Psychiatry as a Specialty Choice

[HarmlessGhost]

When I was growing up, I had always thought I'd want to be a psychiatrist. I then experienced significant emotional and, at times, physical abuse at the hands of a family member, and that family member ultimately committed suicide. This whole situation is incredibly complex and not really something that I should get into here. In any case, this led me to believe that I should not go into psychiatry for multiple reasons. The first is that I was worried the emotional baggage that I received would take away from my ability to give my future patients good care. I've learned since then that this is not necessarily the truth, but it did keep me away from pondering the specialty for a long time. Second, the inpatient care my family member received was not good, and the treatment team let them return to our home despite being a risk to those of us living there. Her treatment while inpatient was ultimately inadequate and chalked up to other medical complications despite their LONG history with mental illness. I did not want to become a physician that would let something like that happen. Again, I've learned that some things are unavoidable, and my one bad experience is not necessarily reflective of the field as a whole. Third, I struggled with the knowledge that psychiatric conditions are often not the direct result of some neurobiological departure from normal. Rather, many often are more related to society, strongly contributing to and worsening mental illness. This is still something I have not overcome, and I doubt I will because it seems to be a more universal truth. Even now, on my psychiatry rotation, I have a patient who is admitted because they are homeless, leading to severe depression with suicidal ideation on top of anxiety. With more social support, this patient likely would not have developed these conditions, and they certainly would not be as severe as they are now. With these things in mind, I have set up a wonderful application for general surgery, which I love.

During the first two weeks, I fell in love with psychiatry. I adored the patients, their stories, the material, and even doing practice questions. I felt that I was able to have a positive impact on my patients, even just through letting them talk and share with me. I worked more closely with my preceptor and started to transition my plans to apply psychiatry. That is how much I loved those first two weeks. Then, over the next few weeks, I have found myself to be exhausted after leaving the hospital around 3:00 PM (and we don't come in until 9:00 AM). I've been more tired on this rotation than I was on general surgery and my busiest rotation where I was independently seeing and writing notes for 20-30+ patients from 7:00 AM until 7:00-8:30 PM Monday through Saturday. I am starting to reconsider my options again because of this. I don't necessarily dread going to the hospital every morning, but I also don't look forward to it. I understand that the lifestyles of general surgery and psychiatry are incredibly different; however, these are both invasive and intimate specialties, albeit in different ways. I just am trying to collect more information or opinions I suppose. I don't really plan on using an online forum to make my decision, but I am thinking that maybe this could give me some other options to consider.

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[Sushirolls]

....I've been more tired on this rotation than I was on general surgery and my busiest rotation where I was independently seeing and writing notes for 20-30+ patients from 7:00 AM until 7:00-8:30 PM Monday through Saturday. ...

This line above, is what would make me say lean into surgery.

Your psych/abuse history can be overcome and not a barrier for doing psych.
Patients you identify with will become less, and change over time. I.e. in time the same homeless patient who presents to the unit you may have negative counter transference for knowing they had numerous supportive services before them presented to them and they still chose a harder path...

There are plenty of folks who wandered into psych because of their own personal or family mental health overlaps. Sometimes this can be a barrier that should keep a person away from the field, other times its just another life experience to add to their understanding of the greater human journey.

But that line above, if you are feeling tired, drained, whatever with your psych rotation; surgery may be the better play of Psychiatry.

 

[TexasPhysician]

Many experience hardships. That isn’t a barrier to psych. It could even make you more effective.

That said, I really enjoy psych. If I didn’t have kids, I could easily do this for 12 hours/day regularly. In many environments, psych is fun for me. In training, you could be doing psych for 24-36 hour shifts. If it is draining now after 6 hours, that would be a red flag for me. Is there something else that is enjoyable to you that you could do regularly?

 

[J ROD]

If you tend to be emotionally drained or even affected by seeing psychiatric patients, I would recommend surgery. Some folks take it home with them everyday.

 

[clozareal]

You don't have a wrong choice, just two different life paths with two different sets of pros and cons. I'll offer a different perspective. If you can work through your past experiences, you may have a meaningful career and personal fulfillment with psychiatry. That would take time, effort, lots of therapy, and you will grow and become a better person as a result. It would help you get over the emotional strain that is making you fatigued during the psychiatry rotation. Not to say you can't do the same with surgery, but you won't have as much time to work on yourself in the same way. Psychiatry would integrate your past, present, and future in a more cohesive manner than surgery would.

 

[Old&InTheWay]

You don't have a wrong choice, just two different life paths with two different sets of pros and cons. I'll offer a different perspective. If you can work through your past experiences, you may have a meaningful career and personal fulfillment with psychiatry. That would take time, effort, lots of therapy, and you will grow and become a better person as a result. It would help you get over the emotional strain that is making you fatigued during the psychiatry rotation. Not to say you can't do the same with surgery, but you won't have as much time to work on yourself in the same way. Psychiatry would integrate your past, present, and future in a more cohesive manner than surgery would.

Came here to say essentially this. I suspect psychiatry will be hard for you, but not necessarily in a bad way. Surgery might feel easier, but what if that is because it is slightly abusive in a way that feels familiar and comfortable to you?

These are just thoughts and it's certainly possible I am way off base. That said, one of the hidden benefits of psychiatry training is that if you engage in it in the right way, you by necessity engage in a process of introspection and personal change/growth.

 

[comp1]

I have a lot of trouble relating to being more drained by psych than surgery. I was orders of magnitude more stressed by surgery than psych. As I recall, my worst day during my psych clerkships was still much, much better than my best in surgery. I agree that this is a red flag. However, red flags are just warnings, not definite things. You could try some rotations away from your home institution to see if perhaps it's them. That said, surgery's nothing to be ashamed of. In terms of the oppressive feeling that society failed people, I second the above comment about that fading. Yes, society has a lot of work to do, but so do individuals. As you start to become aware of services that are available and how they often still aren't used when you point people to them...well, the risk is more the negative countertransference described above than just a feeling that society in general has failed.

 

[Stagg737]

Agree with a lot of the above, but wanted to just say "wow" to the OP. Probably one of the most introspective and insightful self-reflections I've seen from any med student looking at different paths, bravo.

Psych can be a great field, and part of what I love about it is the variety and flexibility. There's settings where you'll constantly see the failures of our social system to meet the needs of people leading to exacerbation of MH problem. You can also find settings where this is minimal and resources are extremely abundant or almost all of your patients have the means to get whatever resources they need. There's much good to be done in both settings.

The other thing I'd say is to really ask yourself why there was such a sudden shift in your outlook during that psych rotation. Did the glitter and gold from those first 2 weeks wear off? Were you in a different setting of the rotation? Were there particular cases that wore you down?

 

[Sushirolls]

The older I get, the more experiences I have the more I observe, the more I call Bull Scat on the notion of "Society" failing people, or that it can cause exacerbations of Mental Health. Society owes nothing to people. Any resource propped up for people is a gift. And I observe repeatedly, people scorn, burn, reject, stomp, whatever the gifts and resources offered to them.

Travel to other countries with less relative wealth than the US. The things people shun here - mind boggling. Other countries have straight up ghettos, slums, and yet we have people intentionally choosing year after year to be homeless because the housing they do get - doesn't let them have their dog - or - "I didn't like my roommate."

People aren't victims and the ever pervasent label of victimhood, is nauseating. Case study of perpetual victimhood: NPR. I listened to it for years. Filtered out their bias to extract the kernels of worthwhile news. I can't. Just can't do it anymore, pure victim virtual signaling with +90% of their programming.


Patient anecdotes:
Old guy, doctoral level education, depressed for years, comes in, shuns business as usual, evidence based medicine lets do this to get you better for depression. Dude only wanted psychedelics. Sure, go back to wasting away your retired years as non-functional.

Young guy, first break psychosis, diagnosis and several months into treatment, explained the role and importance of antipsychotics and the consequences of not taking them. Homeless, substances, etc, etc. Family support too. Even when in state of remission and emphasizing med need and options of LAI. Nope. Stops meds. Homeless on streets. And bad things happened...

Young woman, can't give up cannabis. Depresion, anxiety, vomiting, etc

Middle aged man, notable OSA, won't get treated.

The examples go on and on.

In summary, there are numerous time points, decision moments in so many peoples lives where they are faced with healthier decision versus less healthy decision. Rarely do I see a 'true' victim.

 

[vanfanal]

How do you guys deal with envy of other specialties?

I was at a wedding with some old med school friends. I’m sitting at a table with a radiologist, ophthalmologist, gastroenterologist, dermatologist and pathologist. Im sure they all had aspects if the job they didn’t like, of course nobody shared those. Somehow, I felt less then, and have been wondering if I could have done something else, something “more”.

I realise that this is mostly driven my by internal processes; worries about job security with mid levels, lower compensation compared to peers, lack of respect, working in a corrupt and unfair insurance system. But I also know that this is a perennial issue for us as psychiatrists. I was and IMG and I didn’t have the step scores to be a radiologist, but I see a lot of similarities between psych and radiology; detailed analysis, attention to detail, dealing with gray areas…pun intended.

 

[SmallBird]

The older I get, the more experiences I have the more I observe, the more I call Bull Scat on the notion of "Society" failing people, or that it can cause exacerbations of Mental Health. Society owes nothing to people. Any resource propped up for people is a gift. And I observe repeatedly, people scorn, burn, reject, stomp, whatever the gifts and resources offered to them.

Travel to other countries with less relative wealth than the US. The things people shun here - mind boggling. Other countries have straight up ghettos, slums, and yet we have people intentionally choosing year after year to be homeless because the housing they do get - doesn't let them have their dog - or - "I didn't like my roommate."

People aren't victims and the ever pervasent label of victimhood, is nauseating. Case study of perpetual victimhood: NPR. I listened to it for years. Filtered out their bias to extract the kernels of worthwhile news. I can't. Just can't do it anymore, pure victim virtual signaling with +90% of their programming.


Patient anecdotes:
Old guy, doctoral level education, depressed for years, comes in, shuns business as usual, evidence based medicine lets do this to get you better for depression. Dude only wanted psychedelics. Sure, go back to wasting away your retired years as non-functional.

Young guy, first break psychosis, diagnosis and several months into treatment, explained the role and importance of antipsychotics and the consequences of not taking them. Homeless, substances, etc, etc. Family support too. Even when in state of remission and emphasizing med need and options of LAI. Nope. Stops meds. Homeless on streets. And bad things happened...

Young woman, can't give up cannabis. Depresion, anxiety, vomiting, etc

Middle aged man, notable OSA, won't get treated.

The examples go on and on.

In summary, there are numerous time points, decision moments in so many peoples lives where they are faced with healthier decision versus less healthy decision. Rarely do I see a 'true' victim.

I feel like we are supposed to help people figure out a lot of that stuff too.

 

[littlefred]

How do you guys deal with envy of other specialties?

I was at a wedding with some old med school friends. I’m sitting at a table with a radiologist, ophthalmologist, gastroenterologist, dermatologist and pathologist. Im sure they all had aspects if the job they didn’t like, of course nobody shared those. Somehow, I felt less then, and have been wondering if I could have done something else, something “more”.

I realise that this is mostly driven my by internal processes; worries about job security with mid levels, lower compensation compared to peers, lack of respect, working in a corrupt and unfair insurance system. But I also know that this is a perennial issue for us as psychiatrists. I was and IMG and I didn’t have the step scores to be a radiologist, but I see a lot of similarities between psych and radiology; detailed analysis, attention to detail, dealing with gray areas…pun intended.

Envy is a strong word, I think you are asking what if I had pursued another specialty... Choosing a medical specialty is a hard choice and the commitment that sticks with you for a long time. Comparing yourself to others is an easy way to become jealous/envious/depressed etc. I would recommend just do your thing and not focus on what others are doing or have done.

If it makes you feel any better, I matched into rads and came to psych instead. The only regret I have is not having a Ferrari in my garage, other than that I was able to dive into a subspecialty of choice, carve out an awesome schedule/salary and able to share and I get to spend a lot of time with my loved ones.

 

[Sushirolls]

We do. I do. We try. I try.

But looking through the lense of victim glasses only leaves you seeing victims everywhere. It's good to help, to aspire for improvements. But to blame "Society" as some evil thing that has failed people is just more of looking through victim glasses.

 

[Coupd'Cat]

This line above, is what would make me say lean into surgery.

Your psych/abuse history can be overcome and not a barrier for doing psych.
Patients you identify with will become less, and change over time. I.e. in time the same homeless patient who presents to the unit you may have negative counter transference for knowing they had numerous supportive services before them presented to them and they still chose a harder path...

There are plenty of folks who wandered into psych because of their own personal or family mental health overlaps. Sometimes this can be a barrier that should keep a person away from the field, other times its just another life experience to add to their understanding of the greater human journey.

But that line above, if you are feeling tired, drained, whatever with your psych rotation; surgery may be the better play of Psychiatry.

I would disagree. Tiredness from one rotation isn't necessary indicative of inability to weather the work of psychiatry forever. It's data and you can choose what to do with it--for instance, think about what resources and support you might need to train in and practice psychiatry. You might think about what it says about the type of environment you eventually can practice most effectively in. Inpatient, ED, and outpatient demands vary widely.

Working as an attending with 9-5 outpatient hours, control over my own schedule, and the time to see patients I care about has given me the most energy in the past ten years of my life.

 

[Coupd'Cat]

How do you guys deal with envy of other specialties?

I was at a wedding with some old med school friends. I’m sitting at a table with a radiologist, ophthalmologist, gastroenterologist, dermatologist and pathologist. Im sure they all had aspects if the job they didn’t like, of course nobody shared those. Somehow, I felt less then, and have been wondering if I could have done something else, something “more”.

I realise that this is mostly driven my by internal processes; worries about job security with mid levels, lower compensation compared to peers, lack of respect, working in a corrupt and unfair insurance system. But I also know that this is a perennial issue for us as psychiatrists. I was and IMG and I didn’t have the step scores to be a radiologist, but I see a lot of similarities between psych and radiology; detailed analysis, attention to detail, dealing with gray areas…pun intended.

The cure is to spend time with people who aren't doctors, or ones who also don't want to waste their time with shallow, narcissistic, and prestige-chasing puddles of small d* energy.

 

[vanfanal]

Envy is a strong word, I think you are asking what if I had pursued another specialty... Choosing a medical specialty is a hard choice and the commitment that sticks with you for a long time. Comparing yourself to others is an easy way to become jealous/envious/depressed etc. I would recommend just do your thing and not focus on what others are doing or have done.

If it makes you feel any better, I matched into rads and came to psych instead. The only regret I have is not having a Ferrari in my garage, other than that I was able to dive into a subspecialty of choice, carve out an awesome schedule/salary and able to share and I get to spend a lot of time with my loved ones.

A little better, haha, thanks.

You don’t think look back and think rads nay have bern better in terms of money, flexibility and mid levels. I had an interesting guys the other day who wasn’t psychotic, he was young and intelligent and answered everything with metaphors. I spent 90 mins with him. And I thought, the work and acumen I put into reading and analysing this guys is not less than a radiologist, so why don’t i get paid for it?

 

[Dantes]

A little better, haha, thanks.

You don’t think look back and think rads nay have bern better in terms of money, flexibility and mid levels. I had an interesting guys the other day who wasn’t psychotic, he was young and intelligent and answered everything with metaphors. I spent 90 mins with him. And I thought, the work and acumen I put into reading and analysing this guys is not less than a radiologist, so why don’t i get paid for it?

Because radiologists are pumping out studies (and thus RVUs) left and right with little to no downtime and working more hours on average lol

 

[littlefred]

Yeah. It's a question of billable procedures not mental output. If we had more procedures (we do, but hard to fill a TMS/spravato, ECT clinic full time) we would make more cash.

I think the biggest threat to rads is not midlevels but AI interpreting imaging better than humans at one point.

 

[littlefred]

A little better, haha, thanks.

You don’t think look back and think rads nay have bern better in terms of money, flexibility and mid levels. I had an interesting guys the other day who wasn’t psychotic, he was young and intelligent and answered everything with metaphors. I spent 90 mins with him. And I thought, the work and acumen I put into reading and analysing this guys is not less than a radiologist, so why don’t i get paid for it?

Given your expertise from what I've seen in this forum... explore psilocybin treatment. I think it's the best thing happening within the addiction field and it can be considered procedural. Very effective treatment from prelim studies from Ross et al over at NYU.

 

[TexasPhysician]

Given your expertise from what I've seen in this forum... explore psilocybin treatment. I think it's the best thing happening within the addiction field and it can be considered procedural. Very effective treatment from prelim studies from Ross et al over at NYU.

Trying to to derail the thread, but what are you seeing? Everything I’ve read so far is showing psilocybin to be much inferior to ketamine.

 

[littlefred]

Trying to to derail the thread, but what are you seeing? Everything I’ve read so far is showing psilocybin to be much inferior to ketamine.

For the treatment of alcohol use disorder in particular, not for MDD.

Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial - PubMed

ClinicalTrials.gov Identifier: NCT02061293.

pubmed.ncbi.nlm.nih.gov

 

[ElementX]

Another thing to just keep an eye on: other reasons for being tired besides the work. If you are currently finishing your psych rotation, it is completely possible you did this during the darkest, gloomiest part of the year and things like seasonal affective disorder or even stress from the holidays if you've had a difficult family life could be strong considerations. Again, not to say it isn't the psychiatry, but none of these things happen in a vacuum.

 

[tr]

Patient anecdotes:
Old guy, doctoral level education, depressed for years, comes in, shuns business as usual, evidence based medicine lets do this to get you better for depression. Dude only wanted psychedelics. Sure, go back to wasting away your retired years as non-functional.

Young guy, first break psychosis, diagnosis and several months into treatment, explained the role and importance of antipsychotics and the consequences of not taking them. Homeless, substances, etc, etc. Family support too. Even when in state of remission and emphasizing med need and options of LAI. Nope. Stops meds. Homeless on streets. And bad things happened...

Young woman, can't give up cannabis. Depresion, anxiety, vomiting, etc

Middle aged man, notable OSA, won't get treated.

The examples go on and on.

In summary, there are numerous time points, decision moments in so many peoples lives where they are faced with healthier decision versus less healthy decision. Rarely do I see a 'true' victim.

Dude. Do you even MI?

 

[mistafab]

Trying to to derail the thread, but what are you seeing? Everything I’ve read so far is showing psilocybin to be much inferior to ketamine.

A lot of very interesting research in psilocybin in different pops. AUD. TRD. I know they are rolling out other studies as well.

But we are very early in the process. Only recently aregroups publishing dose-finding studies. We are not yet there in terms of getting this rolled out in a clinic.

 

[Sushirolls]

Dude. Do you even MI?

yes

 

[Sushirolls]

A lot of very interesting research in psilocybin in different pops. AUD. TRD. I know they are rolling out other studies as well.

But we are very early in the process. Only recently aregroups publishing dose-finding studies. We are not yet there in terms of getting this rolled out in a clinic.

Same thing with TMS.
Same thing Ketamine.
Just the next flavor of the year.

 

[mistafab]

Same thing with TMS.
Same thing Ketamine.
Just the next flavor of the year.

I disagree. TMS and ketamine are well established at this point. I think nasal ketamine data is not great, but actual ketamine and TMS data are clear.

 

[vanfanal]

My two cents is I think it depends on the indication. Lots of people are seeing or being referred for adjustment, subclinical symptoms or PD. That can make it difficult to see the benefits.

 

[notamindreader]

When I was growing up, I had always thought I'd want to be a psychiatrist. I then experienced significant emotional and, at times, physical abuse at the hands of a family member, and that family member ultimately committed suicide. This whole situation is incredibly complex and not really something that I should get into here. In any case, this led me to believe that I should not go into psychiatry for multiple reasons. The first is that I was worried the emotional baggage that I received would take away from my ability to give my future patients good care. I've learned since then that this is not necessarily the truth, but it did keep me away from pondering the specialty for a long time. Second, the inpatient care my family member received was not good, and the treatment team let them return to our home despite being a risk to those of us living there. Her treatment while inpatient was ultimately inadequate and chalked up to other medical complications despite their LONG history with mental illness. I did not want to become a physician that would let something like that happen. Again, I've learned that some things are unavoidable, and my one bad experience is not necessarily reflective of the field as a whole. Third, I struggled with the knowledge that psychiatric conditions are often not the direct result of some neurobiological departure from normal. Rather, many often are more related to society, strongly contributing to and worsening mental illness. This is still something I have not overcome, and I doubt I will because it seems to be a more universal truth. Even now, on my psychiatry rotation, I have a patient who is admitted because they are homeless, leading to severe depression with suicidal ideation on top of anxiety. With more social support, this patient likely would not have developed these conditions, and they certainly would not be as severe as they are now. With these things in mind, I have set up a wonderful application for general surgery, which I love.

During the first two weeks, I fell in love with psychiatry. I adored the patients, their stories, the material, and even doing practice questions. I felt that I was able to have a positive impact on my patients, even just through letting them talk and share with me. I worked more closely with my preceptor and started to transition my plans to apply psychiatry. That is how much I loved those first two weeks. Then, over the next few weeks, I have found myself to be exhausted after leaving the hospital around 3:00 PM (and we don't come in until 9:00 AM). I've been more tired on this rotation than I was on general surgery and my busiest rotation where I was independently seeing and writing notes for 20-30+ patients from 7:00 AM until 7:00-8:30 PM Monday through Saturday. I am starting to reconsider my options again because of this. I don't necessarily dread going to the hospital every morning, but I also don't look forward to it. I understand that the lifestyles of general surgery and psychiatry are incredibly different; however, these are both invasive and intimate specialties, albeit in different ways. I just am trying to collect more information or opinions I suppose. I don't really plan on using an online forum to make my decision, but I am thinking that maybe this could give me some other options to consider.

FWIW, I too found myself drawn to surgery. I felt like we were 'helping' people right away, it was team-oriented, fast paced with lots of physical movement throughout the day (except of course when standing in the OR). There is an adrenaline like drive that keeps one moving through in a surgery rotation, which I can see being thrilling and exciting. I'm also quite interested in activities that incorporate the use of my hands.

Psychiatry, especially out-patient psychiatry, is like you shifted gears to quite possibly the slowest pace, which can be exhausting if you don't yet know how to navigate working at that speed. Much of our work lacks 'being helpful' in very obvious ways, but our clinical stance can be quite therapeutic for patients, and I suspect you are someone who naturally makes space for others to be seen and heard. One of my favorite mentors in psychiatry shared that our emotional capacity to care for others grows like a muscle, and the more we learn how to do it properly, the better clinicians we will become. It can be draining and difficult to connect with others' suffering and it is truly an art to learn how to hold space for others while also holding firmly your own boundaries.

I cannot tell you how great of a decision I made to pursue psychiatry and not a surgical specialty. My continued education can focus on literally any aspect of the human condition, and importantly, on my own self-care, as I am a key component to the treatment I provide to my patients.

 

[comp1]

Definitely second the outpatient slowness to be exhausting. This is why I'm inpatient for life. I'm sure others adjust to it!

 

[HarmlessGhost]

Agree with a lot of the above, but wanted to just say "wow" to the OP. Probably one of the most introspective and insightful self-reflections I've seen from any med student looking at different paths, bravo.

Psych can be a great field, and part of what I love about it is the variety and flexibility. There's settings where you'll constantly see the failures of our social system to meet the needs of people leading to exacerbation of MH problem. You can also find settings where this is minimal and resources are extremely abundant or almost all of your patients have the means to get whatever resources they need. There's much good to be done in both settings.

The other thing I'd say is to really ask yourself why there was such a sudden shift in your outlook during that psych rotation. Did the glitter and gold from those first 2 weeks wear off? Were you in a different setting of the rotation? Were there particular cases that wore you down?

These are good questions to consider. I will say that the glitter and gold probably did wear off some. The whole of the rotation was at the same inpatient hospital. I also cannot pinpoint any particular case that really wore me down (other than one very sick patient who threatened to kill me... but she was just sick and not really able to know better). I do think that there certainly is the aspect of my own mental health fluctuating as it usually does, and the rotation itself certainly did refresh a lot of not so happy memories. I still do believe that my past trauma can be both a benefit and a deficit in my future practice, but I suspect that this likely is true of whatever specialty I end up choosing. It does seem particularly true that there is not really a wrong choice here.

Another thing I have been reflecting on a lot is one of my last interactions with a patient on Thursday. It was an older gentleman admitted for suicidal ideation who had been admitted dozens of times over the past few years. He had a history of refusing many treatments, and, as others above commented, he chose not to utilize the resources offered to him (for example, pain management referrals for chronic back pain). I was performing the H&P for the patient, and he became increasingly hostile. It culminated in him calling me a wide variety of expletives and insults I would never have thought of on my own and yelling at me to leave him alone (less kindly than this). Of course, I was happy to oblige. In fact, I actually felt angry at this patient to the point that I had to excuse myself from the rotation for a period of time to take a walk.

The cause of my anger likely was his hostility during the interview, and I do realize that he is sick. However, this also is not the first time a patient has been rude like that, and I am sure it is not the last. It was the first time where I have become angry with a patient for this treatment (or perhaps the first time I chose to pay attention to my anger). Still working on figuring this out, but I do think it is an important interaction. Was I angry because it was the last of my psychiatry rotation? Because he as simply being mean? Because I had come to resent the rotation? Who knows at this point. All this to say, there is a lot to consider, and there is not a way to get all of the information in such a short amount of time (wild to think that near three years of med school is not long enough to know what I want to do with the rest of my career). I appreciate the different thoughts so far.

 

[Desired Member]

... I was performing the H&P for the patient, and he became increasingly hostile. It culminated in him calling me a wide variety of expletives and insults I would never have thought of on my own and yelling at me to leave him alone (less kindly than this). Of course, I was happy to oblige. In fact, I actually felt angry at this patient to the point that I had to excuse myself from the rotation for a period of time to take a walk.

The cause of my anger likely was his hostility during the interview, and I do realize that he is sick. However, this also is not the first time a patient has been rude like that, and I am sure it is not the last. It was the first time where I have become angry with a patient for this treatment (or perhaps the first time I chose to pay attention to my anger). Still working on figuring this out, but I do think it is an important interaction. Was I angry because it was the last of my psychiatry rotation? Because he as simply being mean? Because I had come to resent the rotation? Who knows at this point...

I think it's normal for a person to feel angry at someone who yells expletives and insults at them.
As to why you felt angry with this dude and not previous patients demonstrating these unfortunate behaviors... difficult to know.
I tend to feel angry when I am worried about something. Trying to decide what specialty to pursue can definitely be worry-inducing. It's difficult to switch specialties and it's a sacrifice to train in a particular specialty and change one's mind later and do a different specialty. Med school is a huge financial investment and the medical degree is generally not helpful unless one practices medicine. Anyway, all that to say that it's a big decision and understandable that med students trying to decide between specialties may feel anxious (and irritable/easily upset) as the deadline to decide approaches.

 

[Merovinge]

If you tend to be emotionally drained or even affected by seeing psychiatric patients, I would recommend surgery. Some folks take it home with them everyday.

Just to provide another perspective. My SO is a surgeon and that can hit home really hard in a way that just not found in psychiatry. Surgeons are the ultimate buck-stops-with-you job (up there with pilot), when people die, you and what you did/didn't do in the OR is the only thing that comes to blame. She had a colleague who completed a successful case and then the hospitalist ordered a double anticogulation dosage for the patient who subsequently bled out and died. Did anyone blame the IM doc? Absolutely not, 100% was the surgeon to blame from the patient to administration to anyone else involved. You need to be a fricking rock to handle the stress that comes with most specialties in surgery, there's a reason that stating one is a surgeon hits different than saying you're a doctor.

 

[Candidate2017]

Another thing I have been reflecting on a lot is one of my last interactions with a patient on Thursday. It was an older gentleman admitted for suicidal ideation who had been admitted dozens of times over the past few years. He had a history of refusing many treatments, and, as others above commented, he chose not to utilize the resources offered to him (for example, pain management referrals for chronic back pain). I was performing the H&P for the patient, and he became increasingly hostile. It culminated in him calling me a wide variety of expletives and insults I would never have thought of on my own and yelling at me to leave him alone (less kindly than this). Of course, I was happy to oblige. In fact, I actually felt angry at this patient to the point that I had to excuse myself from the rotation for a period of time to take a walk.

The reality is this happens just about every day, at least once a day, in psychiatry residency. Especially in an inpatient or ED setting, or Medicare/caid clinic. This continues long after residency if you work for a large system, whether inpatient or outpatient. While your personal anecdote of being inspired by a family member with mental illness is commendable, the reality is there are large swaths of people sucked into the mental health system who have zero interest in actual psychiatric help.

I say go for GS. And general surgeons seem to be happiest when they limit themselves to certain procedures, such as breast cancer, lap choles, gastric bypass, etc.

 

[clausewitz2]

The reality is this happens just about every day, at least once a day, in psychiatry residency. Especially in an inpatient or ED setting, or Medicare/caid clinic. This continues long after residency if you work for a large system, whether inpatient or outpatient. While your personal anecdote of being inspired by a family member with mental illness is commendable, the reality is there are large swaths of people sucked into the mental health system who have zero interest in actual psychiatric help.

I say go for GS. And general surgeons seem to be happiest when they limit themselves to certain procedures, such as breast cancer, lap choles, gastric bypass, etc.

I worked with a general surgeon in medical school who exclusively did lap choles and appys, more or less. He worked eight months a year and spent the rest of his time following Phish and various other bands around the country. That man was living his dream.

 

[clozareal]

I worked with a general surgeon in medical school who exclusively did lap choles and appys, more or less. He worked eight months a year and spent the rest of his time following Phish and various other bands around the country. That man was living his dream.

What is it with people following Phish? I know two attendings who follow Phish in their time off...