if psychiatry is the only branch of medicine i'm interested in, is med school logical

[organichemistry]

basically i'm flirting with the idea of going to med school to become a psychiatrist or go a different path.

i know med school woul be hell; more hellish for me than even most because surgery doesn't interest me at all... it scares me a bit, actually... and i would dread it every day.

being a medical psychiatrist on the other hand is about as interesting as it gets for me.

i'm just afraid i'll get to medical school, hate it, not want to finish, not even be able to finish, etc etc etc... or get a psychiatry residency somewhere i don't even want to be.

(for what it's worth i'm also considering dental school and dentistry or orthodontics, as well as some really unrelated stuff like meteorology and civil engineering).

and i'm not too interested in plain psychology for a few reasons, but you folks are welcome to try to change my mind.

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[meisteckhart]

basically i'm flirting with the idea of going to med school to become a psychiatrist or go a different path.

i know med school woul be hell; more hellish for me than even most because surgery doesn't interest me at all... it scares me a bit, actually... and i would dread it every day.

being a medical psychiatrist on the other hand is about as interesting as it gets for me.

i'm just afraid i'll get to medical school, hate it, not want to finish, not even be able to finish, etc etc etc... or get a psychiatry residency somewhere i don't even want to be.

(for what it's worth i'm also considering dental school and dentistry or orthodontics, as well as some really unrelated stuff like meteorology and civil engineering).

and i'm not too interested in plain psychology for a few reasons, but you folks are welcome to try to change my mind.

If you hate surgery and you're not sure you would like other medical specialities, plus you're not very interested in psychology, what exactly is attracting you to psychiatry? Its certainly normal to have some doubts about going to medical school. Many people do. But if you really think you'll hate it that much, maybe you should think about something else.

 

[sb_MD]

There is a hell of a lot more to medical school than just your surgery rotation. You can get through that if you really want to be a doctor, no problem. I know plenty of people who hated surgery and survived their clinical years - actually enjoyed them. You have to think about the medical part of it - are you really interested in learning about physiology, pathology, etc... and all that the first two yrs of med school entails? And why don't you like psychology? That may be a indicator of something.

 

[Anasazi23]

I know plenty of people that even THOUGHT they'd love med school, that ended up completely hating it. I know even more that want out now that they're in residency. Medical school has a special way of making you miserable. If you're not really enthralled with psychiatry - passionate about wading through a whole lot of muck to get there. I can't say I suggest it.

That said, people often find new interests and changed ambitions once they get there. The remark about hating surgery is heard often, and there are just as many stories about people that end up loving it. I myself seriously considered surgery at one point...had the letters of rec and everything.

I'd take a look at your options, talk with some people, medical students, residents, psychiatrists, etc, and try to make the most informed decision.

Good luck.

 

[vmc303]

I'm in a similar position. Though I find various other branches of medicine interesting, psychiatry is really the only one I could see myself going into. On top of that, I have my doubts about whether psychiatry really should be part of medicine proper; the fact that one needs to go to medical school in order to become a psychiatrist seems more of an historical accident than anything else. God knows how little of your medical training you'll actually use as a practicing psychiatrist.

At the same time though, for whatever reason, I too have never seriously considered going into clinical psychology. It just doesn't appeal to me in the same way, maybe because it seems less scientific than psychiatry and because of that, a bit "unserious." That may not be the reality of it, but it's my perception of things.

While I realize a lot of my medical school training would essentially go to waste in the end, the fact that I'm interested in the material and would appreciate knowing the stuff is probably enough to get me through it all.

 

[meisteckhart]

I'm in a similar position. Though I find various other branches of medicine interesting, psychiatry is really the only one I could see myself going into. On top of that, I have my doubts about whether psychiatry really should be part of medicine proper; the fact that one needs to go to medical school in order to become a psychiatrist seems more of an historical accident than anything else. God knows how little of your medical training you'll actually use as a practicing psychiatrist.

At the same time though, for whatever reason, I too have never seriously considered going into clinical psychology. It just doesn't appeal to me in the same way, maybe because it seems less scientific than psychiatry and because of that, a bit "unserious." That may not be the reality of it, but it's my perception of things.

While I realize a lot of my medical school training would essentially go to waste in the end, the fact that I'm interested in the material and would appreciate knowing the stuff is probably enough to get me through it all.

This is somewhat of a hotbutton topic for me, but medical school is not a waste for a psychiatrist and it is not a historical accident. Psychiatrists are part of the medical profession for a reason. Not only was it important that we understand medical illness several decades ago because mental illness is so often affected by and affects various other medical problems, but today it is extremely important because of the enormous changes that the specialty has gone through. Part of the reason psychiatry is so exciting now is that we are just beginning to understand the medical and biological underpinnings of mental disorders. We are also often advocates for our patients on medical issues because we see them so much more frequently and for so much more time than their primary doctor does. While it is true that I will never being doing surgery again, or delivering babies, that does not mean those experiences were a waste. Plus the way doctors are taught to think in medical school is vastly different than the way other health care workers are taught to think. There is nothing wrong with knowing you want to be a psychiatrist before going to medical school, or even knowing you will not like some things about medical school. But if you go to medical school, it should be because you want to be a physician, because psychiatrists ARE physicians.

 

[whopper]

There have been plenty of patients I've had who have full blown non psychiatric conditions.

Many psychiatric patients have comorbid conditions. Example depressed patients sometimes don't eat.

The medications can cause physiological complications. You need to know what they are.

I was in the same position too. I wanted to do Psychiatry from the start. Medschool made me miserable. The real hell is the first 2 years. The 2nd 2 years are also tough but you have a semi life.

Yes it was frustrating having only about 15% of your curriculum focus on the behavioral sciences, the rest on stuff you're not interested in. However having my MD IMHO does help me to be a better therapist pyschiatrically. Example a heck of a lot of my alcoholic patients have anemia related to their drinking. I need to treat that. Geodon can cause heart complications, people can become depressed because of their medical condition etc.

 

[vmc303]

This is somewhat of a hotbutton topic for me, but medical school is not a waste for a psychiatrist and it is not a historical accident. Psychiatrists are part of the medical profession for a reason. Not only was it important that we understand medical illness several decades ago because mental illness is so often affected by and affects various other medical problems, but today it is extremely important because of the enormous changes that the specialty has gone through. Part of the reason psychiatry is so exciting now is that we are just beginning to understand the medical and biological underpinnings of mental disorders. We are also often advocates for our patients on medical issues because we see them so much more frequently and for so much more time than their primary doctor does. While it is true that I will never being doing surgery again, or delivering babies, that does not mean those experiences were a waste. Plus the way doctors are taught to think in medical school is vastly different than the way other health care workers are taught to think. There is nothing wrong with knowing you want to be a psychiatrist before going to medical school, or even knowing you will not like some things about medical school. But if you go to medical school, it should be because you want to be a physician, because psychiatrists ARE physicians.

I agree that psychiatrists have an important role to play as physicians. Clearly, a lot of mental illness has roots in biology, and can (and should) be adequately treated from that angle. But it's not at all obvious to me that some forms of "mental illness" are really illnesses at all, so much as natural reactions to life events or simply extreme ends of a normal distribution of traits. Depression, for example, can certainly be as crippling as any other biological disease, and its symptoms can be treated pharmaceutically -- but does that mean that the roots of depression are anything like the roots of heart disease or diabetes? Without a comprehensive understanding of disease etiology (which certainly can't exist in all situations), what's it even mean to say that it's a medical problem that should be treated by physicians? Yes, psychiatrists are physicians, but I think they're unique in that some (or many) of the problems they treat are fundamentally very different from the sort that other physicians encounter.

 

[meisteckhart]

I agree that psychiatrists have an important role to play as physicians. Clearly, a lot of mental illness has roots in biology, and can (and should) be adequately treated from that angle. But it's not at all obvious to me that some forms of "mental illness" are really illnesses at all, so much as natural reactions to life events or simply extreme ends of a normal distribution of traits. Depression, for example, can certainly be as crippling as any other biological disease, and its symptoms can be treated pharmaceutically -- but does that mean that the roots of depression are anything like the roots of heart disease or diabetes? Without a comprehensive understanding of disease etiology (which certainly can't exist in all situations), what's it even mean to say that it's a medical problem that should be treated by physicians? Yes, psychiatrists are physicians, but I think they're unique in that some (or many) of the problems they treat are fundamentally very different from the sort that other physicians encounter.

I mean no disrespect and certainly there are probably many physicians who do think psychiatry is fundamentally different from other medical specialties. However, I do believe that the roots of depression are very much like the roots of heart disease and diabetes. In heart disease, there are genetic makeups that predispose people to have heart disease. So too are there genetic predispositions to depression. There are theories of why heart disease occurs including the buildup of atherosclerotic plaques which may be affected by things such as cholesterol levels, obesity, or psychosocial stress. So too are there theories of why depression occurs, particularly that there is a paucity or excess of various neurotransmitters, or various deficiencies of brain function in certain areas of the brain. These factors may be affected by things such as early childhood experiences, exposure to sunlight, amount of exercise, or psychosocial stresses.

As far as your assertion that some mental illnesses may not be illnesses at all but perhaps the extreme ends of normal, I would agree that one could take that perspective. However, the definition of what makes something a "disease" is a social construct. Our society has typically defined things as diseases when they cause a significant impairment in one's functioning, or when they represent a significant threat to future functioning. For example, heart disease can kill you outright from a heart attack, or perhaps decrease your exercise tolerance. Psychiatry too has included impairment of functioning in the definitions of various mental illnesses. If a person is occasionally sad, but is able to function normally, we don't call that depression we call it normal variance of human emotion. If, however, they stop eating, have sleeping difficulties, are predominately "sad" most of the time, withdraw from social contact, and begin to think about killing themselves, we call it depression. I will grant you that it is not always easy to tell on cases which walk that fine line, but this is not a problem unique to psychiatry. What is the cutoff of a blood sugar to call a person a diabetic? It has changed many times over the years, to the point that they even now have points where they call people "pre-diabetics". When does someone have hypertension? Is it 140/100, 135/95, 120/80? It all depends on the patient and what study you prefer to take as correct.

Finally, yes psychiatry is often viewed as different from other medical specialties, but I believe this to be a function of two things. First off, it is a function of the stigma surrounding psychiatry and the belief that people with mental illness are "different", so therefore psychiatry and psychiatrists must be "different" as well. Secondly, it is a function of a philosophical premise which pervades our society in which people believe that mind and body are two separate things. I would contend (and I am CERTAINLY not the first) that they are, in fact, not separate, or at the very least they are intimately connected such that physical and mental illnesses must be seen as entities which ALWAYS affect one another. I truly believe that to view mental illness and psychiatry (and psychology for that matter) as fundamentally different from physical illness and medicine promotes the marginalization of the mentally ill and misses out on the opportunity to see ourselves as whole human beings with multiple body functions that all affect each other.

 

[vmc303]

I mean no disrespect and certainly there are probably many physicians who do think psychiatry is fundamentally different from other medical specialties. However, I do believe that the roots of depression are very much like the roots of heart disease and diabetes. In heart disease, there are genetic makeups that predispose people to have heart disease. So too are there genetic predispositions to depression. There are theories of why heart disease occurs including the buildup of atherosclerotic plaques which may be affected by things such as cholesterol levels, obesity, or psychosocial stress. So too are there theories of why depression occurs, particularly that there is a paucity or excess of various neurotransmitters, or various deficiencies of brain function in certain areas of the brain. These factors may be affected by things such as early childhood experiences, exposure to sunlight, amount of exercise, or psychosocial stresses.

As far as your assertion that some mental illnesses may not be illnesses at all but perhaps the extreme ends of normal, I would agree that one could take that perspective. However, the definition of what makes something a "disease" is a social construct. Our society has typically defined things as diseases when they cause a significant impairment in one's functioning, or when they represent a significant threat to future functioning. For example, heart disease can kill you outright from a heart attack, or perhaps decrease your exercise tolerance. Psychiatry too has included impairment of functioning in the definitions of various mental illnesses. If a person is occasionally sad, but is able to function normally, we don't call that depression we call it normal variance of human emotion. If, however, they stop eating, have sleeping difficulties, are predominately "sad" most of the time, withdraw from social contact, and begin to think about killing themselves, we call it depression. I will grant you that it is not always easy to tell on cases which walk that fine line, but this is not a problem unique to psychiatry. What is the cutoff of a blood sugar to call a person a diabetic? It has changed many times over the years, to the point that they even now have points where they call people "pre-diabetics". When does someone have hypertension? Is it 140/100, 135/95, 120/80? It all depends on the patient and what study you prefer to take as correct.

Finally, yes psychiatry is often viewed as different from other medical specialties, but I believe this to be a function of two things. First off, it is a function of the stigma surrounding psychiatry and the belief that people with mental illness are "different", so therefore psychiatry and psychiatrists must be "different" as well. Secondly, it is a function of a philosophical premise which pervades our society in which people believe that mind and body are two separate things. I would contend (and I am CERTAINLY not the first) that they are, in fact, not separate, or at the very least they are intimately connected such that physical and mental illnesses must be seen as entities which ALWAYS affect one another. I truly believe that to view mental illness and psychiatry (and psychology for that matter) as fundamentally different from physical illness and medicine promotes the marginalization of the mentally ill and misses out on the opportunity to see ourselves as whole human beings with multiple body functions that all affect each other.

Interesting comments. I do agree that regardless of the nature of something like depression, if its 'symptoms' include things like suicidal ideation or an inability to function, then medicating those symptoms is certainly a good thing to do and firmly within the bounds of medicine. I don't agree with the critics of psychiatry who claim that because much of psychiatry is merely about treating the symptoms of an underlying disorder, that it's somehow "unscientific" or a "sham."

But if the cause of the depression is life circumstances, and the best course for treating the problem is some form of extended therapy, then -- pharmaceuticals aside -- it seems very difficult to conceive of the treatment as truly "medical" in nature. Cognitive therapy, for example, can only be seen as a "medical treatment" in the very loosest, most metaphorical of senses. It's really unlike any of the other disease treatments we find in medicine. Maybe this is simply because the mind is so much more complex than the heart or the liver, I don't know. It's a semantical debate. But in the end, to properly treat someone using all the tools at a psychiatrist's disposal (that is, not restricting oneself to medicating), I still think that the psychiatrist is drawing much less from his medical school training and knowledge of human biology than is any other doctor in their practice.

 

[john182]

basically i'm flirting with the idea of going to med school to become a psychiatrist or go a different path.

i know med school woul be hell; more hellish for me than even most because surgery doesn't interest me at all... it scares me a bit, actually... and i would dread it every day.

being a medical psychiatrist on the other hand is about as interesting as it gets for me.

i'm just afraid i'll get to medical school, hate it, not want to finish, not even be able to finish, etc etc etc... or get a psychiatry residency somewhere i don't even want to be.

(for what it's worth i'm also considering dental school and dentistry or orthodontics, as well as some really unrelated stuff like meteorology and civil engineering).

and i'm not too interested in plain psychology for a few reasons, but you folks are welcome to try to change my mind.

Find out first what you think psychiatry is. Plenty of other types of MD don't know what psychiatr is.

Secondly, go to med school to become a general physician. Durign the time, you will get experience in all or at least a lot of speicalities based on human biological illness. Choose an area you like and move on into residency.

Don't do med school to become a psychiatrist. Med school is to become a doctor to treat patients - psychiatry, like gastroenterology or any other speciality, is a branch of treatment for illnesses.

So ask yourself first, do you want to be a physician? You will say yes or no - and after several years of becoming one in med school you'll then know which type suits you (hopefully).

 

[vmc303]

Right, because exercise, physical therapy, etc. . . has no effect on general health or specific disease processes. If your definition of medicine is pharmaceuticals and surgery, I guess you're right.

By "therapy," I was referring to "talking therapies," like cognitive therapy, various forms of counseling, even psychoanalysis, etc. Things which don't deal with the human body or physical health *directly*. I thought my example made this clear, but I guess not. These are valid ways of treating various mental illnesses which don't resemble any other treatments in medicine, either in their approach or their mechanism. This is why I say psychiatrists are fundamentally different from other physicians. Qua therapist (in the way I speak of it), psychiatrists have less in common with a general surgeon or an internist than even an acupuncturist or chiropractor does.

 

[xenium]

But if the cause of the depression is life circumstances...

I agree with meisteckhart. I don't necessarily see your viewpoint as wrong or invalid, but I think that generally what is happening is an evolution of paradigm on this matter (namely that mental illness is, for the most part, just as biological as any other type of illness). And in the end.. that is what is being argued here.

Above you say that 'if the cause of depression is life circumstances'... to respond with a few quick points:
#1) You are using a difficult example (depression), one that is often used excessively (and wrongly) by the general lay public.. sometimes to mean sadness, sometimes unhapiness, sometimes problems adjusting, etc. Try picking another more severe mental illness to examine (e.g. schizophrenia, severe OCD), and it will be hard to argue that its cause is purely 'life circumstances.'
#2) Is the premise of your argument even true, that the cause of genuine depression solely 'life circumstances'? I would think not -- people who do not have a disposition for it will go their entire lives (even under the worst of circumstances) and never develop depression.. Again I go back to #1, above, as depression may be a bit unwieldly to discuss b/c in the end, its causes are probably on a spectrum of 'bio-psycho-social', and hence treatment may vary according to the situation (or cause).
#3) Lastly and most importantly.. people fairly often attribute mental illness to 'life circumstances' as do you.. and conversely, people often attribute 'medical' illnesses to other causes (e.g. genetic, etc) but NOT to life circumstances. But let's remember.. where do even 'medical' illnesses come from? Diabetes? Sedentary lifestyle + poor diet + familial predisposition --> high cholesterol/sugar/etc --> insulin resistance --> *DIABETES.. and from there? diabetes --> neurologic, nephrologic, etc complications.. vascular complications --> vascular surgery (endarterectomy, etc). Cancer? Sometimes environmental exposure (toxins, UV light), diet, smoking.. Anyway, you get the idea. Medical illness too often has a large 'social' component. As meisteckhart said, 'illness' is a social construct. What is illness at all, and when does one have it and not have it?

In any case.. it is becoming increasingly clear that, yes although mental illness is somewhat different from medical illness (e.g. cognitive decline, dementia, privacy, etc), in most ways it is not all that different from 'medical' illness. I agree with other posters -- to see it as dinstinct from
medical illness is using an older world view, one that is unfortunately riddled with inaccurate influences (historic stigma, lack of knowledge or experience with mental illness, etc).

 

[PublicHealth]

There has been a recent interest in psychosomatic psychiatry among psychiatrists, particularly Michelle Riba, President of the American Psychiatric Association. In fact, the theme of this year's American Psychiatric Association Meeting is Psychosomatic Medicine: Integrating Psychiatry and Medicine (http://www.psych.org/edu/ann_mtgs/am/05/index.cfm). Personally, I find the intersection of psychiatry and medicine fascinating. Psychologists seeking RxP -- even with their MS degrees in clinical psychopharm -- are in no position to understand the complex relation between these fields.

 

[xenium]

LOL. I would argue that non-researchers in general have shallow understandings of this field. Hell, it is essentially inclusive of my area of research. I suppose it's hopeless given my Ph.D. background.

You know.. it seems like almost every other thread on this group eventually gets hijacked into a 'psychiatry vs psychology' debate.. it is getting rather inane at this point..

.. please take it to a dedicated thread or somewhere else..
(and why is it that this only happens in this forum and not the psychology forum..??? hmmmmmmmmmmmmmm..........)

 

[xenium]

Heh, sure it is a bit silly, but take a gander at the topic, it is psychiatry vs psychology and my entrance into this debate was in defense of psychiatry as a medical discipline.

Which topic are you reading?? Perhaps you should take a second look at the topic..

The topic was not 'psychiatry vs psychology', rather it is someone who is considering medical school / psychiatry as a future career and asking the advice of other medical students, residents, and doctors.. (at which a 2nd poster joined and voiced the same question, mostly based on the uncertainty that psychiatry may not be a fully realized branch of medicine..).

That same poster at one point admitted that he/she never really considered psychology -- I would have thought that that would have been an ample opportunity for someone such as yourself to come in and shed a little light on psychology for them (instead of re-igniting this old, tired debate)..

Looking at your posts, I see that you frequently post about this 'psychiatry vs psychology' debate, albeit in numerous forums and various threads. What is it about this topic that has you so fixated on it??

Regardless, that answer is best suited for a dedicated thread on the matter. Since the psychology folks on here seem to be more interested in it than we are, perhaps such a thread should be placed on *their* forum to perpetually discuss?

.. Again.. really just kind of a silly debate.. in the end the two fields should be practicing in harmony, not the opposite.. good luck, and please take this bickering to another thread/forum.

 

[cyanocobalamin]

I think you still need to know "medicine" to do psychiatry or at least a residency in psychiatry. I'm doing my psych rotation right now and when one admits a person to the psych service one needs to do an entire H&P - a real physical in addition to MSE/MMSE. Also on the wards there's often times when you need to manage some medicine issues and it would be nice to know what cipro or TMP/SMX or nitrofurantoin is/does so you don't need to grab a medicine consult for every little UTI and which abx to choose for the pregnant lady, the sulfa alergic lady and the lady who has uncomplicated first UTI. Also, a lot of medicine drugs have impacts on psych issues, e.g. beta blockers for HTN and depression. Also, you need to know a lot of neuro for psych, especially for older people as a lot of psych drugs have neuro effects - cogwheeling, tardive dyskinesia, etc.

The psych residents at my school rotate through months of medicine and neuro..which would be hard to do if one never attended full medical school.

I mean, one could argue more convincingly so that radiologists or pathologists don't have to go to medical school because they will never touch a (live) human being...