I'm completely torn...any of you out there want to tell me why you chose one or the other?
psych vs. PM&R
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Those fields are completely different. You're probably not going to get a helpful answer without providing a lot more information about what you think is important in a specialty, etc
Hmm...they actually seem similar in a number of ways to me...
I love that both of them involve returning function in areas that are most dear to the patient (tasks of daily living, social interaction with loved ones...). In both of them I would get the opportunity to really talk to the patients and have the continuity of care that I find makes patient interaction gratifying. I think both specialties attract professionals who are team players interested in helping patients first and foremost (where I find in some other specialties it seems to be more about the cool medicine first, and the patients who benefit from it second). I loved primary care too, but DM, HTN, and even well visits just didn't intrigue me much. I also felt like I was running around all day trying to get through all the appointments and didn't get enough time with any one of them.
I really love the time I would get to spend with patients on psych. I loved this rotation and found myself on all the other rotations longing to spend more time attending to the "non-organic" issues the patient was coping with. I think this is why consult service was so much fun for me. I do wonder, though, if I would miss physical diagnosis and procedures...maybe ECT would be enough? I also really enjoy being an advocate for my patients and love doing competence/dementia screening and helping to provide safe home environments for my patients who could not have done this for themselves. I really enjoyed doing home competency visits with my attending. I do wonder, though, if it would become exhausting to be the receptacle for so much psychosis and negative emotion.
On the rehab side, I would get to use such great gadgets and be able to perform procedures and use my hands for physical diagnosis. I always find myself drawn to reading about biotech applications in a rehab context and think about new stuff I could help design, etc. There is so much fascinating technology in the works and I see this to be a very exciting field to be involved with. I think there is great variety in rehab and I love the idea of being able to do EMG's, injections, etc. I also really enjoy doing musculoskeletal exams and find this pathology a lot of fun to address. You run the gamut from athletes to CP to little old ladies and each one has their own brand of pathology to tend to. I wonder, though, if in practice I would really see that kind of variety or if I would really get the opportunity to talk to my patients as much as I would like.
There are many more reasons I find both to be gratifying possibilities, but I waver back and forth.
So...why did you guys choose one or the other? What were your biggest selling points?
I love that both of them involve returning function in areas that are most dear to the patient (tasks of daily living, social interaction with loved ones...). In both of them I would get the opportunity to really talk to the patients and have the continuity of care that I find makes patient interaction gratifying. I think both specialties attract professionals who are team players interested in helping patients first and foremost (where I find in some other specialties it seems to be more about the cool medicine first, and the patients who benefit from it second). I loved primary care too, but DM, HTN, and even well visits just didn't intrigue me much. I also felt like I was running around all day trying to get through all the appointments and didn't get enough time with any one of them.
I really love the time I would get to spend with patients on psych. I loved this rotation and found myself on all the other rotations longing to spend more time attending to the "non-organic" issues the patient was coping with. I think this is why consult service was so much fun for me. I do wonder, though, if I would miss physical diagnosis and procedures...maybe ECT would be enough? I also really enjoy being an advocate for my patients and love doing competence/dementia screening and helping to provide safe home environments for my patients who could not have done this for themselves. I really enjoyed doing home competency visits with my attending. I do wonder, though, if it would become exhausting to be the receptacle for so much psychosis and negative emotion.
On the rehab side, I would get to use such great gadgets and be able to perform procedures and use my hands for physical diagnosis. I always find myself drawn to reading about biotech applications in a rehab context and think about new stuff I could help design, etc. There is so much fascinating technology in the works and I see this to be a very exciting field to be involved with. I think there is great variety in rehab and I love the idea of being able to do EMG's, injections, etc. I also really enjoy doing musculoskeletal exams and find this pathology a lot of fun to address. You run the gamut from athletes to CP to little old ladies and each one has their own brand of pathology to tend to. I wonder, though, if in practice I would really see that kind of variety or if I would really get the opportunity to talk to my patients as much as I would like.
There are many more reasons I find both to be gratifying possibilities, but I waver back and forth.
So...why did you guys choose one or the other? What were your biggest selling points?
Psych and PM&R are my two top choices at this point as well- I thought I was the only one! I'm drawn to these fields for a lot of the same reasons as physpsy, especially the aspect of restoring function. I also like the fact that both of these fields involve longer visits and often involve long-term relationships with patients. Not that I have a bunch of experience in either field- I won't begin my 3rd year rotations until this April- but I've done my homework, so to speak. I'm interested to hear from MS 4's, residents or docs who made a similar choice at one point.
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Well, I was definitely torn between the two. Psych was always my first love but I am an exercise phys and rehabilitation guy by avocation and necessity. I ultimately stayed with psych, although I'd be lying if I said I never wondered if I made the right choice (granted, I'm only 3 weeks into residency lol).
Both of you covered why they really are so similar. They are the only two fields in medicine in which we seek to help the patient heal themselves. Sure, every specialty gives lip service to lifestyle change and prevention, but these are the only two fields that roll up their sleeves and get their hands dirty with the actual act of helping the patient put it into practice.
I still intend on making a huge focus of my practice and research working with people with MSK/neuro issues. And ultimately I felt like psych was a better vehicle for that.
I've been a MSK/neuro patient myself for almost 12 years (parsonage-turner syndrome with involvement of superficial back muscles...leading to becoming a walking textbook of spinal pathology and si joint, wrist, elbow, and shoulder issues). I don't look it. Or act like it. And although call nights are so bad I'm swaying on my feet from pain and myelopathic leg weakness half the night, I have no clue what taking an opiate feels like.
I've seen my share of back pain and neuro patients. And while some do great despite their physical pathology (I'm a chump compared to say...Tim Champion, Master Hinkle, or Nick Scott), most don't. Some of this of course comes down to basic genetic and constitutional resilience, pain tolerance/sensitivity, and muscle genetics. But that still leaves a huge gulf between your 'average' chronic MSK/neuro patient, and the exceptional.
Rightly or wrongly, my personal experience, the testimonies of the people who put me to shame, and hearing the stories of others with similar debilities who've allowed their physical injuries dictate their lives, have led me to believe--rightly or wrongly--that much of the difference is psychological.
Which is ultimately why I ended up choosing this path. I felt like I could do more with these patients by helping them get their minds right, so to speak. Mindfulness and breathing-relaxation techniques to decrease pain, to break the cycle of pain-spasm-pain-spams that can leave your whole back locked up as a single unit, to keep them from becoming dependent on opiates and muscle relaxants. Cognitive approaches to help them recognize pain as a signal of underlying dysfunction. To help them see the dysfunction as the real enemy, not the pain. And to help them recognize that not all pain is bad.
That said, there is a lot of work and a lot of research on the physical side of things that needs to be done. And we need inspired and open-minded people in PM&R now more than ever. We are a far, far cry from having optimized approaches to rehabilitation for a lot of MSK/neuro issues. I hit the limits of what conventional pm&r could provide as far as rehabilitation a long, long time ago. I got where I am by a combination of stubborn bloody-mindedness (which both hurt and helped), and having to resort to going back to first principles and designing my own rehabilitation/PT protocols from first principles, reading the kinesiology and exercise phys textbooks on my own (and no small amount of help along the way from Cressey, Boyle, and Robertson...none of whom are physicians).
Sorry for the ramble. And I'm sure that sounded extremely egotistical, but *shrug* hopefully you get something out of it.
Both of you covered why they really are so similar. They are the only two fields in medicine in which we seek to help the patient heal themselves. Sure, every specialty gives lip service to lifestyle change and prevention, but these are the only two fields that roll up their sleeves and get their hands dirty with the actual act of helping the patient put it into practice.
I still intend on making a huge focus of my practice and research working with people with MSK/neuro issues. And ultimately I felt like psych was a better vehicle for that.
I've been a MSK/neuro patient myself for almost 12 years (parsonage-turner syndrome with involvement of superficial back muscles...leading to becoming a walking textbook of spinal pathology and si joint, wrist, elbow, and shoulder issues). I don't look it. Or act like it. And although call nights are so bad I'm swaying on my feet from pain and myelopathic leg weakness half the night, I have no clue what taking an opiate feels like.
I've seen my share of back pain and neuro patients. And while some do great despite their physical pathology (I'm a chump compared to say...Tim Champion, Master Hinkle, or Nick Scott), most don't. Some of this of course comes down to basic genetic and constitutional resilience, pain tolerance/sensitivity, and muscle genetics. But that still leaves a huge gulf between your 'average' chronic MSK/neuro patient, and the exceptional.
Rightly or wrongly, my personal experience, the testimonies of the people who put me to shame, and hearing the stories of others with similar debilities who've allowed their physical injuries dictate their lives, have led me to believe--rightly or wrongly--that much of the difference is psychological.
Which is ultimately why I ended up choosing this path. I felt like I could do more with these patients by helping them get their minds right, so to speak. Mindfulness and breathing-relaxation techniques to decrease pain, to break the cycle of pain-spasm-pain-spams that can leave your whole back locked up as a single unit, to keep them from becoming dependent on opiates and muscle relaxants. Cognitive approaches to help them recognize pain as a signal of underlying dysfunction. To help them see the dysfunction as the real enemy, not the pain. And to help them recognize that not all pain is bad.
That said, there is a lot of work and a lot of research on the physical side of things that needs to be done. And we need inspired and open-minded people in PM&R now more than ever. We are a far, far cry from having optimized approaches to rehabilitation for a lot of MSK/neuro issues. I hit the limits of what conventional pm&r could provide as far as rehabilitation a long, long time ago. I got where I am by a combination of stubborn bloody-mindedness (which both hurt and helped), and having to resort to going back to first principles and designing my own rehabilitation/PT protocols from first principles, reading the kinesiology and exercise phys textbooks on my own (and no small amount of help along the way from Cressey, Boyle, and Robertson...none of whom are physicians).
Sorry for the ramble. And I'm sure that sounded extremely egotistical, but *shrug* hopefully you get something out of it.
