knowing your medicine while on call

[PittBoo50]

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Residents on Call at Upitt are required to know their medicine. While doing call at Western Psychiatric (which is only a few months of the intern year), they have to take care of all the medicine and psych issues of 300+ pt, and at night, the majority of pages are medicine related. After the technicians leave, the residents have to do all their blood draws, EKGs, etc. They can call a code and have the patients shipped to Presby if they feel the condition is that severe.

I felt that this is a worthy post, because I was disillusioned about the medicine knowledge required for psychiatry. When making my decision about going into psychiatry, I was a bit hesitant because i felt that I would have to give up medicine. This is however not the case (at least at Pitt). I am curious to hear others' thoughts.

 

[maranatha]

Residents on Call at Upitt are required to know their medicine. While doing call at Western Psychiatric (which is only a few months of the intern year), they have to take care of all the medicine and psych issues of 300+ pt, and at night, the majority of pages are medicine related. After the technicians leave, the residents have to do all their blood draws, EKGs, etc. They can call a code and have the patients shipped to Presby if they feel the condition is that severe.

I felt that this is a worthy post, because I was disillusioned about the medicine knowledge required for psychiatry. When making my decision about going into psychiatry, I was a bit hesitant because i felt that I would have to give up medicine. This is however not the case (at least at Pitt). I am curious to hear others' thoughts.

Can't offer any thougths as i'm still a med. student...BUT I was literally just debating whether or not to do an extra inpatient medicine rotation or a more "cushy" outpatient elective....I think you've just convinced me to do more medicine!!! 😱

 

[Anasazi23]

If you're not good with medicine, your skill as a psychiatrist will be limited.

 

[Analyzethis]

I have to disagree unfortunatly-Psychiatrist career is NOT limited by their medicine knowledge. A private psych pracitice is based on no medicine whats sover-I am sorry. If you want to be a top notch C and L position in adademia then ok-sure you may need medicine but other than that it is a bit silly to think medicine will LIMIT your psych practice. You may struggle through a couple months of medicine if you are not great at it-intern year but after that you will be golden-lets get real poeple!

 

[Anasazi23]

I have to disagree unfortunatly-Psychiatrist career is NOT limited by their medicine knowledge. A private psych pracitice is based on no medicine whats sover-I am sorry. If you want to be a top notch C and L position in adademia then ok-sure you may need medicine but other than that it is a bit silly to think medicine will LIMIT your psych practice. You may struggle through a couple months of medicine if you are not great at it-intern year but after that you will be golden-lets get real poeple!

We're all probably talking about different birds of a same color here.

Having limited medicine knowledge will, by definition, lower your overall effectiveness as a fully functioning psychiatrist. If for no other reason than to recognize suspicious syndromes or symptom clusters and make a proper referral.

As physicians, we all have a base level of medical knowledge. That is probably the two different but related topics to which we are referring. In other words, a level of medical knowledge suitable for independent practice is required of ALL physicians. All psychiatrists have demonstrated (at some time) this ability (step III and licensing) or they wouldn't be independent practicing physicians.

If we're talking about in-depth, increased anion-gap metabolic acidosis with compensation-type management. Then yes, these might not contribute heavily to your ablility to practice good psychiatry.

There are also differences between inpatient and outpatient psychiatry. The former requiring more medical skill. You don't want to be that psychiatrist that calls 5 consults on every patient, do you?
🙂

 

[nortomaso]

I have to disagree unfortunatly-Psychiatrist career is NOT limited by their medicine knowledge. A private psych pracitice is based on no medicine whats sover-I am sorry. If you want to be a top notch C and L position in adademia then ok-sure you may need medicine but other than that it is a bit silly to think medicine will LIMIT your psych practice. You may struggle through a couple months of medicine if you are not great at it-intern year but after that you will be golden-lets get real poeple!

I couldn't disagree with you more. As a psychiatrist-- even as a an outpt psychiatrist-- you will be seeing the hardest, most complicated cases, the onces that stump the family docs. You will be a specialist after all. You better know and understand all the many medical causes of treatment refractory depression and new-onset psychosis. And as medicine and psychiatry both advance, the line between them becomes blurrier. You will have patients with diabetes, HIV, etc. Their diseases will interact with their psychiatric presentation and vice-versa in ways we are just beginning to elucidate. You'll want to understand how their meds interact with yours too. I could go on, but the bottom line is that as Anasazi says your psychiatric practice will be limited by the scope of your medical knowledge. And as family docs and psychologists (with or without RX privileges) chew up the easy cases, you'll need to carve out a niche for yourself as a psychiatrist. What makes you unique is the breadth of your expertise.

So learn your medicine and learn to love it.

 

[maranatha]

I couldn't disagree with you more. As a psychiatrist-- even as a an outpt psychiatrist-- you will be seeing the hardest, most complicated cases, the onces that stump the family docs. You will be a specialist after all. You better know and understand all the many medical causes of treatment refractory psychosis and new-onset psychosis. And as medicine and psychiatry both advance, the line between them becomes blurrier. You will have patients with diabetes, HIV, etc. Their diseases will interact with their psychiatric presentation and vice-versa in ways we are just beginning to elucidate. You'll want to understand how their meds interact with yours too. I could go on, but the bottom line is that as Anasazi says your psychiatric practice will be limited by the scope of your medical knowledge. And as family docs and psychologists (with or without RX privileges) chew up the easy cases, you'll need to carve out a niche for yourself as a psychiatrist. What makes you unique is the breadth of your expertise.

So learn your medicine and learn to love it.

This post has been very helpful. It's not that I thought I wouldn't have to know basic medicine, but it sounds like i need to know it a bit more then i thought.

Of all the medicine subspecialities, which one is the most relevant? I was thinking about adding an endocrine elective before I graduate in May. Any thoughts on electives?

 

[DrIng]

The other thign to bear in mind- i have been asked at interview medical questions, and when I discussed it with them their response was "I just wanted to make sure you were running to psychiatry and not away from medicine". (It was thigns like a discussion of a well-dressed man who acts funny in a city bookshop- few more details in the interview but obviously you needed to exclude a DKA).
Also, working at a tertiary psych hospital I've had people with minor head injuries and decreased alertness arrive ont eh doorstep at 11pm- it's worthwhile knowing a decent neuroexam in a hurry!