Is it typical...? Anything but IM/FM

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commonwealth ki

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Is it typical for students to be torn between psychiatry and surgery or psychiatry and ROAD specialties?

Where I am going is that I hate IM/FM.
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Psych seems to draw a pretty wide range of personalities.
Someone was once telling me about their psychiatry rotation in which the attending was very aggressive about pimping students and that sort of thing. I jokingly said, "Wow, that doc sounds like he should have become a surgeon instead of a psychiatrist". Turned out that the doc actually was a former surgeon who switched over to psych. :)
 
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I liked IM quite a bit and FM somewhat. I absolutely hated my OB/Gyn rotation and didn't really like my road specialty rotations(I didn't do derm, but did anesthesia, rads ortho, & optho).
If I didn't do psych, I'd probably do IM.
 
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billypilgrim37 said:
Psychiatry and surgery are both very attractive to people with narcissistic traits.

Just sayin... ;)
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The other similarity is that these are both specialties where the phsyician themself is the agent of change/treatment. Unless, of course, you're a "psychopharmacologist" which is a lot more similar to IM.
 
Doc Samson said:
The other similarity is that these are both specialties where the phsyician themself is the agent of change/treatment.
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I also heard a resident (who tends to make people more stupid every time she opens her mouth) once say that people consider psychiatry and surgery because "both specialties are about getting inside people." It would have been funny had she not been dead serious.
 
Doc Samson said:
The other similarity is that these are both specialties where the phsyician themself is the agent of change/treatment. Unless, of course, you're a "psychopharmacologist" which is a lot more similar to IM.
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I don't understand that...can you explain further? Wouldn't any doc be considered just as much of an agent of change? What you said sounds interesting but it went over my head.
 
billypilgrim37 said:
I also heard a resident (who tends to make people more stupid every time she opens her mouth) once say that people consider psychiatry and surgery because "both specialties are about getting inside people." It would have been funny had she not been dead serious.
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I thought about radiology for the same reason--figuring out what was going on internally non-invasively.
 
seth03 said:
I don't understand that...can you explain further? Wouldn't any doc be considered just as much of an agent of change? What you said sounds interesting but it went over my head.
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The surgeon and the psychiatrist (doing psychotherapy) both act directly on the patient. With the prescription of meds, the med is the agent of change not the physician. It's a much more direct relationship. If things go bad it's because of YOU, not because of something you gave the patient. Obviously this applies to all the surgical subspecialties and any "interventional" specialty - but the intimacy of the patient relationship with a psychiatrist or a surgeon is still pretty unique.
 
Doc Samson said:
The surgeon and the psychiatrist (doing psychotherapy) both act directly on the patient. With the prescription of meds, the med is the agent of change not the physician. It's a much more direct relationship. If things go bad it's because of YOU, not because of something you gave the patient. Obviously this applies to all the surgical subspecialties and any "interventional" specialty - but the intimacy of the patient relationship with a psychiatrist or a surgeon is still pretty unique.
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I think this a very fallacious arguement. Ultimately, YOU are prescribing any treatment and YOU are responsible for consequences, improvements, side effects etc. Also, a good psychiatrist will inadvertently use many psychotherapy based skills even when prescribing medications. Last time I checked, many IM doctors established IV lines, put in foley catheters. Many so-called psychopharmacologists gave depot shots, administered ECT and examined patients for neuroleptic-induced rigidity etc.
 
TheWowEffect said:
I think this a very fallacious arguement. Ultimately, YOU are prescribing any treatment and YOU are responsible for consequences, improvements, side effects etc. Also, a good psychiatrist will inadvertently use many psychotherapy based skills even when prescribing medications. Last time I checked, many IM doctors established IV lines, put in foley catheters. Many so-called psychopharmacologists gave depot shots, administered ECT and examined patients for neuroleptic-induced rigidity etc.
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This isn't an issue of clinical responsibility, the need for psychotherapeutic savvy in the prescription of psychotropics (although I'm not sure that their use should be "inadvertent"), whether IM docs place foleys, or psychiatrists perform physical exams. It is a longstanding basic psychodynamic concept. In psychotherapy (as with surgery) the physician themself is the "active agent." With meds it's the med, with ECT it's the seizure (or the machine, or both). It's definitively a different type of relationship with the patient.
 
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I didn't like IM mostly becuase I spent hours a day just fishing for charts, and having to deal with staff that would botch up the job out of laziness. E.g.--I suspected endocarditis & ordered blood samples be drawn for cultures immediately on a spiking fever, and the nurse never did it and tried to blame me for not clarifying the procedure--despite that I documented it, carefully verbally explained the procedure to the nurse, and highly emphasized that the importance of it had to be transferred to the next shift, and it was witnessed by the attending and other staff.

The staff would often times try to blame the resident at some of the hospitals I worked at, but attendings were held immune. In the case above the attending saw what happened & filed an incident report against the staff member, but several attendings wouldn't protect residents like that one did.

Happens in Psychiatry as well, but you're dealing with the same treatment team on the same unit, and you're usually on that unit for most of the day, so you know what to expect, and you know which staff to hold accountable. Since you pretty much only deal with one or a few units, the nurse managers & the psychiatrist have a better relationship, and you are in a better position to discuss what you need that manager to do to keep the staff working well. Its more on the order of an officer & the sergeant as the officer's right hand. You are in a better position to listen to the staff's needs & act as a proper leader-commanding but also doing what you can to help those under you.

On IM, you have patients on multiple floors and its harder to track which staff member is trying to passive aggressively sneak out of their job responsibilities. The staff frustration factor IMHO was much higher in IM.

I specifically went into medschool to be a psychiatrist, but I really did like field of stufy of IM and highly respect it. Just didn't like working it on the field. Sore feet, searching for charts about 3 hrs a day, staff not doing their jobs and trying to dump things to the next shift, (NJ mob accent voice)--Fuget about it.
 
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commonwealth ki said:
Is it typical for students to be torn between psychiatry and surgery or psychiatry and ROAD specialties?

Where I am going is that I hate IM/FM.
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If anything it just shows me you are wise well beyond your stage in training :)
 
whopper said:
I didn't like IM mostly becuase I spent hours a day just fishing for charts, and having to deal with staff that would botch up the job out of laziness.


I specifically went into medschool to be a psychiatrist, but I really did like field of stufy of IM and highly respect it. Just didn't like working it on the field. Sore feet, searching for charts about 3 hrs a day, staff not doing their jobs and trying to dump things to the next shift, (NJ mob accent voice)--Fuget about it.
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Sounds like you didn't like internal medicine clerkship and the idea of being a medicine ward resident, rather than the field of internal medicine itself. I can assure you that medicine attendings don't have to spend hours looking for charts.
 
billypilgrim37 said:
Don't forget being a doctor AND being somebody who writes on a mostly anonymous message board about once a day!

Self awareness, I has it. :D
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Billypilgrim, doesn't narcissism entail being haughty and aloof? Do you think your deigning to post on this board in fact brings you down to a more plebian level?

I myself have vowed to disappear entirely once my post count reaches 250.

Also, are you ever going to reveal how it is you know that "Psychiatry and surgery are both very attractive to people with narcissistic traits?" Please do this soon--I don't have many visits left! ;-)
 
nancysinatra said:
Also, are you ever going to reveal how it is you know that "Psychiatry and surgery are both very attractive to people with narcissistic traits?" Please do this soon--I don't have many visits left! ;-)
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LOL, well, this was the explanation offered to me by one of our C/L attendings, and as a model, it has profound explanatory power!

Unfortunately no original research, or even a wikipedia article, to back up the claim. We had a long discussion one day when another resident was hitting on an anesthesia intern (who was married w/ a kid, mind you) about how she couldn't decide whether she wanted to be a surgeon or a psychiatrist, and was sure it because of her desire to get "inside people." As the attending and I rolled our eyes through the back of our heads, this conversation ensued.
 
billypilgrim37 said:
We had a long discussion one day when another resident was hitting on an anesthesia intern (who was married w/ a kid, mind you) about how she couldn't decide whether she wanted to be a surgeon or a psychiatrist, and was sure it because of her desire to get "inside people." As the attending and I rolled our eyes through the back of our heads, this conversation ensued.
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You could have put a definitive end to that ridiculous conversation by recommending a career in gross pathology. That's where they really get inside people.
 
Armchair diagnoses temporarily aside, quite a few people are torn between surgery and psych. My residents on psych-- many of whom graduated from my medical school, which pumps out surgeons and psychiatrists like no other-- and I had a long-winded conversation about it when I was on service. Most of them seriously considered surgery. I'm heading into surgery but seriously considered psych. The consensus agreed with Doc Samson-- both surgeons and psychiatrists are the immediate agents of change, and both tend to have very gratifying patient relationships (one obviously very short term, the other very long-term).

Where Billy might be right is that that very desire-- to be the immediate agent of change, and to reap patient gratitude-- is all about you, not the patient.
 
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