Pre-Meds chime in on Psychiatry - can some practicing Psychiatrists offer input?

[flatearth22]

http://forums.studentdoctor.net/showthread.php?t=849247

I know as a pre-med it's far too early to concern myself with medical specialties, but at the same time psychiatry really is what first procured my interest in medicine in the first place. That being said, why is there such demonization/controversy when it comes to Psychiatry? And no, I'm not just talking about scientology, but in general. I realize it may be less "concrete" than other sciences, but still what makes Psychiatry a pseudoscience? Or for that matter a Psychiatrist a "fake doctor".

I shadow several doctors who are very heavy hitters in academic medicine at some very high ranking schools, and they absolutely detest psychiatrists. They will go back and forth on horror stories with psychiatrists, and talk about their incompetence and status of the field as pseudo science. Apparently, this is a fairly common view because they talk about how all their colleagues feel the same way. Lol I cannot even explain how much they hate it. I saw a resident get ridiculed for weeks, just because he once said that he strongly considered going into psych instead of surgery. To a lot of the more prestigious specialties, psychiatrists truly are not seen as actual doctors. Not my view, but I'm just sayin.

I am troubled by some of the controversy about the field tho. Around half of the writers of the DSM-IV receive money from pharmaceutical companies, and it really makes you wonder what their intentions are when they say you should take a certain drug. I saw a psychiatrist once, and she tried so hard to push meds on me. Just because I said I spent more money than I should have on some new clothes the other day, she suspected I had a mania. And tried convincing me that I was depressed, and wanted me to take antidepressants. Lol I'm extremely happy, and I have no idea what her deal was.

Psychiatry is probably the easiest specialty. There are psychiatrists on our mental health unit who diagnose everyone with bipolar disorder disorder. Everyone. How easy is that? You have hallucinations? You have bipolar disorder. You get depressed? You have bipolar disorder. You complain of anxiety? You have bipolar disorder. I'm not even sure that mood stablizers help those people. Whenever I see this, I cringe. It didn't seem that bad in psych 5 or so years ago when I worked there as a student. Unfortunately, we didn't really help patients back then either.

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[Encephalopathy]

There's lots of reasons for the stigma against psychiatry. One is the long-standing societal stigma against mental illness itself, which has extended to the doctors that treat it. I also think a reason that we're not considered "real" doctors is that from around the 50s to the 80s we didn't have great pharmacological treatment options and so relied heavily on psychoanalytic psychotherapy which IMO isn't really "medical". We also don't do procedures or stick our fingers in people's rectums. And lastly, it's true that there are a lot of bad psychiatrists out there practicing (I agree that bipolar is overdiagnosed). This may be a function of the large number of psychiatrists needed and the dearth of medical students willing to go into the field because of the stigma, meaning that many relatively less qualified applicants are accepted to psych residency programs.

My advice - if you like psych, go for it. It's not worth being miserable at your job for the rest of your life (e.g. surgery) because you are worried about other people's perceptions of your profession.

 

[tkim]

We also don't do procedures or stick our fingers in people's rectums.

Dude, that's a plus.

 

[Starlightembers]

I'm merely an hSDN-er (soon to be SDN-alumni, though); however, as much as I respect StudyShy immensely, I feel that I most strongly disagree with her comments. Perhaps the resident and attending psychiatrists here feel differently, so I encourage them to correct me if they feel I'm wrong; but the fact that Bipolar Disorder is becoming an umbrella diagnosis (question for the MD/DOs here: does the need to bill insurance have any bearing on what you technically diagnose someone as) does not somehow make the specialty the "easiest". You can't just diagnose people, you also have to treat them and, in relation to that, I would feel that patients with mental illness and substance abuse issues would be some of the hardest, most complex to treat. Two patients with the same diagnosis will likely never present in the exact same way, nor will they respond to treatment the same (thus why many patients complain of feeling as if they are guinea pigs). Many, if not most, are chronic and going to have more than one episode. More so, you're treating them with limited community resources that will only become more limited as funding is continually cut. For some reason, I can't see that as easy.

 

[Shufflin]

Whoever said that psychiatry was the "easiest" has no clue what he or she is talking about, and has never served on a psychiatry clerkship. Mental illness in the setting of substance abuse and/or pregnancy and/or delinquency cannot be more challenging. Surgeons, I can argue, do the least amount of thinking and analysis of their patient's conditions. Psychiatrists are some of the most intelligent physicians on the ward at my stellar institution, and the patients are grateful for them.

 

[michaelrack]

Whoever said that psychiatry was the "easiest" has no clue what he or she is talking about, and has never served on a psychiatry clerkship. Mental illness in the setting of substance abuse and/or pregnancy and/or delinquency cannot be more challenging. Surgeons, I can argue, do the least amount of thinking and analysis of their patient's conditions. Psychiatrists are some of the most intelligent physicians on the ward at my stellar institution, and the patients are grateful for them.

some surgeons would disagree.

Psychiatry is the easiest specialty to learn/memorize, but can be difficult in the application. The psychiatry written boards are the easiest of all medical boards, the psychiatry oral boards (which require practical application of psychiatric knowledge) are among the most difficult

 

[Manicsleep]

You can't reduce it down to that level of simplicity and then compare the two things. Things are complex and not black and white. Unfortunately there is a level of stigma associated with psychiatry and mental illness.

This is a scenario I have seen play out multiple times on the consult service. Physician didn't learn much about psychiatry and when AP (attending physician) has to deal with patient(s) with mental illness a certain amount of anxiety is bound to be present due to their ignorance of the subject. They of course usually then consult psychiatry, who often states that nothing is acutely wrong, especially with personality disorders. AP then resorts to blaming psychiatry and projecting their incompetence/ignorance on the consulting psychiatric team.

There is also an unfortunate aspect of physicians not really understanding one another. PCPs are just secretaries who don't really understand anything, psychiatrists are crazy, neurologists do actually do anything except order meaningless tests, surgeons are overpaid carpenters/mechanics but not as skilled, ER docs just dump everything and make things worse, pathologists and radiologists have the personality of gollum...the list goes on. The fact is that these things are just not true and generally based on something personal.

For example, in many ways my sleep medicine practice is much easier than my psychiatry practice but in some ways it is more difficult. I could say psychiatry is easier or sleep medicine is easier, depending on the situation but in reality, they are both complex if done correctly. However, my psychiatry colleagues mostly think that my sleep practice are like my days off and my sleep colleagues think the exact opposite. In case you are wondering, if I had to rate it, they are both about the same because we actually see insomnia patients but even then sleep feels easier because of the reimbursement.

 

[atsai3]

There's nothing to defend. Unfortunately, many of the criticisms identified in the premed postings are well deserved.

Those guys who are eating drug rep food, taking drug company research grants, publishing methodologically unfit research, lying about their industry sponsored revenue and KOL activities to their department chairpersons, and overdiagnosing bipolar? They bring shame to the entire profession.

 

[Bartelby]

There's nothing to defend. Unfortunately, many of the criticisms identified in the premed postings are well deserved.

Those guys who are eating drug rep food, taking drug company research grants, publishing methodologically unfit research, lying about their industry sponsored revenue and KOL activities to their department chairpersons, and overdiagnosing bipolar? They bring shame to the entire profession.

Seems to me like you could defend the vast majority of psychiatrists who don't do those things.

 

[notdeadyet]

Seems to me like you could defend the vast majority of psychiatrists who don't do those things.

Yes, but stereotypes of a group aren't based on the majority of its members, they're based on the most repulsive minority.

 

[notdeadyet]

Psychiatry is one of the easiest specialties if you're willing to do it poorly. It's one of the hardest if you want to do it well.

 

[Manicsleep]

There's nothing to defend. Unfortunately, many of the criticisms identified in the premed postings are well deserved.

Umm, not really. I have done nothing to deserve such criticism and neither have any of my colleagues or the overwhelming majority of physicians in this country.

I disagree with you completely and your statement makes it seem like stereotyping and bigotry are always representations of the truth. They may be based in the truth but universally don't represent the whole and those anecdotes can usually be applied across the board.

If you tell me your demographics, I am sure there is evidence of what your profession, race, sex etc etc have done to make you seem like a monster, kind, smart, dumb, rich or poor...if the deeds of others were applicable to you or predictive of your actions. The fact that this has been done in the past should teach us that such generalizations should be avoided at all costs.

 

[Doc Samson]

Umm, not really. I have done nothing to deserve such criticism and neither have any of my colleagues or the overwhelming majority of physicians in this country.

I disagree with you completely and your statement makes it seem like stereotyping and bigotry are always representations of the truth. They may be based in the truth but universally don't represent the whole and those anecdotes can usually be applied across the board.

If you tell me your demographics, I am sure there is evidence of what your profession, race, sex etc etc have done to make you seem like a monster, kind, smart, dumb, rich or poor...if the deeds of others were applicable to you or predictive of your actions. The fact that this has been done in the past should teach us that such generalizations should be avoided at all costs.

AT didn't say all psychiatrists have behaved shamefully, he said that the actions of a group of very prominent psychiatrists that we often refer to as our "leaders in the field" have brought shame to us all. I can't disagree.

I also can't disagree that the lazy psychiatrist in practice who does diagnose everyone with some iteration of Bipolar DO (and there are an awful lot of them in my neck of the woods) also brings shame to us all.

When practiced well, psychiatry is a difficult and noble profession. Unfortunately, some of our colleagues exploit the nebulousness inherent in our diagnostic schema and the vulnerability of our patients for their own gain.

 

[Chimed]

You can't reduce it down to that level of simplicity and then compare the two things. Things are complex and not black and white. Unfortunately there is a level of stigma associated with psychiatry and mental illness.

This is a scenario I have seen play out multiple times on the consult service. Physician didn't learn much about psychiatry and when AP (attending physician) has to deal with patient(s) with mental illness a certain amount of anxiety is bound to be present due to their ignorance of the subject. They of course usually then consult psychiatry, who often states that nothing is acutely wrong, especially with personality disorders. AP then resorts to blaming psychiatry and projecting their incompetence/ignorance on the consulting psychiatric team.

There is also an unfortunate aspect of physicians not really understanding one another. PCPs are just secretaries who don't really understand anything, psychiatrists are crazy, neurologists do actually do anything except order meaningless tests, surgeons are overpaid carpenters/mechanics but not as skilled, ER docs just dump everything and make things worse, pathologists and radiologists have the personality of gollum...the list goes on. The fact is that these things are just not true and generally based on something personal.

 

[peppy]

According to an article someone posted on another forum, psych has the lowest risk of being sued for malpractice of all specialties:
http://www.nejm.org/doi/full/10.1056/NEJMsa1012370
You could argue that this means we're not actually such horrible doctors.
(more seriously, I do recognize of course that many factors go into the issue of litigation).

I do agree with the view that Psych is a hard specialty to do well, but an easy one to do poorly. You might be able to get by diagnosing everyone with bipolar disorder due to how desperate many places are for psychiatrists, but clearly we all recognize that's not really the right way to practice. Just like there are some bad and lazy family medicine docs out there who just refer everything out - but yet to be an excellent family medicine doc is quite challenging. If you want to be a good psychiatrist, it does take effort to educate yourself about the nuances of psychopharmacology, the new research out there about neuroscience, etc. I've definitely seen the good psychiatrists make a difference for patients and help people.

 

[wholeheartedly]

Psychiatry is one of the easiest specialties if you're willing to do it poorly. It's one of the hardest if you want to do it well.

 

[Neurosis]

thanks for the responses.