Lack of respect for psychiatry

[coffeerunner]

To the OP: You should do what makes you happy. If psychiatry is what you really want then you should go for it. Yes, you will have to live for a while with your parents, gf, even some colleagues telling you that you are not a "real doctor" but once they see that you a working and what you are really doing, then they will eventually come around. Life is short so you should do what you truly love.

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[OldPsychDoc]

:...Point out to your girlfriend that a psychiatry residency requires less overnight work, and has more predictable hours, than OB/gyn. ....

...not to mention many fewer naked women...


[Bad Id. Down Id, Down! Down!]

 

[howelljolly]

REALLY??!!?? What community are YOU in?

I'm an MS4, currently applying for OB/gyn. Good luck.

for some reason, I totally thought you were going into general surgery.

Ive gotta get my stories straight.

 

[BobA]

:


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]

Amen to that. . . yeah, Optho is great. Why didn't I think of Derm?

Not that those fields really appeal to me (OK, maybe Optho does), but laypeople don't understand how it all works.

 

[peppy]

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.

Almost every criticism people have about psychiatry applies to at least one other field of medicine.
A lot of laypeople also get confused between a radiology tech vs. a radiologist or an optometrist vs. an ophthalmologist...yet I don't think the majority of rads or optho docs (or the people fighting to get into those fields) lose sleep over that. ;-)
The whole complaint that our specialty's treatments are not effective is also frequently made about Neurology too (just like with psych, that complaint isn't really true about Neurology either - but even if a neurologist only deals with incurable terminal diseases like ALS, they're still "real doctors").

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'm not an attending yet but I am a 4th year who is committed to psychiatry so I've had a chance to see a lot of reactions from doctors and laypeople already. I have actually been surprised by how many people out there do understand that mental illness is a real disease, and respect my choice to go into it...especially in the younger generation.

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.

I actually thought ob/gyn was pretty fun too, but one of the reasons I never seriously considered it was that I didn't want to be away from my family as much as an ob/gyn residency would demand. A lot of times the spouse/partner doesn't really understand what kind of sacrifices they too will have to make in residency for the sake of your career until it happens. What if you were to choose ob/gyn partly to please your girlfriend, but she wasn't prepared for how much separation you two will have during the residency years and it put a strain on your relationship? If your girlfriend broke up with you during ob/gyn residency for someone with a 9-to-5 job, would you then still feel like you made the right choice and still enjoy your career? (That's something you should answer for yourself, not answer to me).

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.

I think the respect you get from colleagues will grow or shrink depending on how good of a clinician you are and how well you treat your colleagues, not what specialty you're in. At one of the hospitals I rotated at, there was a doc in a "prestigious" surgical field who had a reputation in the hospital for being kind of daffy and not the sort of doc you'd refer your loved one to. Specialty choice alone won't make or break your reputation.

I think Family Medicine is appealing to a lot of people who enjoy aspects of more than one field. I considered it too for that reason, but FM has its own problems. One big issue that kept me away from FM is that most of the simple stuff that FM docs do is now being taken over by NPs or PAs, while the complex stuff gets referred to specialists...unless there is a major shift, what will be left for FM docs to do in the future? That concerned me.
I also decided I'd get bored with only getting to manage the most basic psychiatric issues. I find the very acute, more complicated mental illnesses to be where the excitement and challenge of the field is.

Personally, if I were you, I probably would just let the subject drop with my family right now. They don't even need to know what field you're thinking about until you've started going on interviews at least (especially since there is still a chance you may change your mind again and fall in love with a totally different field). Good luck making your choice!

 

[peppy]

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.

That's a good point actually. Some people have "issues" with OB/Gyn too. You might run into laypeople who resent ob/gyns because they're into all that "natural birth"/"homebirthing" stuff and think midwives are better than ob/gyns. If you're a guy, you will inevitably have to deal with women who think that all male ob/gyns are perverts who only went into ob/gyn to see naked women.
There is no one single field that everyone likes and respects out there!

 

[hereandnow]

http://www.panhala.net/Archive/The_Journey.html

 

[Still Kickin]

I
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.

Don't forget that the MOST IMPORTANT person you will be "dealing with" for the rest of your life is YOUR OWN SELF!

(Which I think is pretty much the point of this comment):

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.

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?

If you have the opportunity to do something you really love, are really passionate about, gives your life meaning, etc. vs. the choice to be "not miserable" I think I'd go with the first choice, not the second. (Of course, I don't know if that describes how you feel about Psych, I'm not trying to put words into your mouth...) Not to knock "not miserable". I mean, most people in life don't ever have the luxury of working at something that really resonates with them on a deeper level, and in such a case "not miserable" is actually pretty darn good. But if you ARE lucky enough to have a choice between "not miserable" (ie - "ok") and AWESOME, go for the awesome!

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. Just being realistic.

You never know, I'd go ahead & apply to your "dream programs", you might be very surprised.

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.

If you're a guy, you will inevitably have to deal with women who think that all male ob/gyns are perverts who only went into ob/gyn to see naked women.

Hmm, I thought there was a *different* sterotype about the OB-GYN guys...

OK, and finally...

I can't find the post by the person who suggested combined Fam Med / Psych or Internal Med / Psych. If that's an approach you might be considering, thought I might throw the idea of Neuro / Psych combined program out there. One of my neuro preceptors saw tons of elderly [demented] patients. [Frankly, in my family we always took our demented elderly to see a *psychiatrist*, but I digress...] Anyway, I felt like there was a lot of "overlap" in the psych/neuro fields, and that a lot of people were coming to the NEUROLOGIST because they found that to be more "acceptable" than seeing a Psychiatrist - ie, a Neurologist is more "medical", so I must have a medical condition (mental illnesses ARE medical conditions, but again I digress...) and therefore I'm not crazy because I'm going to a "medical" doctor, not a psychiatrist. Plus there were lots of thorny family dynamics issues my preceptor helped those families with. (But - at the end of the day - I saw that he was the "exception" amongst my neuro preceptors [I was "preceptored" by an entire group practice...], all the others were more "medically"/technically focused (really into doing their EMGs and NCSs and stuff...) and NOT into the emotional reactions to the illness. I don't want to have to spend even one day of my life learning how to do EMGs and NCSs - so no way am I going anywhere near a neuro residency.
(But even though it wasn't for me - I thought I'd point out the overlap and also that this might be a way to "bring" Psychiatry to those who would not accept Psychiatric treatment otherwise. [Same thing goes for Fam Med / Psych - I saw TONS of patients on FM that I thought could benefit from psychiatric care, but NO WAY were they ever going to accept a referral.]

Oh yeah, and one last thought - the thing about your girlfriend commenting about how you enjoyed OB-GYN. I really enjoyed almost ALL of my rotations. But Psych truly was the right fit. Once I just acknowledged that to myself and decided to "go for it" all the stress I'd been feeling about picking a specialty just melted away, because I knew I had made the right choice... I don't think this would have happened if I went with any of the other specialties I was considering.

 

[Messerschmitts]

Wow, I'm about to go to work right now (doing my Emergency Medicine elective right now...no danger of me wanting to go into it, just doing it for fun and enrichment. I do get a little excited when a patient comes in for O.D. of psych meds ) Just wanted to say that I'm humbled this little discussion went onto the second page. Thank you to everyone for their insightful comments!

 

[Encephalopathy]

My dad's Chinese, and I only had to explain to him the difference between a psychiatrist and psychologist about 15 times before he started to come around. Points to emphasize are "first off, be happy I'm even an MD; I'll be making ~200k for ~40h/w, leaving lots of time to have little Chinese babies; my hands stay clean and out of any orifices; lower rate of malpractice suits". If they still want an Ob/Gyn in the family, it's never too late for them to apply to med school themselves.

I'm sure I'm guilty of bashing other specialties (esp. Ob/Gyn and IM) at least as much as they bash psych, but it's all in good fun. I'm just grateful there are people who are actually crazy enough to want to do those specialties so I don't have to.

 

[whopper]

I'm just grateful there are people who are actually crazy enough to want to do those specialties so I don't have to.

I don't understand that drive for several medstudents to have the lifestyle of a stereotype surgeon or ob-gyn doctor that works terrible hours, & is up most of the night, I emphasize the word stereotype because its not fair to think all are alike.

I mean if your guardian angel were to magically appear in front of you, show you 2 paths, one of which you had to choose: one was like the above, the other had you working 40 hrs a week, only more if you wanted to do so, and not having to do calls unless you agreed to them, which one would you pick?

And its not like most of those with that drive to work crazy hours seemed to me to like those fields for the sake of liking them. For example, I actually really enjoyed surgery. I did brain surgery on rats in graduate school. I found it quite peaceful to do that while playing some classic rock or symphony in the background. The act of surgery was highly calming & meditative for me. I love building models, and get the same type of high when doing that--and it was strangely similar. I don't build models like a grade school kid does. I'm a bit OCD with it--researching the item heavily, wearing magnifying glasses, consulting with some master model builders who've worked on major movies (e.g. the guy who actually designed the actual USS Enterprise for the movies). Most of my modeling equipment is the same equipment used in surgery-no kidding.

Why I didn't choose it was becuase I liked psychiatry better, and the terrible hours. If surgery was 9-5 (like it is in the UK), I wouldn't have minded it so much, but still would've rather done psychiatry. I wouldn't have even gone to medical school except out of the desire to be a psychiatrist.

But what I didn't get was my colleagues who went into surgery, I never heard any of them mentioning wanting the type of lifestyle the career usually demands. They knew what they were getting into, but chose to do it anyway. While in residency, I'd hear them all rant (understandibly) about the stressful hours, how they've gained 10-20 lbs, and didn't even have time to pay their bills.

To be fair, of course there are several great surgeons who love the field, and perhaps something of the long hard hours was something that may have even attracted them to the field. I think most of us admire people willing to do hard work for a noble purpose, and would feel gratified in doing so. I just know that I am happy coming home, unwinding for about 1/2 to 1 hr, and do think I'm living a more fulfilling life not being woken up in the middle of the night.

I would certainly hope someone wouldn't only go into psychiatry because the hours may seem a bit easier.

As for myself, maybe I'm being a bit of a hypocrit because I'm on the toughest unit at the hospital I'm at...something I didn't object to when the administration asked me to do it. I figured, "hey I'm young, I just graduated, I'm going to do this & put the feather in the cap". Its very demanding work, but it is burning me out. Well, at least I do get to go home & not get woken up at 2am.

 

[smq123]

...not to mention many fewer naked women...


[Bad Id. Down Id, Down! Down!]

I don't understand that drive for several medstudents to have the lifestyle of a stereotype surgeon or ob-gyn doctor that works terrible hours, & is up most of the night, I emphasize the word stereotype because its not fair to think all are alike.

And its not like most of those with that drive to work crazy hours seemed to me to like those fields for the sake of liking them. For example, I actually really enjoyed surgery.

But what I didn't get was my colleagues who went into surgery, I never heard any of them mentioning wanting the type of lifestyle the career usually demands. They knew what they were getting into, but chose to do it anyway. While in residency, I'd hear them all rant (understandibly) about the stressful hours, how they've gained 10-20 lbs, and didn't even have time to pay their bills.

whopper - I thought long and hard before choosing OB/gyn. I know, quite well, what a difficult life it can be. Between the number of lawsuits to high-strung patients to the hours, it was a hard-thought decision.

I tried, so hard, to like the "lifestyle-friendly" specialties (E-ROAD, path, and even family med and psych). But you can't force interest in something, and expect to be happy with it for the rest of your life.

You may have "really enjoyed" surgery....but that's not enough.

For most people who choose surgery, the OR is the only place in the hospital where they feel truly happy and at home. (For people who choose OB/gyn, it's usually a toss-up between the OR and L&D.) They don't just "enjoy" it...it goes deeper than that. It's hard to explain.

It was funny - for me, I remember one day that I got out of my IM rotation early, ~3 PM. You'd think that I would have been in a good mood to get out so early....but it was all I could do to trudge up the street to my house. My neck hurt, my head was still pounding, and even the bright sunny day did nothing to lift my mood.

Compare that to a typical day on OB/gyn or surgery, where I would get up before the sun rose, spend the daylight hours in L&D or the OR, and then go home again after sunset....but my head was clear, I was in a good mood, and could even make jokes with the interns and residents before heading home.

Nobody wants those hours. But it's the price you pay to be allowed to learn how to perform the skills that you love so much.

 

[whopper]

Nobody wants those hours. But it's the price you pay to be allowed to learn how to perform the skills that you love so much.

And that's very good for you. It seemed you made the right choice. I guess my enjoyment wasn't enough to make me want to go into it.

I can think of some things better in the OR than the psyche treatment team. For example, there's a lot of interpersonal politics going on from treatment teams in my experience. In the OR, and perhaps my memory is not accurate, but it seemed to me that the politics dropped because of the level of intensity of what was going on at that moment.

But in any case, IMHO anyone going into any field needs to get that magic feeling that the field is their true calling. . If you got that, that's great for you. I got that feeling for myself. We are lucky in that sense because I know few who do have that feeling about what they do.

That is more important than wanting just easy hours. I've also mentioned this in past threads, but when I was Chief, I tried to filter out those from the interview process that I got a feeling wanted to go into psychiatry only because of easier hours because from my experience they usually were lazy residents. There will be times where out of duty (and hopefully enjoyment) you just have to sit there & do the hard work.

One of the things I didn't mention in the above post was those I knew who went into surgery or Ob-gyn, unlike you didn't mention how much they truly loved it. I just heard the rants. So then I was thinking to myself "then why rant about this lifestyle if you could've chosen differently?".

Which also I guess could be hypocrisy & lack of understanding on my part because almost everyone at some point will have some complaints about what they do, and just need a friend to hear it. In my field I ought to understand that.

 

[smq123]

One of the things I didn't mention in the above post was those I knew who went into surgery or Ob-gyn, unlike you didn't mention how much they truly loved it. I just heard the rants. So then I was thinking to myself "then why rant about this lifestyle if you could've chosen differently?".

Well, I'm fresh off interviews, so my reasons for liking OB/gyn are still pretty clear. But, I can imagine that doing it day in and day out, with all the headaches and frustrations that accompany it, it can be hard to remember exactly what motivated you in the first place.

I also think that the daily practice of surgery, in particular, can make it worse. Surgery residency, in many places, has lost a lot of its element of autonomy, and it's very top-heavy. So much of your time in your first 2 or 3 years is spent doing floor work and running the ICU. In many cases, you don't really get to go into the OR (and learn what you REALLY went into surgery for) until you're a PGY-4 or 5. This is less true for OB/gyn, ENT, ortho, and urology, where residents tend to start operating earlier, and with less rigid attending supervision, than in general surgery. So, in that case, I think that it's VERY easy to lose sight of your original reasons for choosing that field.

 

[Regnvejr]

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 wonder if they know anybody who committed suicide or who had kids who committed suicide? If you can then point out that you are going to work on that not happening, that might be an inroad. Make it real to them, look at the consequenses of mental illness that they have witnessed or experienced and then tell them this is what you are going to (hopefully) "fix."

 

[Regnvejr]

...not to mention many fewer naked women...


[Bad Id. Down Id, Down! Down!]

LOL, nice to see your superego (kindoff) works.

 

[OldPsychDoc]

LOL, nice to see your superego (kindoff) works.

It works fine---it's just a little slower.

 

[whopper]

In addition to "lack of respect", I think lack of understanding may be a factor.

I had a case where someone during the weekend had an acute medical problem that necessitated that she be moved to the medical floor. The medical resident on duty checked her out, and the patient was transferred to the medical floor. The medical resident requested that 2 security guards accompany her and stay with that patient at all times. That patient had no history of violence, psychosis or agitation. She was an anxiety disorder patient who was cooperative & directable & was known to the psyche staff. That medical resident though was thinking that the "psychiatry" patient would attack her.

I've also noticed that at several hospitals, if a patient is showing several non-psychiatric problems that justify a need for a medical investigation, several non-psychiatric doctors have a "oh they're psychiatric patients" and just blow them off. E.g. the patient can't walk, but was able to do so earlier in the day--"oh its psychosis" and medically cleared them. How many times have people seen psychosis present with an acute change in the inability to walk? Or the person has symptoms that exactly match Trigeminal Neuralgia, but the neurologist refuses to the see the patient because the patient has schizophrenia, reporting to the staff "well she's psychotic, that must explain it."

Its as if some nonpsychiatric doctors believe that psychiatric patients can't have medical problems. That since they're psychotic, that they're not worthy for medical investigation. Since any doctor in their right mind would never consciously believe that a psychiatric patient could be invulnerable to medical disorders, it sometimes leads me to wonder if they think that psychiatric patients are not worthy of quality medical care, i.e. that they deserve lesser care, i.e. they are lower level beings.

Of course this is not all non-psychiatric doctors & staff, nor is my intention to point out non-psyche docs in an us vs them light. There are several things I've heard IM docs complain about psyche docs that I actually agree with (e.g. a consult for a patient with a BP of 135/85, reason: Hypertension), but I have noticed enough, and at several different hospitals in different geographic locations to believe it is a trend (just as much as I've seen psychiatrists request medical consults for silly things as as trend). I've also noticed that some of the non-psychiatric doctors telling the medstudents to not go into psychiatry are some of the same ones not giving proper care to psychiatric patients, sometimes saying something to the effect of "how can you deal with crazy people?"

 

[Regnvejr]

These are the patients that die 10-15 years early because ANY symptom "must just be in their head." I do get after the residents when I see that, but some attendings are guilty as well, not the least the ER physicians.

 

[whopper]

Exactly.

And when you have doctors in the field actively ignoring the needs of psychiatric patients with attitudes like that, what do you logically think their opinions will be of the doctors that chose to treat these people, when they could've chosen to treat the "normal" people?

My bottom line is there is some lack of respect for psychiatry because some doctors feel it is not as demanding, technical or academically intense, which I disagree with. Any good psychiatrist will put just as much effort into keeping up with journals, CME, etc just as much as any non-psychiatric doctors. I've also seen plenty of non-psychiatric doctors whose knowledge of internal medicine is worse than a typical psychiatrist. I actually sometimes find myself correctly diagnosing the medical problem my patients have that the IM doctor misses. However while I may disagree with this, this is a grey, debatable issue.

The above attitude has shunned some medstudents away from the field.

But its also elitism, and ignorance based on a belief that psychiatric patients are lower level human beings that are not worthy of care. In which case any person who realizes that they have just as much right to care as "normal" patients are clearly in the right, and those that disrespect psychiatric patients for this reason are clearly guilty of ignorance. If a non-psychiatric doctor were to disrespect the field for this reason (and for this reason, not the above), you'd have a lot of ammo to call that doctor spade for spade.

Again, my intent is to not split us against our non-psychiatric colleagues. There are trends, ignorances & good things about every field, but we got to admit, there are people in the health care field who percieve psychiatric patients as 2nd class citizens. To ignore that is to be PC to the point of blindness. Just as much as I'm pointing this out, I've had conversations with the head of the hospitalists at my place of residency about what frustrated him with psychiatrists--and I agreed with him all the time, and mentioned that I wish those in our own field were more sensitive to his own needs.

Its somewhat ironic, that despite all the education, the behavioral science & psychiatry rotations, and emphasis on humanity that this still happens. Then again, I sometimes think of the ego that accompanies several doctors (yes psychiatrists too--physician heal thyself), how several compartmentalize that which is not "important" for their field because of the huge amounts of data & stress during a medical education, and that in several places the test scores of a candidate mean almost everything, and then I'm not surprised.

 

[HMSPSYCH]

Exactly.

Any good psychiatrist will put just as much effort into keeping up with journals, CME, etc just as much as any non-psychiatric doctors. I've also seen plenty of non-psychiatric doctors whose knowledge of internal medicine is worse than a typical psychiatrist.

Has anyone watched this show Private Practice on ABC? I wonder if their portrayal of psychiatric MDs on this show as mere ‘therapists’ with very little medical knowledge/training further deteriorate our image with the public. They have a neurologist doing anesthesia, neurosurgery on CVA patients; endocrinologist/alternative medicine/pediatrician/ob/gyn MDs performing surgeries/emergency procedures. Conversely, they have the pregnant psychiatrist asking the male midwife student to help her read an ultrasound, running marriage counseling groups, helping a woman with agoraphobia attend her daughter’s wedding, sleeping with multiple men, prescribing Ativan for crying patients, etc.

 

[smq123]

I wonder if they know anybody who committed suicide or who had kids who committed suicide? If you can then point out that you are going to work on that not happening, that might be an inroad. Make it real to them, look at the consequenses of mental illness that they have witnessed or experienced and then tell them this is what you are going to (hopefully) "fix."

Even for Asians, suicide is not a sign of "mental illness."

A lot of Asians, especially the older ones, see suicide as a cowardly way out for someone who isn't mature or smart enough to figure out another solution. So, no, even suicide wouldn't change the OP's parents' minds.

The ONLY psychiatric illness that Asian parents might "understand" is Alzheimer's/dementia. They see people with Alzheimer's, realize that it is not their "fault," and are anxious to know what treatments exist out there. So maybe the OP could talk about that a little.

 

[whopper]

I wonder if they know anybody who committed suicide or who had kids who committed suicide?

Getting somewhat OT, the worst 2 cases I've seen where Asian parents trying to insert their own plans onto their child-1 was a young Korean American female in music school who had jumped out of a window because they did not approve of her boyfriend. She lived for a few days after the fall, most of her bones broken. She left a suicide note, directly blaming her parents & wishing them a guilt trip for the rest of their lives.

The other was a friend of mine whose parents did not approve of his choices, and cut him off--permanently out of their lives. He ended up getting kicked out of medical school because they were helping him to pay for the tuitition, but also the emotional stress of what had happened. He & his wife ended up getting a job as clerks afterwards at some run of the mill store. He & his wife were both very good students, often in the Dean's list in college. You'd expect better for them. I don't know what happened to him because I lost contact with him.

A friend of mine, she killed herself inhaling CO2 from the car in a garage. She left a suicide note, so I knew it was not accidental. She went to some of the best schools in the country. I still don't know why she committed suicide, though I suspect it was parental pressure.

So when I see non-Asians have a chipper-"Oh they'll come around" attitude, I tend to think its best not to be so optimistic unless you really know what's going on. Yes, several, I think even most will come around. Then again, it could be one of those unfortunate situations where the parents may not. If someone gave the "they'll come around" attitude without understanding the gravity of the situation, it might actually make things worse.

The ONLY psychiatric illness that Asian parents might "understand" is Alzheimer's/dementia. They see people with Alzheimer's, realize that it is not their "fault," and are anxious to know what treatments exist out there. So maybe the OP could talk about that a little.

Agree. Its also a big element in Eastern Asian cultures to very much help out the elders, especially when mentally or physically compromised.

Conversely, they have the pregnant psychiatrist asking the male midwife student to help her

I haven't seen that ABC show, but I think of another show--Frasier. I loved Cheers, loved Frasier, but Frasier during the run of both shows never showed any non-psychotherapeutic medical knowledge other than an episode of Cheers where someone died, he yelled out "I'm a trained professional" & checked him out (and with comic dead-pan timing, the person died and Frasier yelled out something to the effect of "he's dead"). Yeah, I liked how he was a great psychotherapist and that needs more emphasis in our field, but his non-psychiatric medical knowledge never seemed to come into play.

 

[Doc Samson]

And of course, the most blatant example of a CL psychiatrist (House) is identified as a specialist in "diagnostic medicine" (whatever that is).

 

[howelljolly]

The subject of psych vs. med docs has been something of a sore spot of mine for ten years now.

Sure there will be cases of the med consult for 125/85 Hypertension, and thats going to set psychiatry back quite a bit.

But good psychiatrists can make a difference by telling the medicine guys what they are thinking, medically. I don't assume that you arent doing this, but all I can say is keep at it.

Usually, when medicine consults another medical service, its for a specific reason. "I think this patient needs an echo... a c-scope.... I think this patient is acute renal failure.

Likewise, when psychiatry consults medicine, they should do something similar.... Acute paralysis not due to conversion d/o.... metabolic syndrome due to psych meds... Should they be able to say "I think this patient might have neuroleptic malignant syndrome?"

Some of the best medical guys will write directly on the chart "I am thinking of...." or "I think that...." or "I did not find...." One of these docs explained that a lawyer friend of his argues that this informal first-person documentation is not interpreted strictly, and shows that the doctor at least entertained an idea, even if he missed the mark.

Anyway. Just my dos pesos.

 

[Messerschmitts]

The subject of psych vs. med docs has been something of a sore spot of mine for ten years now.

Sure there will be cases of the med consult for 125/85 Hypertension, and thats going to set psychiatry back quite a bit.

But good psychiatrists can make a difference by telling the medicine guys what they are thinking, medically. I don't assume that you arent doing this, but all I can say is keep at it.

Usually, when medicine consults another medical service, its for a specific reason. "I think this patient needs an echo... a c-scope.... I think this patient is acute renal failure.

Likewise, when psychiatry consults medicine, they should do something similar.... Acute paralysis not due to conversion d/o.... metabolic syndrome due to psych meds... Should they be able to say "I think this patient might have neuroleptic malignant syndrome?"

Some of the best medical guys will write directly on the chart "I am thinking of...." or "I think that...." or "I did not find...." One of these docs explained that a lawyer friend of his argues that this informal first-person documentation is not interpreted strictly, and shows that the doctor at least entertained an idea, even if he missed the mark.

Anyway. Just my dos pesos.

Howell-Jolly, I just wanted to say I enjoy your screenname (and your avatar picture) Those poor splenectomy patients!

 

[loser]

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)

Really? A lot of us non-medical folks (I'm a social worker) don't particilarly respect dermatologists. We tend to see dermatologists as overpaid doctors who just do botox injections all day. Now, cardiothoracic surgeon on the other hand, does have a more glamorous reputation.

Although I have a lot of respect for psychiatry, I definitely agree that many people in the medical community and the non-medical community do not give it the respect it deserves. But you should just do what you enjoy. Besides, don't OB/GYNs have to pay an insane amount of money for malpractice insurance?

 

[Faebinder]

I just like to snicker when they desperately call for us to see a patient and I discontinue half the meds and tell them they should treat the UTI. What can I say... I know I'm practicing medicine.

 

[whopper]

don't particilarly respect dermatologists. We tend to see dermatologists as overpaid doctors who just do botox injections all day.

The NY Times had an interesting article a few years ago about how Internal Medicine is the field where you got to know all branches of medicine, yet becuase of the intensity of the workload, most of the more accomplished students & residents will try to get out of IM & go into specialities such as Dermatology because they pay well & are easier in terms of the workload.

In effect, it was causing the most talented people to go away from the fields where they really have to know the most amount of data.

http://query.nytimes.com/gst/fullpage.html?res=9F0DE3DC1031F934A35752C0A9629C8B63

Personally I love real IM, but hated the reality of the hospital work because I spent a few hrs a day just trying to find a chart, and having to deal with whiney staff who weren't doing their jobs right. I can remember all the nurses beeping me on patients I wasn't supposed to cover just because it made their jobs easier, & the passive aggressive ones that'd intentionally beep you 3am when they could've gotten it all out of the way around midnight. Happens in Psychiatry too, but it just seemed a heck of a lot worse in IM becuase you're covering more floors.

As for Ob-Gyn, and several other fields, when you're in medical school, you'll see that medicine-centric view where you're going to get several doctors bashing or praising a field. Its medicine-centric becuase most of the training is centered on internal medicine. They're going to throw in their prejudices against fields they do not understand.

I wouldn't allow that to affect your decision much. The decision is personal, and guess what? How much are you going to work in IM if you don't go into that field after medical school, or even residency?

 

[HCE]

My dad's Chinese, and I only had to explain to him the difference between a psychiatrist and psychologist about 15 times before he started to come around. Points to emphasize are "first off, be happy I'm even an MD; I'll be making ~200k for ~40h/w, leaving lots of time to have little Chinese babies; my hands stay clean and out of any orifices; lower rate of malpractice suits". If they still want an Ob/Gyn in the family, it's never too late for them to apply to med school themselves.

I'm sure I'm guilty of bashing other specialties (esp. Ob/Gyn and IM) at least as much as they bash psych, but it's all in good fun. I'm just grateful there are people who are actually crazy enough to want to do those specialties so I don't have to.

I really think you'll all go crazy if you aren't comfortable with your own career decisions, the general public (and family) be damned. Derm is obviously a tough field to match but, to many in the general public, I wonder if the specialty is considered anything more than a doctor treating pimples with creams and salves....and don't get me started on proctology. All you can do is explain the field (15 times might be too much), educate, and move on, knowing that you have earned your position and expertise through hard work, and you are treating patients with serious problems....to thine own self be true...

 

[RaistlinMajere]

I really think you'll all go crazy if you aren't comfortable with your own career decisions, the general public (and family) be damned. Derm is obviously a tough field to match but, to many in the general public, I wonder if the specialty is considered anything more than a doctor treating pimples with creams and salves....and don't get me started on proctology. All you can do is explain the field (15 times might be too much), educate, and move on, knowing that you have earned your position and expertise through hard work, and you are treating patients with serious problems....to thine own self be true...

I agree with this. The most happy people with their careers are those who stayed true to themselves.

I would also like to point out that generally speaking nearly all physicians with whom I have spoken believe that the specialty that they chose is the best. I mean that's usually why they chose it, right? Or they at least feel like they have to justify their choice anyway.

 

[whopper]

I really think you'll all go crazy if you aren't comfortable with your own career decisions, the general public (and family) be damned.

Agree.

But take into consideration that in different cultures, family approval is more important than the typical American family, and the repurcussions can be worse to the individual from the family.

Most families wouldn't tell their kids what field of medicine to go into, and if they did, would not give their children too much flack. However in other cultures, such as the Eastern Asian cultures, middle eastern, 1st generation immigrant families among others, the dynamics differ.

Don't know what culture you are from, but its easy for someone not of the above cultures, to tell the person to ignore their parent's wishes. I've seen some kids cast out of the family permanently, some commit suicide over this type of thing. It was already mentioned above, but a closer analogy would be to tell a socially right wing Christian family that you are gay.

And even in those cases, several people would still advise the gay person to still come out. Hiding one's true self takes a toll.

Bottom line is this can be a complicated issue.

 

[howelljolly]

Agree.

But take into consideration that in different cultures....

And thats the point here.

Its easy to say that you should be true to yourself, and even go as far as to say that you can cut your family off. But for some people in family oriented cultures, the family is totally inseparable from the self/identity.

In this case, suggesting being true to the self doesnt make much sense because not being a psychiatrist would make one feel just as empty as not being a son/daughter/sibling/niece/nephew/uncle/aunt/cousin.

Its a Catch22

 

[Bleurberry]

And of course, the most blatant example of a CL psychiatrist (House) is identified as a specialist in "diagnostic medicine" (whatever that is).

There was a great article in last weeks NY Times Magazine on the NIH's diagnostic medicine division, and how it's nothing like House, but thought I'd mention it to you, its a great read. They rarely "solve" any disease, but they screen hundreds of cases and pick a few dozen, then try to unravel the mystery. When they do, there's very very little chance of helping the patient, but they've got the record, and when the science catches up, they'll have the research.

http://www.nytimes.com/2009/02/22/magazine/22Diseases-t.html?pagewanted=all

 

[HCE]

Don't know what culture you are from, but its easy for someone not of the above cultures, to tell the person to ignore their parent's wishes. I've seen some kids cast out of the family permanently, some commit suicide over this type of thing. It was already mentioned above, but a closer analogy would be to tell a socially right wing Christian family that you are gay.

And even in those cases, several people would still advise the gay person to still come out. Hiding one's true self takes a toll.

Bottom line is this can be a complicated issue.

Whopper, I understand and agree with your sentimant. I'm not unsympathetic to the dilemma. I'm not from an Asian or socially right wing Christian family, and I'm not gay. I'm not so sure that whether or not a child ends up as a psychiatrist is as woven into the fabric of the Asian culture to the extent that being gay or straight is with social right wing Christians, but I could be wrong. I tend to believe that religious bias is more destructive than the cultural objection. Then again, I'm not a psychiatrist, and would recommend to anyone that they listen to an attending long before listening to an anonymous poster like me if they are concerned with the mental health effects parents can cause by forcing their beliefs/customs on their children.

 

[HCE]

And thats the point here.

Its easy to say that you should be true to yourself, and even go as far as to say that you can cut your family off. But for some people in family oriented cultures, the family is totally inseparable from the self/identity.

In this case, suggesting being true to the self doesnt make much sense because not being a psychiatrist would make one feel just as empty as not being a son/daughter/sibling/niece/nephew/uncle/aunt/cousin.

Its a Catch22

I understand what you're saying and sympathize with your dilemma. I'm assuming you are not the first nor the last person in your extended family to be in the Catch 22 position you are in. How has the dilemma been resolved with others in your family? Have you discussed this with siblings, cousins, uncles who have successfully sold the family on their "undesirable" career choices? Is their an aunt, uncle, grand parent etc. who may have more sway than you with family peers who might be more understanding of your position, and who might advocate on your behalf?

I wish you nothing but the best.

 

[howelljolly]

I understand what you're saying and sympathize with your dilemma. I'm assuming you are not the first nor the last person in your extended family to be in the Catch 22 position you are in. How has the dilemma been resolved with others in your family? Have you discussed this with siblings, cousins, uncles who have successfully sold the family on their "undesirable" career choices? Is their an aunt, uncle, grand parent etc. who may have more sway than you with family peers who might be more understanding of your position, and who might advocate on your behalf?

I wish you nothing but the best.

Well it aint me.... I wrote that because we started moving away from the issue, and we were talking about being happy with ones career choice. Im just pointing out that being happy with a career choice might be 100% contingent on family.

But you bring up a good point...

A family history of going against the grain may make things easier, or more difficult...depending on how those things worked out.

 

[ronaldo23]

My dad is a psychiatrist, and ironically its him always telling me not to go into psychiatry. He would probably rather that I not go into medicine than become a psychiatrist. I've always been interested in the field, but I worry about exploring this field, since my dad will never support that decision. Interestingly, he clearly enjoys it and makes bank, but is always going on tangents about how future psychiatrists will have to compete with psychologists (who are getting prescription rights' priviledges in some states I'm told?), and that slowly they will lose more and more autonomy.

 

[whopper]

My mom is a retired psychiatrist and she said to not go into the field. She pretty much had zero impact on my decision. She didn't like her job, and only picked it because at the time where she had to pick which residency, she didn't knowwhich one, and her father told her psychiatry because to him it seemed easier (and he wasn't a doctor). When I've had discussions with her about the field, she didn't seem to know what she was talking about, nor did she want to talk about it. E.g. She had a DSM III (years after the IV came out), and she was still using it. She didn't even seem to know the IV came out. Heck I sometimes suspect she was pretty much the type of old time psychiatrist I dread that my discharged patients patients will have--fine on their Aripiprazole, but will come back to me 100 lbs heavier 1 year later on Olanzapine because that's the only antipsychotic that particular psychiatrist would prescribe, and they became non-compliant because they asked their doctor several times to be put back on the medication that didn't cause weight gain but the doctor wouldn't listen to them.

As for psychologists taking over, I don't see that happening, and if it does happen it'll only be because we're not churning out enough psychiatrists. Psychologists at least for the next several years will not take over jobs from psychiatrists to the point where it will hurt us. Psychologists also do perform several valuable services in the mental health field that psychiatrists don't do, so everytime I see psychiatrists knocking them as a whole I find it wrong, and pretty much an example of group-think. The only states that have allowed psychologists to prescribe have severe shortages of psychiatrists, and those psychologists are not getting intensive cases as part of their training such as the psychotic person where even Clozaril at maximum dosages is not enough. Every psychologist I have worked with mentioned they have no desire to prescribe nor believe psychologists should have it.

They only way I can see psychologists getting much more power to prescribe to the point where we as a field should be worried about it is if the medications became so safe & effective that they were on the order of OTC meds. IF that ever happens, that's several decades away.

 

[notdeadyet]

One thing that I think is worth noting is that you will see a LOT of physicians who are now retiring advising against careers in medicine. Sometimes that means retiring psychiatrists saying, "Don't go into psychiatry" or internists saying "Don't go into internal medicine" since this is the only field they know.

I think it should be taken with a big grain of salt. If you are retiring now and started your career in the 50's or 60's, you came into your own when medicine was about as lucrative as it gets. Then you saw the decline of reimbursements, the rise of malpractice, and the push to HMOs. Medicine now is not as great a gig financially as medicine then, all things being equal.

Just saying that I wouldn't necessarily take this to be psychiatry specific. I hear this from retiring physicians of all stripes.

 

[Messerschmitts]

Hmm...curiously it seems most people I know who went into psychiatry had parents (or relatives) who are psychiatrists, and usually those parents/relatives were trying to dissuade them. I don't think it's coincidence, Whopper, despite your claims that your mother's profession had no bearing on your decision. If your mother were say, an engineer, I think you simply would not have been as exposed to the field and would not have as likely to have looked into it. Just my theory.

 

[Tradewind]

Hmm...curiously it seems most people I know who went into psychiatry had parents (or relatives) who are psychiatrists...

I can't think of a single family member of mine, including distant ones, who was a psychiatrist or who worked in any area of mental health.

Of my colleagues, including residents across all years as well as recent graduates, I can only think of three individuals who had a psychiatrist parent.

Very roughly, only 5-10% of residents I know have a psychiatrist parent.

As mentioned previously, I think psychiatry attracts medical students for all sorts of reasons.

 

[spemat31]

Please stay in psychiatry. I still MIGHT go for my phD in Addiction and Psychology but I was burned out by the end with the internships I made and went back for a mediation and conflict resolution degree and lawyers get paid less to mediate so I get their clients.

Also, I have been seeing a psych NP and this woman is just terrible. I haven't had a psychiatrist in a few years. She is just really dramatic. She calls me down for my appointment when I am nicotine withdrawing once, and raised my Adderall by almost double so I was ready to hit someone because of that nicotine fit and she pushed every little button. I had to go see her yesterday. I am glad she switched me over to Adderall XR instead of the old school stuff because my regular doctor will give me that too. I deal with bipolar mania and spend most of the time stable so people cannot tell but I am not one of the thick headed ones and am doing well enough I guess. My mother was a social worker too but my grandparents were German and I was basically told by my grandmother that I need to do that to get away from the rest of them.

My aunt's crack head ex broke into my apartment as a child and I think that while they need help to get better, it doesn't make me feel any better to know he stole my heirlooms from Germany and I never saw them again after that. But the way he was enabled was what has eaten me alive for years.

 

[Shikima]

Dude, enough with the necro's!

 

[Nasrudin]

I hope you like pushing people around, because all the patients are like your mum, they think your an idiot. I think you must be some irany kid, if your family is brown then they must have got away without getting the real poo in their genes, which what your genetic chromosome cross ended up with you having, a born psychopathic brain chopping idiot, that experiments without thinking, and after 1 million neuroscience experiments on monkeys. (not much lower than yourself.) you come up with something i came up with just out of my arse just thinking about the topic, and you didnt continue, and i went into machine learning.

Trust me dickhead, engineering is where the intelligence is at, not this pointless crap.
As a superior student, ill point you to a decent set of tutorials about medical imaging, but I dont even trust you with it, so its not here.

Best psychotic post ever.

 

[erg923]

I'm not clear who the rant is directed toward. Although, I am far from a superior student, so i could be missing something.

And who the **** calls somebody "dickhead" on Christmas. Bunch of heathen's in this town....

 

[Doctor Bagel]

There was another recent SDN thread where people were talking about how the quality of trolling on SDN has really diminished.

 

[birchswing]

Where is novopsych when we need her? She's probably off at a dance retreat. She can get lost at those for years at a time.

 

[birchswing]

oooh i found a dancing psychiatrist on twitter! a real one! @lollindialogue

Good for her! I wonder what she means by "ReCreating Psychiatry."

 

[Ceke2002]

oooh i found a dancing psychiatrist on twitter! a real one! @lollindialogue

Good for her! I wonder what she means by "ReCreating Psychiatry."

From what I've been able to read about her (not going to reveal her name of course), she sounds like she has some very interesting ideas. She participated in an early intervention for youth Psychosis through dance that focused on families, community, growth and individual uniqueness in a non judgemental environment back in June of this year. Apparently they had some measurable success with improved functioning and out comes. I believe she's also involved in using dance therapy as an adjunctive treatment with Eating Disorders.