Psych outside the hospital

[withoutface123]

Hello! MS3 en route to MS4 here. So I really enjoyed my psych rotation and rotated at quite a few sites that allowed me to get a hang of different aspects of psych: VA inpatient, VA outpatient, addictions, inpatient adult, consult and liaison. Each one had aspects that I liked and didn't like but overall I came out of the rotation with a positive experience and excited about exploring the possibilities for matching into the specialty.

Something has been bothering me lately. I know a big part of psychiatry is being a good listener and talking with patients. It's one thing that I've enjoyed on every rotation, listening to people's stories, and obviously a major tenet of psychiatry. I've found myself, however, when out in the "real world", every once in a while, when faced or in the vicinity of someone with obvious psych issues, sometimes growing a sense of, I guess, annoyance in my mind. For example, I'm at coffee bean right now, and there is a guy who has been talking the barista's ear off for the last 20 minutes about a bunch of stuff, and I'm just sitting here thinking to myself, thank God I'm not that barista. Another time, while studying at a Starbucks, I engaged in a convo with this man who was clearly schizotypal and quickly within a matter of minutes realized that I needed to find a way out of the convo, otherwise I'd be there for forever. Even in some social situations, I find myself running out of small talk and just sort of patiently waiting to move on.

So I guess my question is, is this worrisome? I feel like in a clinical or inpatient context, I would be happy to sit down and talk or listen to these folks, but my sort of indifference and sometimes borderline annoyance of them outside of the clinical setting worries me. In most of these types of situations, I usually have something else that I'm working on and thus don't have time to sit down and engage in some lengthy conversation. Anyone else have thoughts or experiences like these? Is this just being human? Something to worry about as a future psychiatrist?

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[erg923]

I feel like in a clinical or inpatient context, I would be happy to sit down and talk or listen to these folks, but my sort of indifference and sometimes borderline annoyance of them outside of the clinical setting worries me.

Why?

By definition, these are disturbances in behavior that do not serve the person well in society (e.g., interfere with interpersonal functioning). I enjoy helping those in psychiatric distress. That does not mean that I seek psychopathology when making friends or when I was dating. Delusions are usually a buzzkill, lets be honest. And nothing ruins a round of golf more than the dude who wont shut up about his generalized anxiety. I actually thank God everyday that I am married to such a level-headed superwoman. It makes life (and parenting) much easier.

 

[smalltownpsych]

I have gotten better at avoiding pathological relationships outside the clinical setting. Setting good boundaries in a sensitive and caring way and recognizing when to set them is an important skill that we learn. When I was young and naturally empathic and untrained, I would get sucked into conversations with people with all kinds of problems and at times I hated it. Now they talk to my wife because she hasn't quite learned that skill yet!

 

[Armadillos]

My theory is the world is full of a ton of folks with psych pathology, atleast in psych you can confront and address it instead of just smiling and putting up with it like everyone else.

 

[mcatjelly]

Definitely a human thing. I'm a Psychiatric Technician hoping to one day become a Psychiatrist, and I feel infinitely more patient listening to individuals in the hospital than I do listening to people outside of work. I think a large part of it is simply knowing that in the hospital, it's my job to be supportive, whereas in the real world, my personal responsibility for their well-being is signficantly decreased.

 

[VMSmith]

Just because you enjoy helping people with psychiatric disorders in a clinical setting, where there are clear personal boundaries and you say goodbye to the patient after 30-45 minutes, doesn't mean that you need to also enjoy speaking with someone with schizotypal personality disorder for 30-45 minutes when all you're just trying to do is get yourself some g-d coffee and then go sit quietly, read and relax for a few minutes.

Dermatologists (hopefully) don't go around in their personal lives constantly being interested in other peoples' rashes. They just want to get coffee and relax too.

 

[Bartelby]

I agree with what has been said so far, and (for voluntary settings at least) would add that I have a great deal of respect for people who acknowledge their problems and come willing to work toward a solution. It can be much less frustrating to, for instance, work with a borderline patient who is trying their best to implement positive change than to interact with a borderline person out in the world who flies into an unprompted rage at you.

 

[GreenBirch]

Normal and human response.

In some of the super tough cases, I think to myself... when the encounter is over and the patient goes home, the patient and loved ones will be the ones who have to live with the patient's illness. But lucky for me... when I go home, I get to take off those burdens and live my own life.

 

[MacDonaldTriad]

Mentally ill people who hold up lines or pan handle can be annoying and it is OK to be annoyed if they are.

At all social events, there is a good likelihood that someone there will have a mental illness and an almost certainty that someone is close to someone that does have a mental illness. Inevitably during small talk, someone will ask me what I do. I don’t like telling people I’m a psychiatrist very much so I tell them I’m a physician. This is always followed by “what kind of physician”. So I end up telling them. This always results in one of two responses. Either they stop talking and try and get away from me, or they will not stop asking questions. People have such a distorted view about what we do. I’m considering becoming comfortable with pretending to be a proctologist. I’m sure that would change the subject in a second.

 

[F0nzie]

Inevitably during small talk, someone will ask me what I do. I don’t like telling people I’m a psychiatrist very much so I tell them I’m a physician. This is always followed by “what kind of physician”. So I end up telling them. This always results in one of two responses. Either they stop talking and try and get away from me, or they will not stop asking questions. People have such a distorted view about what we do.

You don't like the paranoia repellant that comes with the title? I think it's a major perk.

 

[MacDonaldTriad]

I agree, the repellant part is probably driving away a larger portion of people I don’t care to converse with than those who would be pleasant. It is really the other side of the coin. Those people trying to get validation that their sibling, child or spouse’s family are nuts and they will keep supplying you with details until you agree with them. All physicians should avoid giving opinions without evaluating a patient, but in psychiatry this is especially true. Family members can give very stilted and highly filtered information.

I’m often tempted to pull out the Don Rickles approach. “Oh, this is your husband’s sister you’re talking about. I assumed this condition was more genetic.”

 

[prone2xl]

OP I felt the sammmmmmme way and halfway through interviewing for psych this year I questioned my choice of specialty and worried I was headed for a world of hurt. But for some reason I feel like it's different in the clinical setting. I can't describe it, but I think it'll be fine. Heck I hope so! Sometimes I worry if I'll be so drained day in and day out in residency and practice beyond. Any tips from the pros would be greatly appreciated !

 

[DD214_DOC]

Setting limits and maintaining boundaries is a skill that will serve you well both in and out of clinical settings. Once I got used to doing it in practice, it became much easier to simply tell a salesperson, "No, not interested" without any explanation and then going on about my business. You will learn why it's not useful to provide a reason/excuse.

 

[smalltownpsych]

OP I felt the sammmmmmme way and halfway through interviewing for psych this year I questioned my choice of specialty and worried I was headed for a world of hurt. But for some reason I feel like it's different in the clinical setting. I can't describe it, but I think it'll be fine. Heck I hope so! Sometimes I worry if I'll be so drained day in and day out in residency and practice beyond. Any tips from the pros would be greatly appreciated !

Knowing what you are doing therapeutically and interpersonally is key to not getting worn out. If you are focussed on getting the most effective medication with the least side effects, don't get embroiled in a discussion about their significant other, disability application, mean case manager, unreasonable employer, etc. If you are working with some of those issues, then you tell the patient over and over that we can't fix them, but what can you do differently. It is very tiring and not therapeutic to listen to someone complain or feel sorry for themselves.