Interested in the Science of Psyhiatry, but not the "touchy feely stuff"

[EMDO2018]

Could a person with my interest like this field? I don't think I would ever want to do therapy sessions where I just treat general depression and anxiety all day. Honestly, I want to focus on the science of things and less on peoples lives. And how often do psychiatrist have interesting patients= people who think they are possessed by the devil, the criminally insane, multiple personality, etc.

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[nitemagi]

 

[CD101.9]

Could a person with my interest like this field? I don't think I would ever want to do therapy sessions where I just treat general depression and anxiety all day. Honestly, I want to focus on the science of things and less on peoples lives. And how often do psychiatrist have interesting patients= people who think they are possessed by the devil, the criminally insane, multiple personality, etc.

You might be interested in doing ECT, TMS, and in doing research in these areas. Not all psychiatrists like doing therapy. You could also do medication management without any therapy.

 

[Promethean]

So, you want to study the mind, just not emotions. But profound aberations and delusions are okay, because then you can be entertained by them.

Maybe don't. Try path, or rads. Both have lots of science, little touchy feely.

EDIT: Certainly, you are going to hate residency, since they are not going to let you cherry pick cases or avoid providing therapeutic support to patients.

 

[Shikima]

Have you considered exploring Neurology?

 

[digitlnoize]

Could a person with my interest like this field? I don't think I would ever want to do therapy sessions where I just treat general depression and anxiety all day. Honestly, I want to focus on the science of things and less on peoples lives. And how often do psychiatrist have interesting patients= people who think they are possessed by the devil, the criminally insane, multiple personality, etc.

I'm going to go ahead and disagree with the majority. I think you can certainly do psychiatry and not do therapy very often. You'll have to do a little bit during residency, but that's a very small amount and you can tough it out. Just don't go to a program that's very heavily therapy based in you'll be fine.

If you want to see that kind of pathology, you might be very interested in working at the state hospital where there are lots of schizophrenics. Psychiatry research is also a wide open field and we need good people doing the work.

I would add that it does help clinically if you care about your patients. I'm assuming that when you say touchy-feely stuff, that you mean the more abstract therapy concepts, and you're okay with normal patient Dr. relationships.

 

[Armadillos]

I think this questions means very different things depending on who its coming from. The wording makes me think this person has very little actual knowledge of what psychiatry is so it seems concerning and psych seems like a poor choice.

On the other hand, if this was asked (differently) by a more educated MS3, I think the answer would be very different. Several of the best psychiatrists Ive worked with would not be considered very touchy feely, they are probably equivalent to what you would expect from a IM hospitalist or something. Seems like the more "touchy feely" psychiatrists (particularly residents) are prone to make some poor decisions in certain situations, driven more by emotion than clinical reasoning.

 

[Merovinge]

Could a person with my interest like this field? I don't think I would ever want to do therapy sessions where I just treat general depression and anxiety all day. Honestly, I want to focus on the science of things and less on peoples lives. And how often do psychiatrist have interesting patients= people who think they are possessed by the devil, the criminally insane, multiple personality, etc.

I would consider neurology, behavioral neurology fellowship after neurology, or neuropsychiatry fellowship after psychiatry. If you go the psychiatry route there will definitely be depression and anxiety cases, but such cases are rarely as mundane as you might believe.

 

[vistaril]

I'm going to go ahead and disagree with the majority. I think you can certainly do psychiatry and not do therapy very often. You'll have to do a little bit during residency, but that's a very small amount and you can tough it out. Just don't go to a program that's very heavily therapy based in you'll be fine.
.

of course he can just hand out meds in med mgt outpt sessions all day(that's what a heck of a lot of psychiatrists do after all), but the idea that he can do a decent job at it while taking the following stance-"Honestly, I want to focus on the science of things and less on peoples lives" is insane.

even if you do straight med mgt with 15 minute med checks, the most important part of it is exactly what the OP doesn't want to do- FOCUSING ON PEOPLES LIVES. If you actually think the most important part of our job in outpt med mgt psychiatry is making all those tough evidence based choices about whether to switch a pt from Celexa to Cymbalta you're being ridiculous. Those decisions in outpt psychiatry in most(not all) case are irrelevant at worst and trivial at best, and the idea that someone who isn't interested in the patients lives themselves could still be a good clinical psychiatrist is absurd.

 

[vistaril]

Several of the best psychiatrists Ive worked with would not be considered very touchy feely, they are probably equivalent to what you would expect from a IM hospitalist or something..

Not being very touchy feely is ok. Heck even preferred. That has nothing to do with whether one takes an interest in the patient themselves however.

 

[F0nzie]

less on peoples lives.

Employers and insurance companies are gonna love you man!

But seriously you will not have time to focus on people's lives unless you do that on your own time. You will be filling out paperwork, clicking buttons, and making sure you CYA 1st and that will take up most of your time.

FYI, not sure if I'm having a bad week.

 

[vistaril]

Employers and insurance companies are gonna love you man!

But seriously you will not have time to focus on people's lives unless you do that on your own time. You will be filling out paperwork, clicking buttons, and making sure you CYA 1st and that will take up most of your time.

FYI, not sure if I'm having a bad week.

it is what it is......we can't have it both ways. If we're going to complain about employers and insurance companies only caring about the bottom line/reducing expenses/patients per hour/etc and less about performance(which is all true), then we are more than welcome to go our own way/chart our own course and set up our own thing where we bypass both the employers and the insurers and provide service for cash.

You've done so, so you of all people know this tradeoff.

In this field you either get the satisfaction of treating patients your way under your rules and by your standards....or you get the satisfaction of a nice secure sizeable paycheck that is guaranteed with all the bennies that come with it.

You can't have both.....nor quite frankly should we be able to.

 

[MacDonaldTriad]

No matter what kind of a psychiatrist you are, understanding therapy concepts and utilizing these skills happens with every patient interaction. To go into psychiatry with the goal of not learning these skills may be possible, but it shouldn’t be. I think I could train a GP to do meds as well as a psychiatrist without these skills in less than a year.

 

[touchpause13]

Can you really be an effective psychiatrist if you are very uncomfortable with feelings though?

I'm not saying you have to cry with every patient, but people will open to you about things in their lives that they probably have strong emotions about. I'd be concerned about OP's ability to be empathic, which I would personally consider a key trait needed in a psychiatrist.

 

[PikminOC]

Employers and insurance companies are gonna love you man!

But seriously you will not have time to focus on people's lives unless you do that on your own time. You will be filling out paperwork, clicking buttons, and making sure you CYA 1st and that will take up most of your time.

FYI, not sure if I'm having a bad week.

How do you feel about that?

Why is your week bad?

 

[psych md jd]

I just want to say one word to you. Just one word. Forensics.

And how often do psychiatrist have interesting patients= people who think they are possessed by the devil, the criminally insane, multiple personality, etc.

All of my outpatients are criminally insane or incompetent. Mostly murderers, sex offenders, and arsonists.

 

[touchpause13]

I just want to say one word to you. Just one word. Forensics.

And how often do psychiatrist have interesting patients= people who think they are possessed by the devil, the criminally insane, multiple personality, etc.

All of my outpatients are criminally insane or incompetent. Mostly murderers, sex offenders, and arsonists.

That's a good point I didn't think of that.

Forensics is a cool gig. Not something I'm cut out for (actually I did work with sex offenders for a while and I just couldn't handle it) but that might be much more up OPs alley

 

[Rogert]

I know that as a patient I would not be comfortable with a psychiatrist who didn't seem interested in my life/feeling/emotions. And there is no specialty where the patients emotional comfort is more important than psychaitry imo.
Some of you are saying that he can just tough it out for a few years until residency is over, but that is still a period of several years in which patients have to work with a doctor who doesn't care for his/her work. I don't see how that can possibly be acceptable.

 

[F0nzie]

How do you feel about that?

Why is your week bad?

Oh yes. This is what I need!

 

[Therapist4Chnge]

How do you feel about that?

Why is your week bad?

[/thread]

 

[HarryMTieboutMD]

Agreed with Vistaril. Whether one trains as an NYC analyst at Cornell, as an evidence based psychopharmacologist at Wash U, or in the Perspectives at Hopkins, as a psychiatrist, you will be trained to take an investment in people's lives. This is the one specialty in medicine where an extensive, social history is actually indispensable, and when not done correctly and thoroughly, can lead to adverse outcomes. I have a penchant for neuroscience/behavioral neurology, which has shaped the way I view psychiatric pathology, but I am adamant about getting to know the life story of every of every patient I see and how their stories intertwine with their diseases... and each time, I grow more as a physician and as a person.

 

[smalltownpsych]

How do you feel about that?

Why is your week bad?

Who cares about your life? All I want to know is if you have any interesting pathology. Something like Capgras Syndrome or Koro, or even just run of the mill paranoid delusions so long as they are not too mundane and dreary. Maybe you really think that you are a character from a 70s sitcom. Now that would be interesting - Fonzarelli Syndrome.

 

[stsa84]

My insight, based on the first 2 weeks of my psychiatry rotation, is that many psychiatrists do absolutely no "therapy". Before my rotation, I was under the impression that that was all they did, and had effectively crossed it off my list. 2 weeks into my psych rotation, I finally asked my attending how much therapy they actually do (studying for the shelf, there are a ton of questions asking what type of therapy is appropriate for a given condition, but I had not seen any of it taking place). She said that it depends on the dynamics of where you choose to practice, but many (most?) practices have full time therapy teams that handle all of the actual "therapy", while the psychiatrists more manage the meds and the overall progress of their patients. All the patients I have seen meet with their psychiatrist every few months, but meet with their therapist once every week or two. The attendings get all the notes from these, but aren't the ones doing the actual therapy. This increased my interest in the field about 100 fold. That's my impression of the field, for what it's worth.

 

[smalltownpsych]

My insight, based on the first 2 weeks of my psychiatry rotation, is that many psychiatrists do absolutely no "therapy". Before my rotation, I was under the impression that that was all they did, and had effectively crossed it off my list. 2 weeks into my psych rotation, I finally asked my attending how much therapy they actually do (studying for the shelf, there are a ton of questions asking what type of therapy is appropriate for a given condition, but I had not seen any of it taking place). She said that it depends on the dynamics of where you choose to practice, but many (most?) practices have full time therapy teams that handle all of the actual "therapy", while the psychiatrists more manage the meds and the overall progress of their patients. All the patients I have seen meet with their psychiatrist every few months, but meet with their therapist once every week or two. The attendings get all the notes from these, but aren't the ones doing the actual therapy. This increased my interest in the field about 100 fold. That's my impression of the field, for what it's worth.

This is true in many settings, but if you don't have the skill set to be an effective psychotherapist, then you won't be a very effective psychiatrist. Medication is a much smaller piece of the puzzle than you might think. If all you know is that piece then you become of limited use to the treatment team and that is a big problem if you are in charge of that team.

 

[Jalapeño King]

Could a person with my interest like this field? I don't think I would ever want to do therapy sessions where I just treat general depression and anxiety all day. Honestly, I want to focus on the science of things and less on peoples lives. And how often do psychiatrist have interesting patients= people who think they are possessed by the devil, the criminally insane, multiple personality, etc.

Your username made me think you might be interested in emergency medicine, and really, someone like you would probably enjoy emergency psychiatry. Some hospitals have dedicated psychiatric emergency departments, where you would evaluate patients when they first arrive to the hospital, many times brought in by police. You would make the decision to admit them, observe them for a day or two, or discharge them home. You still have to ask about their lives to learn who they are as a person, but your main job is just to make sure they don't kill themselves or hurt anyone else, and then send them on to another doctor for further treatment. There isn't much therapy that takes place in an emergency setting, either.

 

[Dharma]

My insight, based on the first 2 weeks of my psychiatry rotation, is that many psychiatrists do absolutely no "therapy". Before my rotation, I was under the impression that that was all they did, and had effectively crossed it off my list. 2 weeks into my psych rotation, I finally asked my attending how much therapy they actually do (studying for the shelf, there are a ton of questions asking what type of therapy is appropriate for a given condition, but I had not seen any of it taking place). She said that it depends on the dynamics of where you choose to practice, but many (most?) practices have full time therapy teams that handle all of the actual "therapy", while the psychiatrists more manage the meds and the overall progress of their patients. All the patients I have seen meet with their psychiatrist every few months, but meet with their therapist once every week or two. The attendings get all the notes from these, but aren't the ones doing the actual therapy. This increased my interest in the field about 100 fold. That's my impression of the field, for what it's worth.

I'm not sure if it's that black and white. Even if an appointment is not considered a therapy session and simply a med check, the skills learned during therapy training could play a role during that time with the patient. Give this a read:

http://www.psychiatrictimes.com/articles/psychotherapy-alive-and-talking-psychiatry

I'm also not sure we can judge the profession based on inpatient experiences either. I'm only a student as well, so my perspective may be a bit too idealistic.

 

[touchpause13]

I actually really want to do therapy. Does that put me in the minority?

 

[EMDO2018]

Your username made me think you might be interested in emergency medicine, and really, someone like you would probably enjoy emergency psychiatry. Some hospitals have dedicated psychiatric emergency departments, where you would evaluate patients when they first arrive to the hospital, many times brought in by police. You would make the decision to admit them, observe them for a day or two, or discharge them home. You still have to ask about their lives to learn who they are as a person, but your main job is just to make sure they don't kill themselves or hurt anyone else, and then send them on to another doctor for further treatment. There isn't much therapy that takes place in an emergency setting, either.

Is emergency psychiatry a large field? Seems like it would be a very interesting specialty. Forensics seems cool too, but is it a specialty where you have to be in court a lot? Its not that I have a problem with therapy, its just that my attention span is short and I tend to need to move from project to project, or manage multiple projects to hold off boredom.

 

[Dharma]

Your username made me think you might be interested in emergency medicine, and really, someone like you would probably enjoy emergency psychiatry. Some hospitals have dedicated psychiatric emergency departments, where you would evaluate patients when they first arrive to the hospital, many times brought in by police. You would make the decision to admit them, observe them for a day or two, or discharge them home. You still have to ask about their lives to learn who they are as a person, but your main job is just to make sure they don't kill themselves or hurt anyone else, and then send them on to another doctor for further treatment. There isn't much therapy that takes place in an emergency setting, either.

How long could someone actually do this career wise though, and by that I mean full-time? Sounds like a decent per diem gig.

 

[splik]

Your question is legitimate you just happened to phrase it in the most provocative way that shows very little understanding of psychiatry or medicine.

You don't have to be touchy feely to be in psychiatry. I certainly am not very touchy-feely (though have my moments). Patients will vote with their feet and if they want that they will find someone else. Conversely, I have many patients who like me because of my straight-shooting, confrontational and abrasive style (though I'm mellowing out a bit in my old age). And something like forensics might be up your street although you will have to spend a long-time (hours and hours) with the same patient doing evaluations if doing private civil/criminal cases.

Personally, I don't like to see patients more than once. I get bored easily. I often do very psychodynamically-oriented interviews, or use MI, socratic questioning, hypnosis, but I do not want to see the patient again if I can avoid it. That is just my preference and many psychiatrists feel the same way. Not everyone wants long-term relationships with patients or wants to be doing long-term psychotherapy with patients.

But what has any of this got to do with science? there is no science. psychiatry is mostly pseudoscience. and science has little to do with the practice of most medical specialties. you deal with patients, their problems, and their lives. that is true for any clinical specialty with patient care to varying extents. if you dont hear patient's stories and understand their problems within the contexts of their lives psychiatry would be very dull indeed. if you pay enough attention you will usually be able to understand what the delusions and hallucinations of even the most psychotic patient mean.

 

[Jalapeño King]

Is emergency psychiatry a large field? Seems like it would be a very interesting specialty. Forensics seems cool too, but is it a specialty where you have to be in court a lot? Its not that I have a problem with therapy, its just that my attention span is short and I tend to need to move from project to project, or manage multiple projects to hold off boredom.

How long could someone actually do this career wise though, and by that I mean full-time? Sounds like a decent per diem gig.

I don't know how big the field of emergency psychiatry is, but there are about a half dozen doctors at my hospital who simply do that and nothing else. Each of them work 12 hour shifts, and work as many days per week as they wish. As far as a career goes, I think it may take a certain type of person who would enjoy working in that type of setting long term. It's not for me, but I know others who really enjoy it and would rather do that than anything else.

Forensics does involve a lot of court. You would basically be a full-time expert witness.

By the way, I was just thinking that another specialty you might be interested in is psychosomatic medicine, also known as consult-liaison psychiatry. I was really interested in this for a while. It involves acting as a consultant to other physicians in the hospital who are seeking help in managing their patients with psychiatric problems. In some cases, you simply see the patient once and give the doctor your recommendations; in other cases, you assume the psychiatric care of the patient while they are being treated as an inpatient for their medical problems.

 

[stsa84]

Edit: sorry, double post

 

[stsa84]

This is true in many settings, but if you don't have the skill set to be an effective psychotherapist, then you won't be a very effective psychiatrist. Medication is a much smaller piece of the puzzle than you might think. If all you know is that piece then you become of limited use to the treatment team and that is a big problem if you are in charge of that team.

I'm not sure if it's that black and white. Even if an appointment is not considered a therapy session and simply a med check, the skills learned during therapy training could play a role during that time with the patient. Give this a read:

http://www.psychiatrictimes.com/articles/psychotherapy-alive-and-talking-psychiatry

I'm also not sure we can judge the profession based on inpatient experiences either. I'm only a student as well, so my perspective may be a bit too idealistic.

Valid points. I guess I could refine my thoughts by saying that while a thorough knowledge of the various therapy types is necessary to be able to provide patients true quality care, actual formal practice of those therapies does not have to be part of a psychiatrist's duties.

 

[nitemagi]

Look up psychodynamic psychopharmacology.

You're always having an interpersonal interaction, no matter what. Even in a 5-minute visit. If you don't learn how to make that interaction effective, your interventions won't be taken.

I'm talking about medication adherence, dropout from care, and the big question of expectation (even placebo/nocebo) with meds.

Knowing therapy benefits every human interaction you have in your life, IMPO, without ever trying to "therapize" people outside of the office.

 

[Hospital Dwelling Nomad]

I just want to say one word to you. Just one word. Forensics.

And how often do psychiatrist have interesting patients= people who think they are possessed by the devil, the criminally insane, multiple personality, etc.

All of my outpatients are criminally insane or incompetent. Mostly murderers, sex offenders, and arsonists.

I agree 100% with the forensics suggestion.

 

[EMDO2018]

I'm gonna try to shadow a psychiatrist at state hospital soon, any suggestions on etiquette? What if one of the patients says something to me or something should I answer?

 

[OldPsychDoc]

I'm gonna try to shadow a psychiatrist at state hospital soon, any suggestions on etiquette? What if one of the patients says something to me or something should I answer?

Talk with your attending about what they expect--it will vary from place to place, doc to doc. When I have students, I don't mind at all it it turns into a 3-way conversation (assuming it's all appropriate), but I take responsibility for redirecting the patient (or the student!) if things get off track.

 

[Dharma]

Look up psychodynamic psychopharmacology.

You're always having an interpersonal interaction, no matter what. Even in a 5-minute visit. If you don't learn how to make that interaction effective, your interventions won't be taken.

I'm talking about medication adherence, dropout from care, and the big question of expectation (even placebo/nocebo) with meds.

Knowing therapy benefits every human interaction you have in your life, IMPO, without ever trying to "therapize" people outside of the office.

I gave this a look and came across Dr. Mintz's papers. Interesting stuff. Thanks.