmacoptherapy for schizophrenia.

 

[notdeadyet]

I actually think this "dichotomy" might become more pronounced, if anything, as "biologically" oriented therapy gets more complicated and involved, with infusion protocols, biologicals, stimulators, medication assisted therapy, imaging etc. should they become more prevalent in 50 years.

I disagree with the false "dichotomy" lots of folks talk about.

There are some good programs that are particularly strong in psychopharmacology and some (fewer) good programs that are particularly strong in psychotherapy. But most of the very good-to-great programs are strong in both.

I have a hunch the notion of the false psychotherapy vs. psychopharm debate is put out there by programs and those associated with such programs, that are weak in the other area. There's absolutely no reason a program needs to be weak in one side of the house to be good in the other.

 

[SmallBird]

I think the NHS is a great example of a medical system that has finally started to thrive on the model of choosing to provide the most cost-effective care in situations when there is little evidence to support the use of the more expensive treatment. One excellent example of that is your description of how psychiatry training has evolved there. But even Australia and Canada are still far from using that model, so I'd be surprised if we see anything like that in the US within our lifetimes.

Don't feel too bad about the US though - psychiatry training in the UK has many other inefficiencies, including a protracted training process (at least 6 years), that requires re-applying for a job on a number of occasions. It is less structured than what we have here and in most aspects of training I would argue we are ahead of them.

 

[shan564]

Don't feel too bad about the US though - psychiatry training in the UK has many other inefficiencies, including a protracted training process (at least 6 years), that requires re-applying for a job on a number of occasions. It is less structured than what we have here and in most aspects of training I would argue we are ahead of them.

Oh, I agree... if I wanted to train in the UK, I would have trained in the UK (or Australia, since that's where I went to med school... they have a similar protracted training process with re-applications and the like). I made a conscious decision to come to the US. I was just trying to say that the UK's training system sounds like something that developed largely due to the needs of the NHS rather than developing purely due to positive progress in patient care.

 

[nancysinatra]

And is that how your residency is teaching you to prescribe? If it is, then my sympathies on going to a horrible residency program.
Decent psychiatrists will also recognize that is a terrible regimen. Just because there are a lot of poor educated or lazy psychiatrists out there doesn't mean that psychiatry as a whole doesn't have sophisticated and evidence based biological treatment.

When did Vistaril say that a resident prescribed these meds? Lists like the one he described are invariably done by community psychiatrists. Don't you see them too?

I disagree with you about our "sophisticated and evidence based biological treatment." We have some biological evidence. But not a ton. We're not orthopedics or cardiology. Or do you seriously think we are? Because people on this forum make it sound like, yes, psychiatry is the single most technologically advanced medical specialty there is (infusions even!!!), and the most life saving one as well, and if there were a single specialty that every medical student should choose, it should be psychiatry, because it combines the best of everything, and if only everyone chose psychiatry, well then we'd suddenly have the workforce we need to implement the "sophisticated and evidence based biological treatments" we have.

Whenever some poor med student comes on here asking this question they never get an unbiased answer. Instead they get blamed! Like in the 2nd and 4th posts here already the OP is being put on the defensive. It's like these wayward medicals students have FAILED to see how miraculously scientific psychiatry is. These same wayward students who sometimes mistakenly choose these antiquated fields like anesthesiology or neurology instead of seeing the light and choosing psychiatry, which has -- gasp -- infusions!!! They also FAIL to appreciate how infinitely more rewarding it is to work with schizophrenic and suicidal patients than treat COPDers or stand in some OR all day. I mean, these poor medical students who go astray and choose fields as useless and unpleasant as surgery!!! Wow it must be so unrewarding to perform someone's CABG and know 30 years later that they are still living! How do those useless doctors sleep at night??? Just like it must be so boring to be a radiation oncologist and actually utilize physics in your work. I bet they say to themselves, "I wish I was prescribing Buspar to patients because that's where the real science in medicine is."

If all I did was read the psych forum day in and day out, I'd have to conclude that the American public should actually CLOSE its medical hospitals and divert the money into more psychiatric treatment, because all medical specialties besides psychiatry are just superfluous.

OP, just pay attention on your clerkships and get as much as you can out of them, and try to see what you like most. There are good things about psych but I doubt you'll get a truly unbiased answer here. Ask a psychiatrist about psychiatry and what you'll come up against are defense mechanisms.

 

[peppy]

When did Vistaril say that a resident prescribed these meds? Lists like the one he described are invariably done by community psychiatrists. Don't you see them too?

Yes, I've seen plenty of these polypharm cases too. A lot of people in medicine make poor prescribing decisions that a conscientious/well trained person in that specialty probably would not. How many FM docs give out antibiotics for viral URIs even though they should know better? How many EM docs give out opiates to drug addicts because it's just easier to be the candyman? I wouldn't take the fact that these kinds of lazy prescribing habits happen often in those specialties as an indictment of the whole field because I know well trained people in these specialties don't do that stuff. I would say that the same is true of psychiatry. Well trained, conscientious psychiatrists don't engage in this kind of indiscriminate polypharmacy that we all see from bad practitioners in psych.

My point was basically this: It seemed to me like vistaril was saying that these bad habits are a reflection on all psychiatrists/psychiatry in general. If you are in a residency where it is the norm for people to be on horrific polypharm and you're not being trained to make better prescribing decisions yourself, then you go to a bad residency program. Don't blame psychiatry - blame your residency.

 

[Armadillos]

When did Vistaril say that a resident prescribed these meds? Lists like the one he described are invariably done by community psychiatrists. Don't you see them too?

I disagree with you about our "sophisticated and evidence based biological treatment." We have some biological evidence. But not a ton. We're not orthopedics or cardiology. Or do you seriously think we are? Because people on this forum make it sound like, yes, psychiatry is the single most technologically advanced medical specialty there is (infusions even!!!), and the most life saving one as well, and if there were a single specialty that every medical student should choose, it should be psychiatry, because it combines the best of everything, and if only everyone chose psychiatry, well then we'd suddenly have the workforce we need to implement the "sophisticated and evidence based biological treatments" we have.

Whenever some poor med student comes on here asking this question they never get an unbiased answer. Instead they get blamed! Like in the 2nd and 4th posts here already the OP is being put on the defensive. It's like these wayward medicals students have FAILED to see how miraculously scientific psychiatry is. These same wayward students who sometimes mistakenly choose these antiquated fields like anesthesiology or neurology instead of seeing the light and choosing psychiatry, which has -- gasp -- infusions!!! They also FAIL to appreciate how infinitely more rewarding it is to work with schizophrenic and suicidal patients than treat COPDers or stand in some OR all day. I mean, these poor medical students who go astray and choose fields as useless and unpleasant as surgery!!! Wow it must be so unrewarding to perform someone's CABG and know 30 years later that they are still living! How do those useless doctors sleep at night??? Just like it must be so boring to be a radiation oncologist and actually utilize physics in your work. I bet they say to themselves, "I wish I was prescribing Buspar to patients because that's where the real science in medicine is."

If all I did was read the psych forum day in and day out, I'd have to conclude that the American public should actually CLOSE its medical hospitals and divert the money into more psychiatric treatment, because all medical specialties besides psychiatry are just superfluous.

OP, just pay attention on your clerkships and get as much as you can out of them, and try to see what you like most. There are good things about psych but I doubt you'll get a truly unbiased answer here. Ask a psychiatrist about psychiatry and what you'll come up against are defense mechanisms.

What specialty are you thinking about switching to? I've asked a couple times and it seems to be pretty relevant to these discussions. Was psych not what you expected or did you just find something else you like better?

 

[notdeadyet]

Because people on this forum make it sound like, yes, psychiatry is the single most technologically advanced medical specialty there is (infusions even!!!), and the most life saving one as well

Who says this? Could you link to something?

I'm a little unclear if this is all for effect (or affect?) or if you think people on this forum actually represent what you're describing here.

Between the Everything is Rosey and The Sky is Falling perspective, there is a whole lot of greyscale where most folks on this forum seem to pitch tents.

 

[Armadillos]

Whoa, SDN is like a time capsule.

In 2008 nancysinatra wrote about choosing psych vs surgery.


"Yet I loved my first month of surgery and was impressed with how pleasant an experience it was...
I like procedures, but don't feel a need to do them every day. I think my concern is more about losing the basic knowledge of what to do for people in a traumatic situation. I hate to admit this, but I watched a lot of "ER" before coming to med school. I totally saw myself rushing around and rescuing people from the brink of death every day, and then wiping my brow at the end, in this dramatic, made-for-tv kind of way. Ok, I know it's loony, but oh-how-sad not to be able to do that... And I do genuinely love the excitement of trauma surgery, so it's a true sadness. Does anyone else feel a little disillusioned that way? Like what you are as you leave med school is not what you thought you'd become when you started?"


Maybe a cautionary tale to follow your heart, even if it means a harder residency?

(For anyone wondering, I'm not just doing this searching back for fun, I'm terrified that I have to figure out what do with the rest of my life in the next 15 months, so seeing how people's thinking changes before and after residency seems super relevant)

 

[digitlnoize]

I'm terrified that I have to figure out what do with the rest of my life in the next 15 months...

Here's Digitlnoize's guide to picking a medical specialty:

Step 1: Decide if you want to do procedures or not.

Yes (more) Procedures: Surg, FM, EM, OB, +\- IM., etc.

No (less) procedures: Psych, Rads (except interventional), Path,

Step 2: Decide if you want to work with children or not.

Yes: FM, Peds, Child Psych

No: IM, etc.

Step 3: Decide if you want to see patients or not.

Yes: most fields.

No: Rads, Path.

Step 4: Think about the lifestyle you want at age 40-50.

Easy: Psych, Path, Rads, etc.

Harder: Surgery, IM, etc.

Step 5: Consider other factors. Money? Be sure to consider $/hr in addition to the common $/yr. Do you want your own practice? Other personal factors?

Step 6: Throw all that out and do what you love.

 

[hamstergang]

Because people on this forum make it sound like, yes, psychiatry is the single most technologically advanced medical specialty there is (infusions even!!!), and the most life saving one as well, and if there were a single specialty that every medical student should choose, it should be psychiatry, because it combines the best of everything, and if only everyone chose psychiatry, well then we'd suddenly have the workforce we need to implement the "sophisticated and evidence based biological treatments" we have.

I wonder what forum you are reading if this is what you are taking away from it.

Whenever some poor med student comes on here asking this question they never get an unbiased answer. Instead they get blamed! Like in the 2nd and 4th posts here already the OP is being put on the defensive. It's like these wayward medicals students have FAILED to see how miraculously scientific psychiatry is.

Since I wrote post 4 I can tell you that wasn't what I was saying. It was half-rhetorical, showing OP that there is this scientific background in psych (and he shouldn't just call any of the scientific-sounding parts neurology and call all the rest psych), and half asking for clarification. All the hyperbole in your post is well beyond what was actually being said.

 

[Ibid]

Perhaps worth a browse....

Silly picture but interesting blog...
http://mancpsychsoc.blogspot.no/2013/03/why-dont-medical-students-choose.html

 

[Ibid]

I'm not sure what to say. Neither of us has a crystal ball. The question is if psychiatry is going to be more or less medical in the future. My gut is more. But maybe you are right. Maybe in 50 years the job won't exist anymore--i.e. psychiatry may be ENTIRELY out of medicine altogether. The whatever is medical in psychiatry today will be subsumed under neurology as a fellowship, and the rest will be farmed out to allied professionals.

 

[Craigz]

I thought psychiatry already went through a major paradigm shift fairly recently. I mean, how do you go from hidden and repressed (often sexual) psychic conflict to chemical imbalance, as underlying cause of mental illness? Personally I miss exorcism. Giving little pills for "imbalance" sounds kind of gay (excuse the high school lingo). Beating the devil out of someone, now that's pretty cool and what psychiatrist really should be doing. And if "The Exorcist" taught us anything, it's that.

 

[shan564]

I thought psychiatry already went through a major paradigm shift fairly recently. I mean, how do you go from hidden and repressed (often sexual) psychic conflict to chemical imbalance, as underlying cause of mental illness? Personally I miss exorcism. Giving little pills for "imbalance" sounds kind of gay (excuse the high school lingo). Beating the devil out of someone, now that's pretty cool and what psychiatrist really should be doing. And if "The Exorcist" taught us anything, it's that.

Wait, that's not what psychiatrists actually do? Crap, I should have done more research before I chose a specialty.

 

[Ibid]

I thought psychiatry already went through a major paradigm shift fairly recently. I mean, how do you go from hidden and repressed (often sexual) psychic conflict to chemical imbalance, as underlying cause of mental illness? Personally I miss exorcism. Giving little pills for "imbalance" sounds kind of gay (excuse the high school lingo). Beating the devil out of someone, now that's pretty cool and what psychiatrist really should be doing. And if "The Exorcist" taught us anything, it's that.

http://en.wikipedia.org/wiki/Malleus_Maleficarum

Well at least the logic of Malleus Maleficarum is alive and well....its just that instead of trial by water, dunking the witches and seeing if they float....that's all gone....sure....it's trial by neuroleptic now...thats whats changed...oh so modern...

Do well on them and you are an actual witch....come off and do well....then you were never a witch...sorry I mean schizophrenic in the first place....

Some things never change....

 

[hamstergang]

Wait, that's not what psychiatrists actually do? Crap, I should have done more research before I chose a specialty.

Well I've suggested exorcism more than once, but my attendings have all refused so far.

 

[shan564]

Well I've suggested exorcism more than once, but my attendings have all refused so far.

Things will be different when we're all grown up and supervising our own residents.

 

[splik]

Well I've suggested exorcism more than once, but my attendings have all refused so far.

we're not allowed to do them here ourselves, have to ask spiritual care. the effects seem to be fairly short-lived.

 

[shan564]

we're not allowed to do them here ourselves, have to ask spiritual care. the effects seem to be fairly short-lived.

The trick is to put haloperidol in your holy water.

 

[splik]

not chlorpromazine?

 

[digitlnoize]

Was Jesus the first psychiatrist? By Fox News.

http://www.foxnews.com/opinion/2011/09/23/what-do-jesus-psychology-and-psychiatry-have-in-common/

They don't go into it in the article, but I've often wondered if, perhaps, Jesus was so successful at curing the diseased because he had some knowledge of medicine others did not. Did he have some Haldol stashed away in his robes somewhere? Are there any natural D2 blockers? Or...time traveling psychiatrist!!! The whole God as man theory is fine tool, I guess... 🙂

 

[billypilgrim37]

Not kidding, I ordered Zyprexa for a pt while the chaplain blessed with holy water in one of my most bizarre consults ever (at children's hospital, no less).

Sent from my DROID RAZR using SDN Mobile

 

[vistaril]

My point was basically this: It seemed to me like vistaril was saying that these bad habits are a reflection on all psychiatrists/psychiatry in general. If you are in a residency where it is the norm for people to be on horrific polypharm and you're not being trained to make better prescribing decisions yourself, then you go to a bad residency program. Don't blame psychiatry - blame your residency.

I think a lot of psychs who have people on regimens like that know these things.....but this is where the real world comes into play. Patients routinely transfer into your care, and they're going to be on a lot of stuff.....and sure, you can 'start over'(well not really but you can try), but then when you add stuff back from ground zero(because you are a psych after all and psychs prescribe drugs) you're going to be adding stuff the patient has been on before, and this will confuse and dismay the patient....and it's just the same cycle all over again.

 

[Shufflin]

This should be called the Heidi Klum cycle.

 

[Dharma]

This should be called the Heidi Klum cycle.

👍