Matched and already regretting psychiatry

[drzoidbergsgotnothingonme]

I was torn all year between psych and peds. I believed that I genuinely loved both fields and couldn't choose between them. In the end, I ended up ranking a psych program that actively recruited me and was a great fit for me #1, and then a ton of peds programs 2-6. As soon as my rank list was in, I regretted my decision, and began hoping I would match into peds. I matched at my #1 and will be going into psych.

I'm devastated. Trying hard to be positive, but really struggling to deal with the loss of practicing more hands on medicine. I also feel guilty since I know people who were better candidates than me failed to match into psych this year.

Does anyone have any advice about dealing with this? Right now I can barely get out of bed and am dreading the rest of my life. I want to make the best of this and be a good resident for my program and a good doctor for my patients.

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[Monocles]

Don't worry brah when you're a psych attending you can just wipe away your tears with your benjamins... whereas as a peds attending you might not know what those are

In all seriousness, if you miss the medicine side, you can always do child psych and work on a consult service in the future. Lots of medicine on that service. The top child psych consult services in the country tend to hire triple boarders and people with more medicine training than your typical psychiatrists.

tl;dr quit worrying and go enjoy the rest of your M4 year

 

[DisorderedDoc417]

For being a specialty you ranked #1, you have a few more MDD symptoms than I would feel comfortable with. Consider talking with someone, will you? You chose a great field! The hands on medicine will happen in first year as a intern, and you will be thankful never to check a prostate or manage treatment resistant diabetes ever again. You get to help people in a very unique manner. I say it like this because you have to have at least a year of this. Alternatively, if you hate it after a year, you can always try to switch.

I'm devastated. Trying hard to be positive, but really struggling to deal with the loss of practicing more hands on medicine. I also feel guilty since I know people who were better candidates than me failed to match into psych this year.

Right now I can barely get out of bed and am dreading the rest of my life. I want to make the best of this and be a good resident for my program and a good doctor for my patients.

 

[OldPsychDoc]

For being a specialty you ranked #1, you have a few more MDD symptoms than I would feel comfortable with. Consider talking with someone, will you? You chose a great field! The hands on medicine will happen in first year as a intern, and you will be thankful never to check a prostate or manage treatment resistant diabetes ever again. You get to help people in a very unique manner. Alternatively you can always try to switch after 2nd year.

If you're really longing to switch into Peds after the first year, I'm quite certain (based on comments on this board) that you'd find someone willing to outright trade positions with you.

 

[WingedOx]

In all seriousness, if you miss the medicine side, you can always do child psych and work on a consult service in the future. Lots of medicine on that service. The top child psych consult services in the country tend to hire triple boarders and people with more medicine training than your typical psychiatrists.

Nice to know that there are at least a few people out there actually using their triple board training.

 

[Attending1985]

I’m sorry this happened. It’s not ideal but picking a specialty is incredibly difficult and many have regrets and switch. I’m not sure if with the Nrmp rules you can try to drop psych and soap into peds but if you can that’s option number 1. The second option is to enter your psych residency and plan to reapply to pediatrics. I know this sounds crappy but in one year of psych I guarantee you will learn at least a few things that will benefit you in pediatrics. It’s just one year. One thing I would not recommend is just giving up and going through the psych residency. This is your life, don’t let it just happen take charge and go after what you want. At least you know what that is.

 

[MacDonaldTriad]

You are contractually obligated to be a PGY-I in psych. MS4s have no concept of what they are getting into so jump in and see if it is what you thought it would be. You would be unusual if it was exactly what you thought. Peds might also be not what you think so embrace the unknown and it might even be OK. If it isn't, get out and go to peds. You still have to try it so get your head around that and do your best. Good luck

 

[thoffen]

It will help to take a step back and sort out your feelings without trying to inform whether you made a mistake and what you should do about it. You've just taken a huge life step and had your ideas about yourself disappointed by matching into psychiatry. That doesn't necessarily mean the disappointment will last or that you've matched into the wrong field. The likelihood is that you'd be able to be fulfilled in each but also let down by what you are missing. You can't have everything. Don't make yourself miserable for it.

 

[drzoidbergsgotnothingonme]

Thanks to everyone for their advice. @DisorderedDoc417 , I know I'm having MDD symptoms, and I actually was before the match, so I'll definitely try to go see someone and hopefully that will help. I'll do my best to make my peace with this, be a good intern, and see how I feel once I'm a little more in the thick of things.

 

[redbandit]

I basically felt the same way you did, last year. I felt totally depressed, and in shock that I wouldn't use my stethoscope ever again. That feeling lingered for a while. Then, when Internal medicine began, and I had to wake up at 430am six days a week, and realizing I had to do that for 3 years, I couldn't wait to be done. Burnout is super prevalent in IM, and I'd say almost every IM PGY1 that I worked with is absolutely miserable. Like others have said, you will very quickly get tired of stool Guiaics, DREs, etc. I would focus on the positives. The work-life balance is amazing. The field is a specialty, and you'll soon become an expert on the field. The stories you'll hear from some / most of your patients are things you couldn't make up if you tried. You really aren't "losing" medicine, because there is a lot of psychopharmacology and neurologic interplay. I think the inherent nature of picking a residency- where you have to commit your entire life to a specific field, elicits anxiety, and it's natural. Plus, I felt the 4-6 months of IM is more than enough to give you a well rounded medicine experience (I can assume peds / IM will probably deal with similar issues in different patient populations). And, if you really love peds that much, you can still study peds with all the free time you have doing psychiatry residency, haha. Stay positive and just know that this feeling will pass. I went through the same emotions you did, and I am so glad I am in psychiatry. Come back in a year and update us.

 

[alina_s]

See if you can do a month of inpatient peds for one of your medicine intern months. That was hands down my toughest intern rotation and I’ve heard the same from other people who did it in other programs. I was delighted to go back to inpatient psych after that. You can fast track child psych after three years and have a much saner lifestyle.

 

[TexasPhysician]

See if you can do a month of inpatient peds for one of your medicine intern months. That was hands down my toughest intern rotation and I’ve heard the same from other people who did it in other programs. I was delighted to go back to inpatient psych after that. You can fast track child psych after three years and have a much saner lifestyle.

Doing inpatient IM/peds is a good start to hating life. I petitioned for all outpatient. Lovely time and more useful to psych.

 

[FlowRate]

Doing inpatient IM/peds is a good start to hating life. I petitioned for all outpatient. Lovely time and more useful to psych.

I think the two main benefits are learning acute medical management (which does sometimes come up on inpatient psych units) and feeling like you could have done something more intense like medicine, if you had wanted to. 4 months of IM are probably unnecessary. Especially the folks here who sometimes get 2 months of inpatient cardiology as part of those 4 months.

 

[Mass Effect]

Doing inpatient IM/peds is a good start to hating life. I petitioned for all outpatient. Lovely time and more useful to psych.

I don't know about that. Outpatient IM is only useful if you're planning to do outpatient psych. As someone who wants to work inpatient, I'm grateful for my inpatient IM months.

 

[DisorderedDoc417]

I don't know about that. Outpatient IM is only useful if you're planning to do outpatient psych. As someone who wants to work inpatient, I'm grateful for my inpatient IM months.

I think it’s good. Gives you a chance to see how outpatient PCPs manage psych problems so you better understand when they come to your office door. Much more practical experience. The main medical things we need to address should be addressed commonly when on inpatient psych months. The rest is a consult to IM or a risk of trouble practicing outside of your scope.

 

[Celexa]

I don't know about that. Outpatient IM is only useful if you're planning to do outpatient psych. As someone who wants to work inpatient, I'm grateful for my inpatient IM months.

You mean you want to do consults? Because outpatient medicine is going to be more relevant to inpatient psych.

I really like consults, and I like inpatient medicine, but I think my preference would be a mix of outpatient and inpatient medicine intern year.

 

[Mass Effect]

You mean you want to do consults? Because outpatient medicine is going to be more relevant to inpatient psych.

Not really. When someone is on an acute inpatient psych unit, you need to be able to recognize and deal with medical emergencies. We assume, as a doctor, you learn how to manage DM and HTN without having to do outpatient medicine.

 

[Candidate2017]

I believe psychiatry should be a subspecialty of IM: 3 years of IM followed by 3 year fellowship. But I'm grateful it's not.

 

[Mass Effect]

I think it’s good. Gives you a chance to see how outpatient PCPs manage psych problems so you better understand when they come to your office door. Much more practical experience. The main medical things we need to address should be addressed commonly when on inpatient psych months. The rest is a consult to IM or a risk of trouble practicing outside of your scope.

Not sure how helpful it is to see how outpatient PCPs manage psych problems since every outpatient PCP manages it differently. Some are terrified of starting SSRIs even. Others will be starting antipsychotics before sending them to you. Also, it's the main medical things that you'd learn in outpatient IM that you'll see on your inpatient psych months. But learning how to recognize and stabilize/treat medical emergencies will be your job if you're on an inpatient psych unit, particularly in the stand-alone ones that aren't attached to the hospital.

 

[redbandit]

I believe psychiatry should be a subspecialty of IM: 3 years of IM followed by 3 year fellowship. But I'm grateful it's not.

Haha what?? I disagree.

 

[Celexa]

Not really. When someone is on an acute inpatient psych unit, you need to be able to recognize and deal with medical emergencies. We assume, as a doctor, you learn how to manage DM and HTN without having to do outpatient medicine.

I still think outpatient is more relevant...family docs have to recognize and do initial management of emergencies quite frequently. They have to see common complaint after common complaint and not miss the dangerous stuff. The 'most people are totally fine, and a small percent of them are dying and just don't know it yet' is what I find most anxiety-provoking about clinic, and probably more analogous to what happens on inpatient psych. While we will need to be able to recognize medical emergencies on inpatient, the minute one actually happens, the patient gets shipped out ASAP given that in most psych settings people can't have IVs, much less get any higher level of medical care.

Ideally I think intern year medicine for psychiatry residents should be a mix of emergency, outpatient, and inpatient.

 

[NontradCA]

I believe psychiatry should be a subspecialty of IM: 3 years of IM followed by 3 year fellowship. But I'm grateful it's not.

 

[Merely]

I believe psychiatry should be a subspecialty of IM: 3 years of IM followed by 3 year fellowship. But I'm grateful it's not.

What kind of **** are you smoking

 

[michaelrack]

Not really. When someone is on an acute inpatient psych unit, you need to be able to recognize and deal with medical emergencies. We assume, as a doctor, you learn how to manage DM and HTN without having to do outpatient medicine.

Managing DM correctly, whether or not the patient is on insulin, is quite difficult. The basics of DM management are something the psych intern should try to pick up on IM months (whether inpatient or outpatient).

 

[Monocles]

I believe psychiatry should be a subspecialty of IM: 3 years of IM followed by 3 year fellowship. But I'm grateful it's not.

wtf... no... why?

 

[Mass Effect]

I still think outpatient is more relevant...family docs have to recognize and do initial management of emergencies quite frequently. They have to see common complaint after common complaint and not miss the dangerous stuff. The 'most people are totally fine, and a small percent of them are dying and just don't know it yet' is what I find most anxiety-provoking about clinic, and probably more analogous to what happens on inpatient psych. While we will need to be able to recognize medical emergencies on inpatient, the minute one actually happens, the patient gets shipped out ASAP given that in most psych settings people can't have IVs, much less get any higher level of medical care.

Ideally I think intern year medicine for psychiatry residents should be a mix of emergency, outpatient, and inpatient.

What?? Have you ever rotated on an inpatient psych unit? No doubt, some exist that are as you describe, but most of the ones I've worked on are med/psych and they absolutely do not ship a patient out for an IV. Outpatient family med is nowhere near inpatient psychiatry from my experience. Outpatient FM is more analogous to a PHP program.

 

[Mass Effect]

Managing DM correctly, whether or not the patient is on insulin, is quite difficult. The basics of DM management are something the psych intern should try to pick up on IM months (whether inpatient or outpatient).

Agreed, and when you learn it on the inpatient medicine service, I don't see a need to do outpatient. However, you can't compare learning it outpatient to what happens inpatient when a nurse calls you at 2 a.m. with a FS of 40.

 

[raisinbrain]

What?? Have you ever rotated on an inpatient psych unit? No doubt, some exist that are as you describe, but most of the ones I've worked on are med/psych and they absolutely do not ship a patient out for an IV. Outpatient family med is nowhere near inpatient psychiatry from my experience. Outpatient FM is more analogous to a PHP program.

I've definitely seen plenty that will send a patient out for an IV, and asked about this at most places I interviewed as well. Most places seemed to have the technical capabilities of placing an IV, but many would not insert an IV if there were any plans to leave it in more than a few hours (i.e. most IVs) due to concerns of having extra lines in the room / harm risk. Plenty of hospitals (academic center, VA, private, etc) would temporarily send back to a medicine floor and have psych on consult for the time being.

 

[Celexa]

What?? Have you ever rotated on an inpatient psych unit? No doubt, some exist that are as you describe, but most of the ones I've worked on are med/psych and they absolutely do not ship a patient out for an IV. Outpatient family med is nowhere near inpatient psychiatry from my experience. Outpatient FM is more analogous to a PHP program.

Med/psych units are not particularly common. I've worked in two inpatient psych settings formally (academic medical center and a community hospital) and in neither place could a patient receive IV medications. Same goes for my academic medical center's psych emergency room--PO and IM medications ONLY. We've very rarely taken patients onto the unit who had slightly heavier physical requirements--ie, injured in a suicide attempt and needing increased assistance in mobility, but the medical stability requirements remained. I don't know what you mean by 'medical emergency'; to me a medical emergency by definition means a patient can't be on a psych unit. Basic management of diabetes, HTN, routine UTI etc would be taken care of on the unit but no IV meds, no oxygen tanks, no advanced wound care, etc. I've never seen an inpatient psych patient who was receiving medical care that could not be administered outpatient.

Nice job insulting my experience and family medicine at the same time for no good reason. I interviewed at 13 programs this season and exactly two had med/psych units. If you've mostly rotated on med/psych units, which are distinctly different from general inpatient, that's great for you but not at all representative.

 

[Mass Effect]

Med/psych units are not particularly common. I've worked in two inpatient psych settings formally (academic medical center and a community hospital) and in neither place could a patient receive IV medications. Same goes for my academic medical center's psych emergency room--PO and IM medications ONLY. We've very rarely taken patients onto the unit who had slightly heavier physical requirements--ie, injured in a suicide attempt and needing increased assistance in mobility, but the medical stability requirements remained. I don't know what you mean by 'medical emergency'; to me a medical emergency by definition means a patient can't be on a psych unit. Basic management of diabetes, HTN, routine UTI etc would be taken care of on the unit but no IV meds, no oxygen tanks, no advanced wound care, etc. I've never seen an inpatient psych patient who was receiving medical care that could not be administered outpatient.

Nice job insulting my experience and family medicine at the same time for no good reason. I interviewed at 13 programs this season and exactly two had med/psych units. If you've mostly rotated on med/psych units, which are distinctly different from general inpatient, that's great for you but not at all representative.

First of all, no one insulted your experience. Given that you're a medical student, I think it's perfectly reasonable to ask if you've rotated on psych yet. I didn't realize you were an MS-4. I've been almost exclusively at med/psych units with the exception of MS-3. At my hospital, we absolutely do wound care, CPAP, IV meds, and the basics of HTN, UTI, etc. By medical emergency, I mean that you should be to recognize things like delirium, malignant catatonia, NMS, etc. all in the setting of acute psychiatric decompensation. Do some of them get transferred off the unit? Yes. But some of them are treated right on the psych unit with medicine input/reccs. When you're on call alone at 2 a.m., having a bit of inpatient medical knowledge is important.

 

[FlowRate]

having a bit of inpatient medical knowledge is important

Mostly for knowing when to call for help.

 

[DisorderedDoc417]

Not sure how helpful it is to see how outpatient PCPs manage psych problems since every outpatient PCP manages it differently. Some are terrified of starting SSRIs even. Others will be starting antipsychotics before sending them to you. Also, it's the main medical things that you'd learn in outpatient IM that you'll see on your inpatient psych months. But learning how to recognize and stabilize/treat medical emergencies will be your job if you're on an inpatient psych unit, particularly in the stand-alone ones that aren't attached to the hospital.

I don’t know what part of the country you’re in, but it is pretty sad if you know a single pcp “terrified of SSRIs”. That may be an oversight on your part. Also, I’d love to know which “medical emergencies” you plan on “stabilizing”. You dare touch a patient with a art line or CVC and you will be welcoming a lawsuit. I am in such a facility and they have IM staff in at all times to manage these sorts of situations. That and we don’t allow people who are not medically stable on admission. When something happens, you get them to an ER and the only “stabilizing” you’ll do is CPR. Seizures you have a little more that can be done, but you’ll get that on neuro, not inpatient IM.

 

[Celexa]

First of all, no one insulted your experience. Given that you're a medical student, I think it's perfectly reasonable to ask if you've rotated on psych yet. I didn't realize you were an MS-4. I've been almost exclusively at med/psych units with the exception of MS-3. At my hospital, we absolutely do wound care, CPAP, IV meds, and the basics of HTN, UTI, etc. By medical emergency, I mean that you should be to recognize things like delirium, malignant catatonia, NMS, etc. all in the setting of acute psychiatric decompensation. Do some of them get transferred off the unit? Yes. But some of them are treated right on the psych unit with medicine input/reccs. When you're on call alone at 2 a.m., having a bit of inpatient medical knowledge is important.

You implied I had no idea what I was talking about because I stated most psych units won't administer IV medications when your own experience appears to be the one that's outside of the norms. Med/psych is a different beast.

I never argued that inpatient medical knowledge is not important to psychiatry, I'm saying that emergency and outpatient evaluation are more salient to the vast majority of psychiatrists because our job most of the time with regard to medicine is to recognize when the patient needs a different type of doctor. Inpatient medicine is not ideal for developing that triage sense. I chose between medicine and psychiatry; I'm a little sad I'll be giving it up, but the fact remains we do not stabilize medical emergencies as psychiatrists. We transfer to the people who can.

 

[Mass Effect]

Mostly for knowing when to call for help.

That's where the recognition part comes in.

I don’t know what part of the country you’re in, but it is pretty sad if you know a single pcp “terrified of SSRIs”. That may be an oversight on your part. Also, I’d love to know which “medical emergencies” you plan on “stabilizing”. You dare touch a patient with a art line or CVC and you will be welcoming a lawsuit. I am in such a facility and they have IM staff in at all times to manage these sorts of situations. That and we don’t allow people who are not medically stable on admission. When something happens, you get them to an ER and the only “stabilizing” you’ll do is CPR. Seizures you have a little more that can be done, but you’ll get that on neuro, not inpatient IM.

We work at very, very different facilities. We never send our patients to the ER. We're in a hospital. We call medicine to come eval the patient if we think it's a problem worthy of a medical admit. But in the meantime, you deal with what's in front of you, get labs, order imaging, order EKG, etc. You don't just twiddle your fingers waiting for medicine resident to come see your patient.

And yes, there most certainly are PCPs terrified of SSRIs. They'll prescribe Prozac, maybe even Zoloft, but anything beyond that, they want a psych consult. Seen it multiple times. Has nothing to do with being an "oversight" on my part.

 

[DisorderedDoc417]

You implied I had no idea what I was talking about because I stated most psych units won't administer IV medications when your own experience appears to be the one that's outside of the norms. Med/psych is a different beast.

I never argued that inpatient medical knowledge is not important to psychiatry, I'm saying that emergency and outpatient evaluation are more salient to the vast majority of psychiatrists because our job most of the time with regard to medicine is to recognize when the patient needs a different type of doctor. Inpatient medicine is not ideal for developing that triage sense. I chose between medicine and psychiatry; I'm a little sad I'll be giving it up, but the fact remains we do not stabilize medical emergencies as psychiatrists. We transfer to the people who can.

He is right though that there are psychiatric emergencies (like the above listed) that we would deal with.

 

[DisorderedDoc417]

That's where the recognition part comes in.



We work at very, very different facilities. We never send our patients to the ER. We're in a hospital. We call medicine to come eval the patient if we think it's a problem worthy of a medical admit. But in the meantime, you deal with what's in front of you, get labs, order imaging, order EKG, etc. You don't just twiddle your fingers waiting for medicine resident to come see your patient.

Lol? I order these things on a routine basis. Chest pain workup isn’t a medical emergency. It’s a routine problem. Please don’t try to act like you’re not just another psych resident. When that patient has a STEMI, you’re done.

 

[DisorderedDoc417]

Lol? I order these things on a routine basis. Chest pain workup isn’t a medical emergency. It’s a routine problem. Please don’t try to act like you’re not just another psych resident. When that patient has a STEMI, you’re done.

Also — you don’t know what kind of place I work in. Don’t infer, that’s silly!

 

[Mass Effect]

You implied I had no idea what I was talking about because I stated most psych units won't administer IV medications when your own experience appears to be the one that's outside of the norms. Med/psych is a different beast.

I asked if you had done psych. You're a med student. Not everyone knows you're an MS-4. Stop being so sensitive. Also, I mentioned med-psych many, many posts ago so it was clear that's what I was referring to.

I never argued that inpatient medical knowledge is not important to psychiatry, I'm saying that emergency and outpatient evaluation are more salient to the vast majority of psychiatrists because our job most of the time with regard to medicine is to recognize when the patient needs a different type of doctor. Inpatient medicine is not ideal for developing that triage sense. I chose between medicine and psychiatry; I'm a little sad I'll be giving it up, but the fact remains we do not stabilize medical emergencies as psychiatrists. We transfer to the people who can.

I disagree and you may too, once you actually start residency and start taking solo call.

 

[DisorderedDoc417]

Lol? I order these things on a routine basis. Chest pain workup isn’t a medical emergency. It’s a routine problem. Please don’t try to act like you’re not just another psych resident. When that patient has a STEMI, you’re done.

Also — there are no medicine residents here. I see my patients. IM staff are on call for our facility though, to manage those problems that would be inappropriate for both you and myself to manage.

 

[Mass Effect]

Lol? I order these things on a routine basis. Chest pain workup isn’t a medical emergency. It’s a routine problem. Please don’t try to act like you’re not just another psych resident. When that patient has a STEMI, you’re done.

It becomes a medical emergency when it's a STEMI is my point. Don't mischaracterize what I said. I never implied I'm doing CT surgery or angioplasty at bedside on an inpatient psych unit. I said it's my job to RECOGNIZE a medical emergency and stabilize those people until the medicine team comes up. And I specifically mentioned emergencies specific to psychiatry.

 

[DisorderedDoc417]

It becomes a medical emergency when it's a STEMI is my point. Don't mischaracterize what I said. I never implied I'm doing CT surgery or angioplasty at bedside on an inpatient psych unit. I said it's my job to RECOGNIZE a medical emergency and stabilize those people until the medicine team comes up. And I specifically mentioned emergencies specific to psychiatry.

Hey, I agreed with you on that above my friend. We are on the same team here. We are both residents that need to know how to do our jobs. Absolutely there are valuable inpatient complaints that we see that aren’t strictly psych, but it is debatable whether or not 4 months of grueling inpatient *IM is necessary to handle them. We need to know how to recognize medical and psych emergencies of course and the first few steps... absolutely.

 

[Celexa]

He is right though that there are psychiatric emergencies (like the above listed) that we would deal with.

Of course, but you could spend literally months on inpatient medicine and not see NMS or malignant catatonia so more time isn't exactly going to hone your management of those. Delirium is of course as common as dirt, both on inpatient medicine and psych consults. We don't do inpatient medicine wards to learn psychiatry. My emergency month felt far higher yield in terms of starting to sort out medicine vs. psychiatric issues...granted I did it in a place without a separate psych emergency room so the medical emerg docs had to sort through everything that came in the door. Felt like 80% of what we get in inpatient medicine is diagnostically sorted before it gets to us, the 20% that isn't tends to be the chronically complexly ill with rare diseases (at least at my tertiary medical center), and it was in the family clinic that I saw some actual emergencies I could imagine walking into a psych clinic or being on a psych floor when they happened.

 

[DisorderedDoc417]

Of course, but you could spend literally months on inpatient medicine and not see NMS or malignant catatonia so more time isn't exactly going to hone your management of those. Delirium is of course as common as dirt, both on inpatient medicine and psych consults. We don't do inpatient medicine wards to learn psychiatry. My emergency month felt far higher yield in terms of starting to sort out medicine vs. psychiatric issues...granted I did it in a place without a separate psych emergency room so the medical emerg docs had to sort through everything that came in the door. Felt like 80% of what we get in inpatient medicine is diagnostically sorted before it gets to us, the 20% that isn't tends to be the chronically complexly ill with rare diseases (at least at my tertiary medical center), and it was in the family clinic that I saw some actual emergencies I could imagine walking into a psych clinic or being on a psych floor when they happened.

The things that are valuable to learn on IM are going to look more like: pt complains of SOB, CP, HTN urgency, Diarrhea/constipation, Headache, Pain, also I had one guy have a CVA, dysuria/Anuria/UTI, and lots of other common concerns. Even with NMS though, when things really hit the fan, that patient is going to the ICU. I think a mix of outpatient and inpatient is probably best. Get some all around exposure.

 

[DisorderedDoc417]

The things that are valuable to learn on IM are going to look more like: pt complains of SOB, CP, HTN urgency, Diarrhea/constipation, Headache, Pain, also I had one guy have a CVA, dysuria/Anuria/UTI, and lots of other common concerns. Even with NMS though, when things really hit the fan, that patient is going to the ICU. I think a mix of outpatient and inpatient is probably best. Get some all around exposure.

Lots of delirium in the older patients. Surprisingly the IM docs usually consult psych for that.

 

[Celexa]

The things that are valuable to learn on IM are going to look more like: pt complains of SOB, CP, HTN urgency, Diarrhea/constipation, Headache, Pain, also I had one guy have a CVA, dysuria/Anuria/UTI, and lots of other common concerns. Even with NMS though, when things really hit the fan, that patient is going to the ICU. I think a mix of outpatient and inpatient is probably best. Get some all around exposure.

Which is...exactly what I've been saying, no? I'm not the guy who said we should do all outpatient.

In my facility it seems like the IM docs handle delirium if it's straightforward, and then kind of toss a coin into the air for whether or not they first call psych or neuro for AMS.

 

[DisorderedDoc417]

Which is...exactly what I've been saying, no? I'm not the guy who said we should do all outpatient.

In my facility it seems like the IM docs handle delirium if it's straightforward, and then kind of toss a coin into the air for whether or not they first call psych or neuro for AMS.

Yeah — no doubt they are capable, just seems like they punt it like as you elude to.

 

[TexasPhysician]

I've been almost exclusively at med/psych units with the exception of MS-3. At my hospital, we absolutely do wound care, CPAP, IV meds, and the basics of HTN, UTI, etc. By medical emergency, I mean that you should be to recognize things like delirium, malignant catatonia, NMS, etc. all in the setting of acute psychiatric decompensation. Do some of them get transferred off the unit? Yes. But some of them are treated right on the psych unit

Amazing how different geography can be. I’ve worked at multiple inpatient centers, and I’ve never even smelled a med/psych unit.

 

[Mad Jack]

Amazing how different geography can be. I’ve worked at multiple inpatient centers, and I’ve never even smelled a med/psych unit.

I've been in quite a few hospitals in the NE, and I've never seen a true med/psych unit either. The second a patient sneezes they get transferred to the hospitalist at most places.

 

[WingedOx]

I've been in quite a few hospitals in the NE, and I've never seen a true med/psych unit either. The second a patient sneezes they get transferred to the hospitalist at most places.

There's been one at a community hospital in Chicago, but I'm not entirely convinced of its quality. None of the academic places in the area have one, though UIC's unit handles more medically sicker places than most.

In truth though, the rate limiting step for what can be handled on the unit isn't usually physician skill, it's nursing.

 

[Mass Effect]

I've been in quite a few hospitals in the NE, and I've never seen a true med/psych unit either. The second a patient sneezes they get transferred to the hospitalist at most places.

That's definitely not the case at mine. Depends on where you're at. In fact, in recent weeks, residents have complained our inpatient unit has too many medical patients.

Just a quick scan and I found a few med/psych units at academic centers. There are many more. It may not be the norm, but it's definitely not an anomaly either. Anyway, my point was that inpatient medicine is valuable for call during residency and to those planning a career in inpatient psych.