interested in psychiatry but not much else... how to get through 3rd & 4th yr

[Psych318]

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I'm a medical student and decided to take some time off after I completed my 2nd year to figure out if medicine is really the right route for me. I thoroughly enjoy Psych and Neuro and would love to pursue Psychiatry, but through my first 2 years of classes and massive amounts of mentoring I came to realize that most stuff outside of psych and neuro just doesn't seem to be for me. I know, I know that 99.99999% of medical students out there would be appalled at reading such a statement, but it's something I just figured out through going through the medical school process. I had no idea I would feel that way prior to school/mentoring because I originally wanted to go into cardiology. As a result, I was thinking about switching gears and becoming a Clinical Psychologist by dropping out of med school and going the PhD or PsyD route. However, after thinking about it I kind of feel like I'm making a huge mistake for several reasons (less ability to provide adequate care to my patients because I won't be able to prescribe needed meds & have to send them elsewhere, price of tuition, time to completion, & family logistics since my fiancee is a medical student and it's easier to couples match than it is to hope I get into a program where he does residency).

Basically, I wanted to know how those people out there who definitely knew that they wanted to do Psychiatry were able to get through their 3rd & 4th year. The thought of spending a total of about 11 weeks doing stuff I love and about 40 weeks doing stuff I could live without seems daunting. Is there any advice that you have for me?

 

[ACSurgeon]

I'm a medical student and decided to take some time off after I completed my 2nd year to figure out if medicine is really the right route for me. I thoroughly enjoy Psych and Neuro and would love to pursue Psychiatry, but through my first 2 years of classes and massive amounts of mentoring I came to realize that most stuff outside of psych and neuro just doesn't seem to be for me. I know, I know that 99.99999% of medical students out there would be appalled at reading such a statement, but it's something I just figured out through going through the medical school process. I had no idea I would feel that way prior to school/mentoring because I originally wanted to go into cardiology. As a result, I was thinking about switching gears and becoming a Clinical Psychologist by dropping out of med school and going the PhD or PsyD route. However, after thinking about it I kind of feel like I'm making a huge mistake for several reasons (less ability to provide adequate care to my patients because I won't be able to prescribe needed meds & have to send them elsewhere, price of tuition, time to completion, & family logistics since my fiancee is a medical student and it's easier to couples match than it is to hope I get into a program where he does residency).

Basically, I wanted to know how those people out there who definitely knew that they wanted to do Psychiatry were able to get through their 3rd & 4th year. The thought of spending a total of about 11 weeks doing stuff I love and about 40 weeks doing stuff I could live without seems daunting. Is there any advice that you have for me?

Honestly, third year is NOTHING like the first two years of medical school. If you were able to TOLERATE and PASS the first two years, you should be able to get through third year without too much pain. The hours can be long, but the effort is a fraction of what you did in second year. Most of the clinical grade is just showing up and being interested. I think breezing through third and fourth year is much easier than dropping out and starting over in a grad program. It's your decision, but I'd say tough it out, and you get to learn a ton along the way.

 

[deleted263296]

Psychiatrists need to be able to rule out a medical condition for everything they see and refer the patient appropriately. So you'll use the third year to assimilate the knowledge you'll need to do that.

 

[OveractiveBrain]

Read First Aid for the Wards to get an idea of how you should behave, study, and interact.

But I will challenge you a little. Psychiatry is not a stand alone field. You will need to be a doctor first, psychiatrist second. There is knowledge, techniques, and conditions that you should be aware of. Whether you use them in your practice or for your family, you will be part of the best trained people in the world. The MD (with residency) has the longest training over any other field. It is that way because we become masters of the human condition. Disease, spirituality, psychiatry, etc. all merge into one common theme. Helping people. Try not to focus on "what you want" but on "what others need you for." With that perspective you will hopefully find joy in other rotations. Will that help you when you get dumped on by some dumb surgery intern? Of course not. But it will inspire you to learn from other fields you may not have considered.

Now I will give you a practical approach. To be a doctor you have to pass Step 2 and Step 3. Step 2 and Step 3 are 10% psych, 90% everything else. You not only should learn all you can for the sake of patients and the integrity of the field, but you must learn all you can so you can manage to actually graduate and practice as a doctor.

 

[Bartelby]

But I will challenge you a little. Psychiatry is not a stand alone field. You will need to be a doctor first, psychiatrist second. There is knowledge, techniques, and conditions that you should be aware of. Whether you use them in your practice or for your family, you will be part of the best trained people in the world. The MD (with residency) has the longest training over any other field. It is that way because we become masters of the human condition. Disease, spirituality, psychiatry, etc. all merge into one common theme. Helping people. Try not to focus on "what you want" but on "what others need you for." With that perspective you will hopefully find joy in other rotations. Will that help you when you get dumped on by some dumb surgery intern? Of course not. But it will inspire you to learn from other fields you may not have considered.

Now I will give you a practical approach. To be a doctor you have to pass Step 2 and Step 3. Step 2 and Step 3 are 10% psych, 90% everything else. You not only should learn all you can for the sake of patients and the integrity of the field, but you must learn all you can so you can manage to actually graduate and practice as a doctor.

This pretty much says it all. I'm probably going into Psych and this is how I look at things. Psychiatrists and psychologists differ in more than just ability to write prescriptions. That isn't a jab at psychologists, who fill a different niche than we will, it's just an observation.

Plus when the hours are reasonable it fulfills a lot of curiosity about the "how" of the things you learned about the first two years in an enjoyable way. It's cool to watch how a person's abdominal aortic anyeurism gets fixed from start to finish, or to see what exactly happens when someone comes in from a messy motorcycle accident. It's just two years of your life, it's actually relevant to what you will do, and it's really not that bad except when a service decides to make you their 80 hr/week b**ch.

 

[Dirt]

Take solace in the fact that there are crazy people everywhere.

I would say there is more psych in medicine than there is medicine in psych if you catch my drift. The same goes for other rotations.

 

[peppy]

Take solace in the fact that there are crazy people everywhere.

As a psychiatry resident, I think there is a lot of truth to this!
You absolutely will see psychiatric patients on pretty much every rotation and it often does influence their care even if the psych issue isn't the chief complaint for the visit. I think Emergency Medicine, Neuro, and Family Medicine in particular see a lot of psych patients.
A lot of times people in other specialties get frustrated with psych patients so your team on other rotations might appreciate it if you were interested in spending time interacting with the psych patients so that they don't have to.

(During one of my neuro rotations I am pretty sure I saw more pseudoseizure patients than real seizures 🙂 ).

 

[Dirt]

A lot of times people in other specialties get frustrated with psych patients so your team on other rotations might appreciate it if you were interested in spending time interacting with the psych patients so that they don't have to.

Ha. Not might, they will absolutely love you if you go talk to the borderline bipolar woman with 10/10 low back pain or the alcoholic that keeps pulling his catheter out and trying to urinate on his nurses.

 

[Cruzinman]

Make sure that when you get to your surgery rotation that the Surgical Residents and Attendings know that you are only interested in Psychiatry. That way, they won't give you strange looks when you are spending what seems to them to be an inordinate amount of time actually talking to a patient.

 

[gman33]

As said above, to be a pysch, you need to understand general medicine.
You can't prescribe drugs without understanding the medical conditions of your patients.

Just getting through the rotations won't be a problem as long as you show up.

Another thing to think about, have you actually spent a significant amount of time taking care of psychiatric patients? If not, you really have no idea if you want to go into that field.

I thought for sure I was going to go into psych.
I find the material the material the most interesting.
Got to my rotation and realized I had no interest in taking care of the patients. I have great respect for what psychs do, but realized pretty quickly it just wasn't for me.

 

[MedLover25]

Make sure that when you get to your surgery rotation that the Surgical Residents and Attendings know that you are only interested in Psychiatry. That way, they won't give you strange looks when you are spending what seems to them to be an inordinate amount of time actually talking to a patient.

Uhhhh - I would never tell anyone on surgery I was interested in Psyc. Buddy of mine did that. He "earned" a low B (and he was one of the more competent people on the rotation). Of all the specialties, avoid saying anything but "surgery" to a surgeon.

 

[Irrashaimase]

Uhhhh - I would never tell anyone on surgery I was interested in Psyc. Buddy of mine did that. He "earned" a low B (and he was one of the more competent people on the rotation). Of all the specialties, avoid saying anything but "surgery" to a surgeon.

How do you know for sure that you're friend got a low B because he said he wanted to go into psychiatry?
In general, I think it's a bad idea to lie about the specialty you intend to go into. Even saying you're undecided is better than attempting to lie if you aren't prepared to spend the next 4-12 weeks of a rotation putting on a sincere act; it could in the end make you look like an idiot.

 

[2012mdc]

Uhhhh - I would never tell anyone on surgery I was interested in Psyc. Buddy of mine did that. He "earned" a low B (and he was one of the more competent people on the rotation). Of all the specialties, avoid saying anything but "surgery" to a surgeon.

It depends on the particular attendings. Ours don't want us to lie. I told them I wanted to do rads and I was able to get an A

 

[tbone0705]

It's always important to get a grasp on all the other aspects of medicine because in order for a psych issue to be diagnosed, you have to first rule out any other medical causes.

 

[SGuttenberg]

It depends on the particular attendings. Ours don't want us to lie. I told them I wanted to do rads and I was able to get an A

Ive learned not to tell people I want do rads. Also bad things to say you are interested in are derm, optho or ortho. I think a lot of attendings/residents are unhappy with their careers and take it out on students who they perceive will have a better lifestyle then them.

Second, there is a huge amount of disrespect for rads, path and psych among some stereotypically egotistical specialties like surgeons and subspecialists. They will look down on you if you say you have interest in those fields.

3rd year is all about mind games and butt licking. Choose your words wisely. Never trust a seemingly down to earth and straightforward attending because they are likely to turn out to be two-faced when it comes time to fill out your evaluation.

 

[2012mdc]

Ive learned not to tell people I want do rads. Also bad things to say you are interested in are derm, optho or ortho. I think a lot of attendings/residents are unhappy with their careers and take it out on students who they perceive will have a better lifestyle then them.

Second, there is a huge amount of disrespect for rads, path and psych among some stereotypically egotistical specialties like surgeons and subspecialists. They will look down on you if you say you have interest in those fields.

3rd year is all about mind games and butt licking. Choose your words wisely. Never trust a seemingly down to earth and straightforward attending because they are likely to turn out to be two-faced when it comes time to fill out your evaluation.

Not disputing this is probably true in the majority of the cases but it's easy to find out from upperclassmen which attendings care and which don't. Again in my school the Surgery ones just want the truth and didn't treat people differently or grade harder. If you said Surgery you were likely to get graded harder not easier

On FM, I was told to say IM if you weren't interested in FM and did so.

I definitely agree with your last statement and that's why it's vital to get info from upperclassmen.

It can be helpful to tell the truth sometimes as if they are nice they might you do things in your downtime like go to the IR suite

 

[myhandsarecold]

Ive learned not to tell people I want do rads. Also bad things to say you are interested in are derm, optho or ortho. I think a lot of attendings/residents are unhappy with their careers and take it out on students who they perceive will have a better lifestyle then them.

Second, there is a huge amount of disrespect for rads, path and psych among some stereotypically egotistical specialties like surgeons and subspecialists. They will look down on you if you say you have interest in those fields.

3rd year is all about mind games and butt licking. Choose your words wisely. Never trust a seemingly down to earth and straightforward attending because they are likely to turn out to be two-faced when it comes time to fill out your evaluation.

haha, true this (am also interested in rads), especially the surgeons, was told multiple times I will not be a real doctor, will undeservingly make more than them doing <1/2 the work, and was told I was "disinterested" in learning... blah blah blah, and so I was excluded out of many boring lap choles and deliveries (happy with this), so, point is, you get buttlicking points for saying "I'm interested in X specialty.. " and try to smile until it's all over.

 

[greg1184]

Ive learned not to tell people I want do rads. Also bad things to say you are interested in are derm, optho or ortho. I think a lot of attendings/residents are unhappy with their careers and take it out on students who they perceive will have a better lifestyle then them.

Second, there is a huge amount of disrespect for rads, path and psych among some stereotypically egotistical specialties like surgeons and subspecialists. They will look down on you if you say you have interest in those fields.

3rd year is all about mind games and butt licking. Choose your words wisely. Never trust a seemingly down to earth and straightforward attending because they are likely to turn out to be two-faced when it comes time to fill out your evaluation.

ALL specialties have stupid stereotypical things to say about the other specialties in medicine. You should see what surgeons have to say about internal medicine people and vice versa. If one is incredibly worried about what people will think about a certain specialty, he/she should choose a different career path altogether.

I have an interest in psych, and everyone I have told has told me that either it is an interesting subject or that they liked their psych rotation.

 

[SGuttenberg]

ALL specialties have stupid stereotypical things to say about the other specialties in medicine. You should see what surgeons have to say about internal medicine people and vice versa. If one is incredibly worried about what people will think about a certain specialty, he/she should choose a different career path altogether.

I have an interest in psych, and everyone I have told has told me that either it is an interesting subject or that they liked their psych rotation.

The point I was making is that while we shouldn't care what others think about our career choices, it DOES matter what you tell attendings & residents what you want to do because it affects how these childish bozos will treat us as well as grade us.

While you may have had perfectly level headed attendings/residents, there are enough clowns out their with the power to effect our grades that its SAFEST to give ambiguous answers to the "what do you want to be when you grow up?" question.