Is psych more draining than other fields?

[Gavanshir]

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I'm wondering if it is more difficult for psychiatrists to leave their work behind at the office/hospital when coming home. Does the emotional nature of the field have a lasting effect on your lives and your personal relationships with family and friends?

Do you find that you spend more time thinking and reflecting on a daily basis than an IM or family medicine physician for example, who also have to do a lot of running around?

I love psych and its the field that seems to come more naturally to me than other fields of medicine, but I sometimes wonder if I would prefer to come home physically exhausted rather than emotionally drained.

I'm an MSIII in the process of choosing a field so I'm using some conjecture here, please let me know if my assumptions are incorrect.

 

[Shikima]

I'm coming home to a beer and video games knowing that I've done a job well done.

 

[notdeadyet]

I personally find therapy can be draining. I notice the days that I have four or five hours of therapy leave me more exhausted than other days working similar length.

That said, I don't think it's unique to being a psychiatrist. I'm sure heart surgery can be the same. Any endeavor in which you are trying to be completely aware of the experience and 100% attentive will be exhausting.

 

[Doctor Bagel]

You know, our jobs are emotionally hard, and I often feel drained at the end of the day. However, I suspect I'd also feel pretty drained after getting out of a busy IM/FP clinic, too. It's also really interesting (at least to me), which is exciting. The most draining part of my job is doing stupid documentation at the end of the day. I don't really take other people's sadness/worries/tragedies with me in a way where they have a big impact on my life.

Actually thinking it over, another draining aspect is dealing with a lot of anger and hostility, which is a significant feature of a pretty small amount of our work. However, we also get the best tools in dealing with this type of stuff, and again, all doctors with patient contact deal with this.

 

[wolfvgang22]

I come home equally tired and drained, but I enjoy psychiatry most of the time, and loathe IM and other specialties much of the time. Winner = psychiatry.

 

[hamstergang]

I don't find myself drained, but I doubt I'd be drained in any field. I do see some of my co-residents get drained, though. I wonder if this is more about personality than field.

 

[heyjack70]

nothing could be worse than outpatient geriatric primary care

 

[F0nzie]

You will have encounters with the narcissist, the anti-social, the drug seeking, the circumstantial and hyperverbal, the manipulative, the seductive, the aggressive, the cognitively impaired, the paranoid, the spoiled brat, the nightmare parents/family...it's not for everyone.

While that may seem intimidating your training should give you a good handle on this and you will learn more every day after you graduate.

Last year I had a bipolar + borderline patient send me multiple loud and harassing voicemails in the evenings and weekends. She made extreme statements saying that she was 10x worse than when she started treatment, that I was prescribing inappropriately and profiling her as being crazy. She left voicemails stating if I didn't do something right away that she might hurt someone. She was also taking the medications erratically--missing days and taking too many when her anxiety spiked. She was complaining of every possible side effect with meds. I remember getting some of the voicemails while I was out having dinner with my wife and 2 year old son. I felt completely disengaged and spaced out that I could not enjoy the moment or respond appropriately when my son would say "dadda". I was getting so fed up that I started rehearsing how I was going to fire her. I was filled with rage-- how could she be so nice to me in person then go ballistic on me by phone after the session. I took some deep breaths. On the day of our therapy session she greeted me with a smile as if nothing happened. I asked her if she remembered the voicemails she sent me. Of course, she did not. So I played the voicemail in the session. It shocked her "wow I cannot believe I said that. I was a mega #%^**" She was very apologetic and admitted to fears that I would fire her as a patient. It was then that she opened up about her abandonment issues with men, her history of rape, and childhood neglect. From that point on we were able to look at how her fears and paranoia (protective mechanisms of her past) lead to sabotaging relationships with others including our patient-doctor relationship. Now she is making huge progress, anxiety and depressive symptoms are better and her relationships with others has dramatically improved. She was previously fired from multiple jobs because of her volatility and inability to work with others. She is now able to keep it together and interact appropriately with others.

This is our version of open heart surgery IMO. You don't need to specialize in it but you should recognize it, know how to deal with it, and refer appropriately.

To answer your question psych is draining but the rewards are huge if this is what you want to fix.

 

[Armadillos]

nothing could be worse than outpatient geriatric primary care

+100

I don't know how they do it. I remember during my family rotation, I looked at the first patient, listed as 2 month DM followup. Preceptor sees patient in the hall, looks puzzled and tells me, "the O2 and wheelchair are new, go see what's up"

Turns out in the last 2 months patient had an MI, then while in hospital had stroke, ended up with HCAP. Didn't call PCP because "figured we would just keep this visit and didn't want to bother anyone"

And the PCP has like 9 minutes to deal with all this

 

[Ceke2002]

You will have encounters with the narcissist, the anti-social, the drug seeking, the circumstantial and hyperverbal, the manipulative, the seductive, the aggressive, the cognitively impaired, the paranoid, the spoiled brat, the nightmare parents/family...it's not for everyone.

While that may seem intimidating your training should give you a good handle on this and you will learn more every day after you graduate.

Last year I had a bipolar + borderline patient send me multiple loud and harassing voicemails in the evenings and weekends. She made extreme statements saying that she was 10x worse than when she started treatment, that I was prescribing inappropriately and profiling her as being crazy. She left voicemails stating if I didn't do something right away that she might hurt someone. She was also taking the medications erratically--missing days and taking too many when her anxiety spiked. She was complaining of every possible side effect with meds. I remember getting some of the voicemails while I was out having dinner with my wife and 2 year old son. I felt completely disengaged and spaced out that I could not enjoy the moment or respond appropriately when my son would say "dadda". I was getting so fed up that I started rehearsing how I was going to fire her. I was filled with rage-- how could she be so nice to me in person then go ballistic on me by phone after the session. I took some deep breaths. On the day of our therapy session she greeted me with a smile as if nothing happened. I asked her if she remembered the voicemails she sent me. Of course, she did not. So I played the voicemail in the session. It shocked her "wow I cannot believe I said that. I was a mega #%^**" She was very apologetic and admitted to fears that I would fire her as a patient. It was then that she opened up about her abandonment issues with men, her history of rape, and childhood neglect. From that point on we were able to look at how her fears and paranoia (protective mechanisms of her past) lead to sabotaging relationships with others including our patient-doctor relationship. Now she is making huge progress, anxiety and depressive symptoms are better and her relationships with others has dramatically improved. She was previously fired from multiple jobs because of her volatility and inability to work with others. She is now able to keep it together and interact appropriately with others.

This is our version of open heart surgery IMO. You don't need to specialize in it but you should recognize it, know how to deal with it, and refer appropriately.

To answer your question psych is draining but the rewards are huge if this is what you want to fix.

Sounds like you handled that patient brilliantly 🙂. I must admit I was kind of nodding my head and thinking 'Yep, I bet I can guess what's underlying this behaviour' as I was reading through your description.

 

[F0nzie]

Sounds like you handled that patient brilliantly 🙂. I must admit I was kind of nodding my head and thinking 'Yep, I bet I can guess what's underlying this behaviour' as I was reading through your description.

Thanks! I could not have done it without the psychologist who taught our psychodynamic classes. Whenever I get frustrated I ask myself what she would do. With her help I was able to gain insight into my own cognitive distortions, narcissism, avoidance, and fears.

For example, playing the voicemail was an important intervention that gave my pt insight, accountability, and an opportunity to reflect. But my automatic reaction was not to not play the voicemail because I did not want to offend her. She was already anxious and I did not want to make her more anxious. I wanted to protect her from experiencing distress. Internally I was fearful of playing the voicemail... Possibly my own fears of her rejecting me (****)!

I have let a good number of patients go-- some of whom I could have helped if I had ongoing supervision. I am just trying to learn as much as I can.

 

[Ceke2002]

Thanks! I could not have done it without the psychologist who taught our psychodynamic classes. Whenever I get frustrated I ask myself what she would do. With her help I was able to gain insight into my own cognitive distortions, narcissism, avoidance, and fears.

For example, playing the voicemail was an important intervention that gave my pt insight, accountability, and an opportunity to reflect. But my automatic reaction was not to not play the voicemail because I did not want to offend her. She was already anxious and I did not want to make her more anxious. I wanted to protect her from experiencing distress. Internally I was fearful of playing the voicemail... Possibly my own fears of her rejecting me (****)!

I have let a good number of patients go-- some of whom I could have helped if I had ongoing supervision. I am just trying to learn as much as I can.

I can imagine working with personality disorder patients it can feel like you're almost being held to ransom sometimes - if you go ahead with X interpretation/intervention, are they going to be triggered into acting out, or will they be accepting of it; if you make a mistake, are they then going to go home and self injure or make a non lethal suicide attempt, etc etc. I can definitely see how practitioners might start second guessing themselves, or rejecting patients out of fear of not being able to handle them, if they haven't had the right levels of supervision, training, and experience in dealing with these types of patients. It's good that you were able to reflect, and recognise the role of your own countertransference in regards to your initial reluctance to play the voicemail, it sounds like your teacher in Psychodynamic therapy did a great job. 🙂

 

[Indodo]

As a general adult psychiatrist who sees a little of everything including child, gero etc etc I would say no.
I limit my workday to 40 hours though with at least 3 and usually 4-5 weeks of vacation/cme.

 

[clausewitz2]

+100

I don't know how they do it. I remember during my family rotation, I looked at the first patient, listed as 2 month DM followup. Preceptor sees patient in the hall, looks puzzled and tells me, "the O2 and wheelchair are new, go see what's up"

Turns out in the last 2 months patient had an MI, then while in hospital had stroke, ended up with HCAP. Didn't call PCP because "figured we would just keep this visit and didn't want to bother anyone"

And the PCP has like 9 minutes to deal with all this

My favorite story like this from family medicine was a gentleman who experienced sudden and complete visual loss in one eye and did not seek any kind of medical attention because he figured he could just bring it up at his regular appointment a week later. Which is what he did.

 

[Baller MD]

I come home equally tired and drained, but I enjoy psychiatry most of the time, and loathe IM and other specialties much of the time. Winner = psychiatry.

Would you be less drained if you were in PP instead?

 

[Shikima]

Would you be less drained if you were in PP instead?

Not necessarily. We're drained/exhausted because of the quality of work we're putting in - maybe it may be worthwhile to explore if we're putting too much energy in the health and wellfare of the patients and this brings up a separate discussion about expending more energy than the patients.

 

[notdeadyet]

Not necessarily. We're drained/exhausted because of the quality of work we're putting in - maybe it may be worthwhile to explore if we're putting too much energy in the health and wellfare of the patients and this brings up a separate discussion about expending more energy than the patients.

Boy that's a good advice this. I need to check myself for this a bit sometimes. Guilty....

 

[DD214_DOC]

I think psychiatry can be very draining, and the effect is probably less obvious and noticeable than in some other fields. I typically do not think about patients when I go home, but I think I continue to carry the burden placed upon me by patients and displace the anger onto places it should not go.

One caveat that nobody talks about is that the field permanently alters the way that you think about EVERYTHING. It's near impossible to, "turn off" the psychological mindedness and sometimes one can fall into the trap of trying to find meaning in everything. Sometimes it's nice to just be angry and not really care why.

Boundaries are very important in this field, probably more so than other fields. I am not talking about the, "don't have sex with patients" boundary, which is also important. It's the other stuff, like creating and maintaining expectations of your availability, schedule, hours, duration of encounters, etc., because some patients -- particularly parents in child psych -- will walk all over you if they can.

My unofficial mentor once revealed to me the, "3 rules of psychiatry" that keeps him sane: 1) The patient is the one with the illness. I interpret this to mean that you are there to help the patient figure things out, but at the end of the session they are the ones that go home and have to deal with things and live their life. An oppositional kid is still going home with his parents, and it's really them who have to learn to deal with it. (2) The patient is entitled to their illness. If a patient is not yet ready to address their concerns and try something different, that's their choice. Don't work harder than they do. (3) The psychiatrist goes home at 4:30. Take off the shrink hat and leave it on your desk at the end of the day. You have your own life and problems to worry about.

 

[whopper]

A lot of it depends on the personality. Some people thrive on different types of stress.

For me the most draining thing in the field is a patient where there really isn't much that can be done. They are few but they're out there. I had a guy with POTS syndrome and a hypotonic bladder in his 20s. Due to that nothing worked on him. The med either didn't work, it made his HR go above 200 or he couldn't urinate. It got to the point where I considered deep brain stimulation or cingulotomy. The guy had OCD, PTSD, panic disorder with agoraphobia and MDD. I'm not joking. He went through about a dozen psychiatrists and each one terminated him, not because he did anything wrong but because his case was so tough they basically referred him out because they didn't want to invest the time and effort into the case.

The other draining situation is when a staff member has issues and it's showing in the work or they're causing a hostile atmosphere. Makes going to work a nightmare.

 

[PikminOC]

Boundaries are very important in this field, probably more so than other fields. I am not talking about the, "don't have sex with patients" boundary, which is also important. It's the other stuff, like creating and maintaining expectations of your availability, schedule, hours, duration of encounters, etc., because some patients -- particularly parents in child psych -- will walk all over you if they can.

My unofficial mentor once revealed to me the, "3 rules of psychiatry" that keeps him sane: 1) The patient is the one with the illness. I interpret this to mean that you are there to help the patient figure things out, but at the end of the session they are the ones that go home and have to deal with things and live their life. An oppositional kid is still going home with his parents, and it's really them who have to learn to deal with it. (2) The patient is entitled to their illness. If a patient is not yet ready to address their concerns and try something different, that's their choice. Don't work harder than they do. (3) The psychiatrist goes home at 4:30. Take off the shrink hat and leave it on your desk at the end of the day. You have your own life and problems to worry about.

 

[PikminOC]

I remember getting some of the voicemails while I was out having dinner with my wife and 2 year old son. I felt completely disengaged and spaced out that I could not enjoy the moment or respond appropriately when my son would say "dadda". I was getting so fed up that I started rehearsing how I was going to fire her. I was filled with rage-- how could she be so nice to me in person then go ballistic on me by phone after the session. I took some deep breaths. On the day of our therapy session she greeted me with a smile as if nothing happened. I asked her if she remembered the voicemails she sent me. Of course, she did not. So I played the voicemail in the session. It shocked her "wow I cannot believe I said that. I was a mega #%^**" She was very apologetic and admitted to fears that I would fire her as a patient. It was then that she opened up about her abandonment issues with men, her history of rape, and childhood neglect. From that point on we were able to look at how her fears and paranoia (protective mechanisms of her past) lead to sabotaging relationships with others including our patient-doctor relationship. Now she is making huge progress, anxiety and depressive symptoms are better and her relationships with others has dramatically improved. She was previously fired from multiple jobs because of her volatility and inability to work with others. She is now able to keep it together and interact appropriately with others.

This is our version of open heart surgery IMO. You don't need to specialize in it but you should recognize it, know how to deal with it, and refer appropriately.

To answer your question psych is draining but the rewards are huge if this is what you want to fix.

I hate it when that happens and impinges on our personal lives...