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Lack of respect for psychiatry

Discussion in 'Psychiatry' started by Messerschmitts, Feb 18, 2009.

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  1. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    Hello, I'm a 3rd year med student whom some of you may remember posted a thread about my surprising discovery that I loved psychiatry, after being gung-ho for OB/GYN for most of my med school career.

    There are things I love about both fields, and I have not yet made a final decision, but I was completely unprepared for the backlash from my family and friends regarding my interest for psychiatry. I don't want to retype what I wrote in the previous thread, but the Cliff-Notes version is that I made my mom cry, and she said angry things like "they're not even real doctors!" My 12 year old little brother thought becoming a psychiatrist meant I was going to drop out of medical school and get a Ph.D instead. My girlfriend's mom commented, "don't they just sit and talk all day? I really liked the idea of you being an OB/GYN!" The general gist is that laypeople in my life all think it's a waste to have exerted so much effort to get into, and get through medical school "just" to become a psychiatrist. Even my friend who's applying to medical school right now (though supportive), admitted to me that he did not know the details of how a psychiatrist is different from a psychologist.

    My question to attendings/residents is this. How do you deal with this? Does it bug you at all, when you're all alone late at night, that 90% of America thinks you have a Ph.D and just talk to patients on a couch? Does it/has it ever bothered you that, having spent the same 4 years in medical school as your peers, they never have to justify the value of what they do, or have to prove that they are "real" doctors?

    I know the cliched adage is to do what you love, and to not care about what other people think. But that's easier said than done, isn't it? We're social creatures, of course we care what others think, especially our loved ones. My girlfriend claims she'll support me no matter what field I want to go into, but she keeps pointing out positives of OB/GYN, and negatives of psychiatry, and it's clear that she's trying to nudge me towards OB/GYN. OB/GYN doesn't get a ton of respect within the medical field either (certainly not the kind of respect that dermatologists or cardiothoracic surgeons get), but they are apparently well-loved and well-thought of out in the community. Not so with psychiatry. Why is it that out of all the fields of medicine, psychiatry is the odd black sheep in terms of prestige and respect? True, Family Medicine suffers from lack of respect, but it is mostly from within the medical community, from peers. The lay community does not confuse a FM doctor with a nurse practitioner, and does not question that FM doctor is a "real" medical doctor.

    It is so petty, I know. However, part of me feels that having worked so hard, don't I deserve a little respect? And don't I deserve to let my mom be proud of her son and brag to all her Chinese relatives? Another part of me thinks I need to start getting angry, angry at other people having so many opinions about how I should live my life and what is or is not prestigious. And yet another part of me thinks I should just go into family medicine where I can do a little bit of OB/GYN, a little bit of psych, and still be considered a "real" doctor.

    I still have a lot of thinking to do.
     
    Salt Salt likes this.
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  3. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor 10+ Year Member

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    IF I were ever alone late at night (which I'm not, since I'm married with too many children...) I think the thought that would occur to me is "Damn I'm glad I'm not at the hospital in the middle of the night ..."

    I'm sorry you're going through so much hassle from your family, and sorry that our discipline doesn't make for good TV viewing except when we've become deranged and eat our patients. :rolleyes:

    Honestly though--Dude--are you REALLY going to be that much more happy spending days on end dopplering fetal pulses and doing pelvic exams and being on call in the hospital as an attending JUST BECAUSE YOUR POTENTIAL MOTHER-IN-LAW "LIKED THE IDEA OF YOU BEING AN OB/GYN"????????

    I'd say that you have a HUGE opportunity here to educate the people who surround you. What is it that you saw in psych that made you fall in love? Tell them and tell them again. Drag out interesting news articles that illustrate suffieciently that you will be a really doctor. Start rehearsing the lines--"Psychiatrists are MDs (and DOs--but that's another long explanation... ;)). They prescribe medicines. Powerful medicines. Things "real doctors" are AFRAID to touch--like clozaril and lithium. We are responsible for the total health care of people who die on average 25 years sooner than the general population. We get to see lives changed every day. And when the "real doctors" have a suicidal psychotic patient on their service, they are REALLY glad to see us coming by." You will have many opportunities to recite this script patiently and kindly, and eventually you'll stop caring what others think.
     
    kirkirkir and AlfonsTheGuru like this.
  4. pingouin

    pingouin just chillin' Moderator Emeritus 10+ Year Member

    I re-ran across this post the other day. One of the best posts I've ever seen on SDN, and certainly worthy of a little bump here.
     
    kirkirkir likes this.
  5. Doc Samson

    Doc Samson gamma irradiated 10+ Year Member

    Any lack of respect that either our colleagues or the lay public have for us is based on the perception that they don't need us. This, of course, rapidly changes when they do need us. The most rabidly psychiatry-demeaning surgeon will ingratiatingly whimper a consult request over the phone when a delirious patient has summoned the police and lawyers to their hospital room.
    As I've said before, the question I ask every interviewee for psychiatry residency is "Have your family gotten over it yet?" This is part of the territory and I've seen plenty of promising future psychiatrists back away from the field because of "what my parents/wife/friends think." To me it's almost a weed-out for appropriately developed ego structure.
     
  6. whopper

    whopper Former jolly good fellow 10+ Year Member

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    I wouldn't say you made your mom cry. You didn't do anything wrong.

    How did I deal with going into psychiatry? My family was more open to it than yours, and I had it a lot easier in that respect. My family still would've wanted me to go into something else such as surgery or Ob-Gyn.

    Don't know if this will help you, but my younger brother went into art. He's seen plenty of people making 6 or more figures in more "respectable" jobs as his classmates in artschool. They hated their jobs, burned out and after the equivalent of a mid life crisis or some other emotional melt down quit their job & went to art school.

    Training to be a medical doctor-in any field,is a long tough road. You have to like what you're doing. Otherwise this very difficult journey is going to be intolerable & mentally unhealthy.

    As for my brother, he's actually making more money than I do, and more money than most doctors, has a lot of fun at his job, travelling to places because of his work that he has always wanted to go (e.g. China, Japan, comic & video game conventions) and loves his work-as an artist who eventually became a video game designer. He still comes home & my father gives him a lecture to go to medical school. I don't know why the heck my dad won't let it go.

    As for our non-psychiatric medical colleagues, its as Doc Samson said. You got a case where the IM doc or surgeon needs you, they're putty in your hands. Also in medical school, you're going to get an Internal Medicine centered education, where IM docs & residents may pick on psychiatry. When you work outside of IM more & more (at least from what I've seen), you notice other fields of medicine appreciate you more than the IM doctors such as the PCPs.
     
    Last edited: Feb 18, 2009
  7. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor 10+ Year Member

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    All Hail Lord Anasazi!:thumbup:
     
  8. Kazema

    Kazema In a kingdom by the sea 7+ Year Member

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    This is more of a response to your previous post where you described your mom's reaction, but it seems like it's still on your mind so I'll go ahead and reply here even though I'm not a resident or attending ;).

    I'm also Chinese, and even though I've been interested in psychiatry since before medical school, when I told my mom that I had decided to become a psychiatrist she was pretty upset. The two things she said that stuck in my mind were, "Why don't you want to be a real doctor?" and "Mrs. X (actually one of her Caucasian friends) says that all psychiatrists eventually go crazy. I'm scared that psychiatry will make you become crazy."

    My sister had a pretty hostile reaction, she angrily told me, "Psychiatric drugs don't work and cause all kinds of terrible side effects, haven't you read those articles about [Drug X] and [Drug Y] in [some newspaper or magazine]???"

    But eventually, when they realized how serious I was about doing psychiatry (and after my brief flirtation with a couple other specialties) they relented and have more or less accepted my decision and are excited to find out where I'll end up on Match Day.

    One thing that surprised me was the reaction of my family's Chinese physician friends (an orthopedic surgeon and an OB/GYN). They were pretty supportive of my choice - they said things like, "Oh, psychiatrists make good money," and "You'll be able to work into your 80s," and "That's become a very interesting field." I think hearing those comments from them helped my family's acceptance of my decision.

    As far as respect goes, I've found that people who know (or are themselves) someone with mental illness who has received appropriate psychiatric treatment are very respectful and excited about my choice. This includes physicians in other specialties, lawyers, executives, clergy, and every walk of life you can think of. The unfortunate thing is, like you said, that the stigma against psychiatry within the Chinese culture is still strong enough that relatively few Chinese will see a psychiatrist (or other mental health professional) for anything other than the most severe forms of mental illness. And so it's likely that a lot of your mom's friends just know nothing about the field.

    Coming from a Chinese family, I know the pressures (both internal and external) to make your family "look good". But if psychiatry is truly your passion, you need to help your family understand this. You can look at this as an opportunity to practice explaining why you're interested in psychiatry; after you convince your family, writing your PS and going on interviews will be a piece of cake!
     
    Last edited: Feb 18, 2009
  9. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    Thanks Dr. Samson, I really like that quote. :p It's very insightful and inspiring. However, I wish psychiatry wasn't something that a med student's family needed to "get over", making things much more complicated than it has to be. I wish things were simpler.

    When I finished my OB/GYN rotation, I loved delivering babies, and loved gyn clinic. The material was fascinating. However, I discovered that I was not a huge fan of the O.R. I didn't like the hours of standing, not being able to use the restroom. My shoulder was killing me from standing all day for some reason. I didn't like how the attendings felt the need to humiliate and "put you in your place" the moment we scrubbed in to show the surgical team that he/she runs a tight ship. So OB/GYN was a good fit, but not perfect.

    Then I started my psych rotation, a specialty I never even considered, and found myself completely fascinated by the cases and patients, and couldn't wait to get to work everyday. The reading material on personality disorders, eating disorders, etc. was so interesting it hardly felt like studying. I would have read it for fun. I haven't gotten my score back yet, but the psych shelf was the first shelf exam I felt prepared for, and actually finished on time. I felt so delighted, relieved, and excited that I finally knew what I was going to do for the rest of my life. I ran to call my family/friends to let them know. I was completely unprepared for their response, as I mentioned. It's like you're happy and skipping along, and suddenly someone pours a bucket of ice water over your head.

    It was difficult to fathom the depths of my mother's disappointment, in particular. "You've broken my heart", she told me. "You would've made such a wonderful OB/GYN. I guess life always has a way of mangling your hopes and dreams. [sobs]" She went on to say many shocking, absurd, and hurtful things. I never even dreamed she had such deep prejudices against psychiatry.

    I suppose nothing is fair, no specialty is perfect. OB/GYN's got its own problems that's keeping people away from it (bad hours, malpractise).
     
  10. strangeglove

    strangeglove 7+ Year Member

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    The fact that most people confuse psychiatrists for psychologists is not necessarily insulting, in my opinion. After all, psychologists go through 4+ years of graduate school to have the privilege of doing psychotherapy with their patients. Psychiatry residency (if it's good) will teach you many of those skills, along with some other useful stuff, like how to manage psychotic, agitated and suicidal patients, administer ECT, and understand how thing like infections and head traumas can make people act and feel abnormally. Those are things that clinical psychologists aren't really trained to do, as they usually require medications (rather strong medications with sometimes serious side effects, as pointed out by OPD, and sometimes requiring injection!). Also, consider that hospitalizing an otherwise healthy suicidal, psychotic or agitated patient is one of the most unambiguously life-saving procedures in all of medicine, next to an appendectomy. And isn't saving lives what doctors are all about, Mom (in-law)?
     
  11. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    OMGs, that is EXACTLY what my mom said!!! :D (More or less) Glad to see I'm not the only one. Or more precisely she kept bringing up that article in the Chinese newspaper about the psychiatrist in Taiwan who committed suicide, and all the negative karma I will be accumulating by dealing with "crazy people" whom I should be shunning along with the rest of society.

    Is this a Chinese thing, or do Caucasian parents also believe that becoming a psychiatrist will cause you to become "crazy" and commit suicide?
     
  12. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    'ouin for the win!
     
  13. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    Verbatim! Well, almost. My mom says, "from what I can see, psychiatrists just throw a bunch of drugs at patients that don't work and just pretend to be doctors".

    I haven't told my father yet. He's been away on business trip and just came back from China. I feel like such a wuss, but I'm actually physically afraid to tell him. I think he might just punch me in the face. You'd think I was telling them I'm gay or something (which, lucky for them, I am not).
     
  14. whopper

    whopper Former jolly good fellow 10+ Year Member

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    I just noticed you're in my area--Cincinnati. Want to have dinner sometime and discuss this? I'll pay for it as long as its not expensive (hey I'm going to be a fellow next year).

    Oh, and by the way, I'm not gay either, this isn't an attempt for a date, not that there's anything wrong with it. (I'm a happily married man)
     
  15. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    Ha ha I dunno Whopper, with your avatar, one wonders :p j/k I'll PM you. I agree, nothing wrong with being gay, but my girlfriend would be very disappointed. :p (And she's disappointed enough about psych).
     
  16. sunlioness

    sunlioness Fierce. Proud. Strong 10+ Year Member

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    My father always tells people that I went into psychiatry because he is crazy. "With a dad like me, what else could she have done?" :love:
     
  17. Abram Hoffer

    Abram Hoffer 2+ Year Member

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    That's awfully nice. Perhaps you two can "have it your way" and share a Whopper at BK! :rolleyes:

    To the OP, I think you will find a lot of happy people in psych who are far more empathetic than other "doctors". (You will also find a lot of psychopathology=people trying to "fix" themselves too. That's another story.)

    In light of the difficulties you face, may I suggest you glean some of the best of both worlds and combine family medicine with psychiatry. This will serve more than one purpose: it will allow you to tailor your practice to those things you find most interesting and desirable. You can do OB and psych and steer clear of the OR. And all of the naysayers will not be able to say nay.
     
    Last edited: Feb 18, 2009
  18. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor 10+ Year Member

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    Better include the S.O.s in that dinner invite, guys.
    Maybe Mrs. Whopper has some reassurances to offer.

    (Best yet--include your moms! :eek:)
     
  19. hereandnow

    hereandnow 5+ Year Member

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    I understand how difficult it can be -- especially with Chinese parents.

    Chinese parents gain status culturally in virtue of the accomplishments and achievements of their children. The child who is a psychiatrist does not confer status to the parents in the same way as a child who is a neurosurgeon or OB/GYN. In fact, the psychiatrist child may confer negative status to the parents. Instead of other Chinese families enviously saying "Oh, how wonderful that your child is a doctor -- OB/GYN -- aiya -- such a good boy!" -- the other Chinese families will say "Oh, he wants to study psychiatry?" And then there will be awkward silence.

    I know it is difficult.

    Realize, several things. When they rail against psychiatry, they do not have your best interests at heart. They are concerned, principally, about their social standing and status within the community. They are not, at these moments, concerned about your well being -- or your joy.

    However, since I believe, ultimately, that they love you, they will come around. As long as you show commitment and resolve within yourself and close the door firmly on their pleas to reconsider.

    In the meantime, perhaps you might use humor to deflect. For example...

    Father: "Why do you want to be a psychiatrist?"

    Response: "Actually I changed my mind. I think I just want to take a break from medical school and go backpacking around the world for a while."

    Father: "What?!!"

    Response: "No, really -- I ve been reconsidering the whole medical school thing. I think I'd want to just try this writing a thing for a while."

    Of course, they might pull up the big guns.

    Father: "Your father is getting older. He is going to die soon. Why don't you try to make him happy?"

    Ultimately, the truth is you cannot make them happy. Or at least, it sounds like you'll have to sacrifice something, something very important, in the process. Good luck.
     
    Over9000 likes this.
  20. Doc Samson

    Doc Samson gamma irradiated 10+ Year Member

    You could, of course, soften the blow by matching at one of the Harvard programs. ;)
     
  21. Tradewind

    Tradewind 2+ Year Member

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    Since status and perception within the community are issues, I'm curious whether your family would feel any differently if you were a psychiatrist at a renown hospital?
     
  22. whopper

    whopper Former jolly good fellow 10+ Year Member

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    Not a bad suggestion. If the parents in this situation are anything like mine, getting into a Harvard program would definitely turn the parents around (Though I don't know if Messerschmitts's parents are exactly like mine in this respect, but they do sound similar).

    Don't worry, it'd be a few notches above BK, but don't expect the Precinct, the Crystal Palace or Morton's Steakhouse.

    And don't worry about the avatar. Trust me, I don't ever dress like that in real life.
     
  23. billypilgrim37

    billypilgrim37 Unstuck in Time 7+ Year Member

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    I think my family actually took me becoming vegetarian harder than they took me being a psychiatrist.

    Mine were initially hesitant, but it's remarkable how many parents, once faced with the reality of the children they love, find new ways to be proud. They cook a tofurkey ever thanksgiving now, and they brag about how their boy wants to work with the kind of kids that other people give up on. Or something. They don't really know what I do. The anonymized stories a psychiatry resident has to tell crush the souls of people who aren't in medicine. But my family knows I went to a good medical school, a really good residency program, and that I haven't been arrested or divorced yet.

    Neither of these were their initial reactions by any stretch of the imagination. Granted, I'm a white guy, but coming from a Southern Baptist redneck background, there were definitely some cultural issues. Coincidentally, my early days of med school were filled with talks of doing OB, and they were a little crushed when I wasn't going to be pulling babies out of the ephemera anymore.

    Even Asian parents want their children to be happy, right? They may not have learned to trust your ability to make decisions about what is going to make you happy yet, but if you make your choice and love it, I think it would be really hard for them to begrudge their child who a) is making a great, secure living, and b) enjoying doing it.

    If you choose OB because that's what you wanna do, that's cool. If you choose it because that's what your parents want you to do, you're going to be seeing a psychiatrist soon enough anyway.
     
  24. Regnvejr

    Regnvejr Banned

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    Cadre is toast.
    Back when I was in residency, our senior attending asked us why we wanted to be in psychiatry. We gave the usual "want to help people," etc, after which he chewed us out and said that unless we want to save people's lives, we should stay home.

    Remember that the thought disorder patients have high rates of suicides, as do patients with untreated mood disorders and substance users.

    Aside from that, every patient is interesting. You hear stuff you will never hear anywhere else. Compare that to the "when was your last bowel movement" of IM and then see who got the better deal. :laugh:

    Psychiatry is interesting. Every day I go to work, I tell myself "Today, I get to do Psychiatry." And that makes it a good day.
     
  25. Faebinder

    Faebinder Slow Wave Smurf 10+ Year Member

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    I can attest Whopper is not gay and so does his wife I think. :D
     
  26. masterofmonkeys

    masterofmonkeys Angy Old Man 7+ Year Member

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    At the end of the day, other peoples' opinions only matter to the degree that they're founded on logical and reasonable concerns.

    Just today I got the comment from a medicine attending that I'm 'too good' to do psychiatry. And another attending (more experienced and more involved in teaching) shouted 'hey! we need good people in psych!' Similar conversations regarding my career choice have played out in everything from the OR to the cardiac critical care unit. Whenever someone tells me that I'm too smart to do psych, I always have to stop myself from retorting that I'm too smart to follow algorithms for the management of diabetes and HTN like a mindless automaton (ODD much?). But i've also noticed that the ones tending to diminish psych are a) junior, b) arrogant or a combination of both. In general, the more respected the doctor is at our institution, the more likely they are to value psych. Take from that what you will.

    That said, I do get frustrated about not training to be a 'real' doctor myself. I enjoy medicine. I'm good at medicine. And I hate the thought that because i'll be a psychiatrist, people will assume I can't manage general medical issues and do a damned good job at it. But again, do I really care what those people think? Should I really care about it?

    On the cultural issue, yeah it's tough. I'm lucky that despite being Indian, my parents never even wanted me in medical school, and were just happy that I chose a field that I found personally and intellectually satisfying. But at the end of the day, the degree to which our cultures value education and prestige in their twisted way, and the degree to which familial and societal concerns are emphasized do place us in a tough position.

    On the one hand, you don't want to be less happy and fulfilled than you could have been simply because of the neuroses of the culture and the family you're born into. On the other hand, you don't want to cut ties with that culture.

    There is a compromise between the two: a dual IM/Psych or Family/Psych residency. Now, as I understand it, most people who train IM/Psych end up doing one or the other. But it is possible to do a mixed primary care/psych practice. More importantly though (in your situation), it gives you the chance to say 'yes I am a 'real' doctor'. After all, it's hard to argue with the fact that you're BC/BE internal medicine, even if 100% of your practice is psych.
     
  27. whopper

    whopper Former jolly good fellow 10+ Year Member

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    Not every parent is the same. I've seen some extreme cases. Of course I've seen some cases where the child is worrying about it too much, but I've also seen cases where the parents truly are a bit too extreme, though perhaps well intentioned in their dreams for their children. It certainly did cause a lot of problems & frustration for the child.

    It doesn't matter the race or culture though yes, from my experience it tends to happen more in the eastern Asian cultures, though I've also seen it a bit more in upper class families, families with a tradition of education, middle eastern, among other cultures.

    Also, in defense of this aspect, while it may sound negative from what's going on in the thread, any aspect of any culture can be positive or negative given the situation, and level of magnitude under which it is practiced. Education, and wanting your children to be high achieving certainly doesn't sound negative when presented in that manner.
     
  28. anesthesiarocks

    anesthesiarocks 2+ Year Member

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    1) yes, there is a lack of respect for psychiatry from most people outside of medicine compared to other fields.
    2) yes, there is a lack of respect for psychiatry from many people inside medicine in other fields.

    If these things bother you to a high degree, probably pick another field.
     
  29. Abram Hoffer

    Abram Hoffer 2+ Year Member

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    Lest we forget, sometimes "being bothered" is the impetus to do great things.
     
  30. jocg27

    jocg27 Senior Member 2+ Year Member

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    Of course, if people already don't believe that you're a real doctor, telling them that your patients die 25 years earlier than everyone else probably won't help them change their perspective. Just saying... :p
     
  31. jocg27

    jocg27 Senior Member 2+ Year Member

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    Just dropping in and checking out the thread -- I'm going into peds, not psych, but did like my psych rotation a lot and have a lot of respect for the attendings and residents I worked with.

    I know it sucks to hear that kind of thing from every angle, but for whatever it's worth you just can't get away from this kind of unwelcome commentary on your career choice, no matter what you're going into. This kind of venting is going on in almost every forum on here. I get 'you're too good for peds' all the time, in addition to frequent reminders about just how poverty-stricken I'll be; I've gotten this from attending psychiatrists several times, actually. Although it sounds like you were pretty supported going into ob/gyn, most of them complain that they get razzed all the time for making that choice, with constant reminders about how busy and how miserable they'll be. And if they are a guy, even worse -- I am very surprised that you got positive feedback on that choice, as I think good responses to that decision are pretty rare. The future surgeons hear all the time about how awful their life will be, and anyone going into anything even remotely 'lifestyle friendly' is used to getting skeptical looks and and an eye roll, if not an outright comment on their motivations. People going into family get looked at like they have a third eye growing out of their head, and people doing IM get to be 'fleas,' and just don't seem to be making a very interesting choice at all, unless they're planning on cards or gi, in which case they get the same look and treatment as the lifestyle people.

    I could go on; we've all heard them all.....but the fact is, the only way to make some people happy is to tell them that you're doing the specialty that they are in. So the only way to please everyone is to just tell everyone in medicine that you're doing what they're doing, and everyone outside of medicine that you're doing to be Dr. Derek "McDreamy" Shepherd.

    So really, you just have to pick what you like and what makes you happy, and no matter what it is, get used to the fact that people are going to give you a hard time for it. Just let it roll off your back the best you can (easier said than done, I know, especially if it's a family and more so a tight-knit traditional one), and enjoy what you're doing.
     
  32. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor 10+ Year Member

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    I don't remember that part from Anatomy. I thought it was called something else...;)
     
  33. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    I totally agree with what you're saying. I did get a lot of flak about going into OB/GYN from within the medical community, ie. internal medicine attendings telling me that, "if you were my brother/son, I'd never let you go into OB/GYN." However, the flak was almost entirely from within. Outside the medical field, especially in the Chinese community, OB/GYN has a lot of "street cred", for lack of a better descriptor. And since there are much fewer female doctors in Asia anyway, these relatives have never considered anything unusual about a male OB/GYN. Everyone around me who was not a doctor loved the idea of their son/boyfriend/cousin/nephew/grandson being a OB/GYN. There was a real "gee-whiz" factor of awe and wonderment.

    So, unlike OB/GYN, the flak for psychiatry is entirely from without. Inside the medical community my attendings and fellow med students all think it's dandy if I want to switch to pscyhiatry. But these are not the people I have to deal with the rest of my life, my family is. It would be an easier decision if I just loved psychiatry and hated OB/GYN, but obviously I love OB/GYN very much too, I just think psychiatry is a slightly better fit. I really don't think I'd be "miserable" as an OB/GYN (as my girlfriend is quick to point out, "you loved OB/GYN too, so why don't you just do that instead?") I just think I might be even happier as a psychiatrist. So the question is, is the difference of fit significant enough for me to endure all this flak for the rest of my life? Still working on it.
     
  34. HCE

    HCE 7+ Year Member

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    If the moms are going, wouldn't it be best to have a team of attendings present....Doc Samson and OldPsychDoc, step up to the plate and go to dinner...
     
  35. HCE

    HCE 7+ Year Member

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    agreed...mothers love the Harvard name...
     
  36. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus 10+ Year Member

    I am again humbled.
    :)
     
  37. masterofmonkeys

    masterofmonkeys Angy Old Man 7+ Year Member

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    Another question is whether you'll really have to endure all the flak for the rest of your life. You're assuming your parents and family won't come around. Which isn't necessarily true. They tend to have a low opinion of psychiatrists, but they also care deeply about you and have a high opinion of you. Resolving that inner conflict within themselves could lead to them being quite ok with your decision to go into psych.

    Also, something I didn't touch on earlier in the asian-american thing is that in many cases our parents were the frontiersmen so to speak. They struggled, and they felt alienated. Culture and tradition were anchors that got them through tough times. And they are also operating on experience as well. For many asian immigrant doctors, psychiatry was their last resort in getting into residency slots in this country. I know many Indian immigrant psychiatrists. I only know one for whom psychiatry was far and away his first choice. Our parents' experience and that of their peers is thus that psychiatry is bottom of the barrel. And that many of the asian psychiatrists they know are incredibly disgruntled about the fact that they 'had to' become psychiatrists (no one forced them to come to this country though, so i I don't really buy that rationalization). Hard to have a lot of good will toward psychiatry when you see it as a last ditch effort to get into this country, and when many of the psychiatrists you meet from your place of origin didn't want to do it in the first place.
     
  38. howelljolly

    howelljolly 7+ Year Member

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    For the sake of your own sanity, you might want to start daydreaming about getting into an Ivy League psych residency, and making a niche for yourself in mentally ill pregnant patients.

    Allthough most people here would disagree... Psych and Neuro appealed to me for similar reasons. You might want to try an elective in Neuro, and see how that fits.

    It seems that your biggest hurdle is the family issue. When you get past that, other things will sort themselves out. One thing that you might do after July 1st, once Mom stops crying, is to keep your family closely informed about what you do (like - daily), as a psych resident. Enthusiasm can be infectious, and they'll come round eventually. Appeal to what your family's perception of real medicine is. Fodder for dinner conversations shouldnt be too hard to find, since as an intern, you'll be in medicine and neurology. Tell them about the C/L issues that you deal with.... the old guy with AMS due to pneumonia.... life threatening depression due to undiagnosed hypothyroidism..... TBI.... CVA....

    Many cultures... Asian/Chinese, African, born-again-Christian... see mental illness as being caused by misplaced priorities and perceptions, indiscipline, and the patient's lack of self-monitoring before psychosis becomes out of hand. Theres not much you are going to do to change that. Ive seen with my own two eyes, at least one jaw-dropping example of these mores in each of these three cultures from my fellow med students on the wards.
    The third example almost brought me to tears, because while my poor psychotic patient was drooling and mumbling scripture verbatim, my colleague commented on how though he can recite the Bible almost as well, he knows that God will not delude him this way. (isnt that in itself a delusion, though culturally accepted...anyway).........I digress....

    So, you can't change your family's perception of mental illness.... unless.... you can change your family's perception of mental illness. Share your enthusiasm. Give them some examples of mental illness that they turn over in their mind and see a purely biochemical etiology... Just as you can turn an example of addiction over and see a biochemical and psychosocial etiology.

    You might care that Patient XYZ had a psychotic episode because a certain stressor was too much for him as an individual, because said stressor elicited a conditioned response because of an association with whatever.... but, not many people do, and most certainly not your parents. But, they just might care that Patient XYZ attempted suicide because their thyroid medication wasnt titrated properly.

    As far as respect from other medical types... I dont think you are too worried. But, I think that the biggest source of disrespect from the Medicine or Surgery guys comes when the Psychistrist makes things difficult for the Medical and Surgery guys. Yes this does happen, and in some of the worst ways. Psychiatry doesnt always rescue Medicine from difficult patients. They say that a little learning is a dangerous thing. With the little that some psychiatrists know of medicine, they do become dangerous. So, keep up on medicine during your carreer, and be empathetic toward the medicine guys. They arent always trying to dump patients on you. If they tell you that theres nothing that medicine can do for the patient, believe them. Be empathetic towards them as much as you are with your patients.

    Anyway... hope this helps.
     
    Last edited: Feb 19, 2009
  39. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor 10+ Year Member

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    Whopper's an attending. He can handle it on his own now.
    I'll give him my pager number if he REALLY needs it. :D
     
  40. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor 10+ Year Member

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    Also let them know that OB/GYN isn't all happy moms and babies!
     
  41. howelljolly

    howelljolly 7+ Year Member

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    Welcome to America
     
  42. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    Gilroy, CA
    I think this is true, but not really applicable to my family, as there are no doctors or medical professionals in my extended family. However, I do think there's a cultural fear of mental illness that it is somehow "evil", "contagious" not in the microbial sense, but contagious in the "voodoo/bad-karma" sense. It is something that has no cure, and greatly shames the family, and the stench of the shame is so pungent it wafts all the way up to the psychiatrist treating the patient. Then there is the contradictory belief that despite being so evil and horrible, mental illness doesn't actually exist. It is something western doctors invented to make everything complicated. It is a luxury; whiny Americans/Europeans need to cry to a psychiatrist about how hard their lives are, when people in other countries who can't even put food on the table just "suck it up" every day. "What about schizophrenics who can't function in society without treatment?" My mother's answer is that they should just be locked up by their families in the house and hidden in shame.

    There's this feeling that psychiatrists are treating "fluffy" things that are bothersome, but not life-threatening, and people of strong will can just "suck it up". I think that's the root of the problem. They were so proud that their son was going to be a doctor, an Asian parent can have no greater aspiration and pride than their son becoming a doctor. Becoming a psychiatrist is not being a "real" doctor, so it feels to them like I dropped out of medical school, and that having a doctor son was "snatched away". "My son prevented a depressed teenager from killing herself" still doesn't have the "oompf" of "My son performed emergency C/section on a woman with severe pre-eclampsia and saved both mother and child."
     
  43. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    First of all, I am a very mediocre student in my class, I've never failed any exams or rotations, but I'm not going to get into Harvard anything. :p Just being realistic. Secondly, I don't think it would matter. Harvard or not, it's still psychiatry. For example, going to a prestigious art school will not make Asian parents happier about the fact that you are going to art school.
     
  44. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    Gilroy, CA
    So sad, and so true! :( Don't forget evil spirits.
     
  45. howelljolly

    howelljolly 7+ Year Member

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    yes, exactly!
     
  46. nancysinatra

    nancysinatra 7+ Year Member

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    Still walkin'
    Hey there,

    If it's any consolation at all, I seriously considered not going into psychiatry for the opposite reason--my family wants nothing MORE than for me to become a psychiatrist, and for all the wrong reasons. They are a bunch of brooding Swedish-Americans who believe all too MUCH in mental illness and are constantly speculating as to which member of the family/town must have this personality disorder or that degree of seasonal affective disorder or who belongs in such and such Ingmar Bergman movie on this or that day of the week. Then there's the debate about which person at church really ought to be heading off to rehab now, don't you think, because they sure have been volunteering a lot to serve communion wine? I am not kidding. I really, really wish they would learn some proper denial and stop turning everything into an existential crisis!

    They actually believe I will come home one day and vindicate their silly beliefs. Long after I had clearly decided on psych for my own completely unrelated reasons (which they will neeeeeever understand), I seriously backtracked and considered neurology and some other specialties just to get away from all that provincial nonsense.

    At least you have other people who can relate to the pressure your parents are putting on you. I don't! You've gotten 43 responses so far, so feel reassured! I know you're in a tough situation, but take heart that others are there with you, and I hope this helps a little.
     
  47. Messerschmitts

    Messerschmitts Mythic Dawn acolyte 10+ Year Member

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    Gilroy, CA
    That's true, I've gotten virtually no flak from within the medical community. They give me much more flak about OB/GYN. It's mostly the laypeople in my life. Unfortunately, as I do not come from a medical family (and my girlfriend's family is Kentucky redneck, don't tell her I said that :D), most of the non-professional people in my life are "laypeople." Worse of all, Chinese laypeople. :p
     
  48. Doc Samson

    Doc Samson gamma irradiated 10+ Year Member

    If I wanted to deal with enmeshed mothers I would've done a child fellowship. I hired a social worker to deal with patients' families - I'll send her.
     
  49. smq123

    smq123 Roy Lichtenstein SDN Advisor SDN Administrator 10+ Year Member

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    :eek::confused: REALLY??!!?? What community are YOU in?

    I'm an MS4, currently applying for OB/gyn. While some people have fond memories of their own OB/gyns, many don't....and decide that I need to hear these stories. I hear stories from women who have some kind of post-partum PTSD, and angrily tell me about the "mean" OB/gyn who yelled at them, or ignored their pain. The last date I went on, the guy told me that his mother's OB/gyn "messed up" his bellybutton....a comment that utterly confused me.

    Yeah, your girlfriend sounds REALLY supportive. :rolleyes:

    I gather that she's not in med school, correct? Well, if she's so all-fired impressed with the "prestige" of OB/gyn, then why doesn't she go to med school HERSELF and become one? :mad:

    Sorry, but this is a huge pet peeve of mine. I am tired of laypeople telling med students and residents "Why don't you go into X field instead? They get more respect and more money!" Well, if those things impress you SO MUCH, then go to med school and get your own freakin' degree. Then maybe YOU can see how "easy" it is to go into a field for such trivial things like "prestige." [/rant]

    Point out to your girlfriend that a psychiatry residency requires less overnight work, and has more predictable hours, than OB/gyn. Which means that you might actually be able to spend more time with her, and not holed up on L&D. ;)

    I guess it's different out in Ohio, too. Here in Pennsylvania, with the malpractice situation as it is, even laypeople know that OB/gyns are some of the most frequently sued physicians.

    I know. I know how difficult it is to explain the premise behind psychiatry to Asian parents. (I'm also Asian.)

    Mental disease is such a foreign concept to most Asians, to the point that most Asian languages don't even HAVE words for things like depression, bipolar, schizophrenia, etc. They don't even have a word for "mental illness" either, for that matter.

    But, as you probably already know, OB/gyn and surgery are those types of fields where, if you can see yourself being happier in something else, then GO. If you let your family badger you into OB/gyn, at some point you're going to start resenting them for it. You're also going to start resenting yourself for it, for not being strong enough to stand up for what is best for you. While I wouldn't agree with the assertion that "Even Asian parents want their children to be happy, right?," I DO feel that Asian parents don't want their children to hate them. Which may very well be what ends up happening here.

    Good luck.
     
  50. Doc Samson

    Doc Samson gamma irradiated 10+ Year Member

    Never say never. Psychiatry (more than any specialty) looks beyond grades and numbers. My interview selling point was that I was going to be a nephrologist until I did a CL elective and discovered that I loved it and could never picture myself doing anything else. Your OB-to-psych story would likely gain similar traction, especially if you had already started making a niche for yourself in an area like women's mental health. A stellar performance on an externship will also gain you a lot of points. I don't think that the Yale name would generate any less buzz (or any of the Ivies for that matter), so you don't have to put all your eggs in the Crimson basket.

    FWIW, my (Jewish) parents only came around to the idea of psychiatry when they could drop the Harvard name when their friends asked what I was doing.

    If you want to look into the OB/Psych crossover, this is a good starting point:

    http://www.womensmentalhealth.org/
     
  51. billypilgrim37

    billypilgrim37 Unstuck in Time 7+ Year Member

    2,387
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    Faculty
    That may be the nerdiest story I have ever heard.

    Your welcome. :D
     

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