A "both pro and con" that hasn't yet been mentioned (and which can relate to the issue of countertransference, etc.) is the awesome continuity of care psychiatry allows you to do. I think as residents you often get into a mode in which "continuity" means that you see a patient more than once, or they're in your therapy clinic for a whopping 18 months. Now that I've been doing this gig for 6 1/2 years (and many of my patients show no sign of leaving) I think I'm appreciating this more. The downside of course is that you can have a few PITAs that you wish you could rotate away from, but even with these, the ongoing repeated encounters gives a better idea of who they are as people, why they rely on the hospital for their socialization, what factors contribute to their repeated relapses, etc. As an admitting resident, I know that the frequent flyer is someone that you just want to scorn and turf off as quickly as possible. However, as an attending, each subsequent admission can be an opportunity to assess what they're doing well, or what safety outlets we failed to put into place last time, or why the medications that seemed to be working well for the past year suddenly stopped helping. I've follow a number of patients now who 3-4 years ago were the med seekers and frequent flyers who looked like they'd never leave the hospital, or who would be back in the ER the minute you discharged them--but now are relatively stable (albeit not always "high functioning") outpatients. I need to add that these aren't people I've done a lot of real therapy with--it's mostly been through repeated monthly 20 minute med checks and occasional repeat admissions that I've gotten to know them well and help them make these incremental lifestyle adjustments.
