Psychiatry- Do you find it emotionally difficult?

[futureherooftime622]

It is such a rewarding field as you are really helping so many people with mental health issues. At the end of the day, you do take all that home with you. Does this take a toll on you? Especially with child psych where you would come across many abuse cases. You hear a lot of disturbing things. I remember how difficult it was a few times during my psych rotation in school.

I'm just wondering what are your thoughts? Should I consider another specialty? Still in the process of rulings things out.

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[futureherooftime622]

I was just having a recent conversation with my parents about it and while they do acknowledge that I love psych they are worried how it could potentially affect me if I choose to do this for the rest of my life. My mom was like, "Why not endocrinology or something else?" I think endocrine is really interesting too. People back home keep saying, "But you're such a happy person! How can you think of doing psychiatry?"

 

[TexasPhysician]

Unless you decide to open up an aesthetics clinic, you are going to experience countertransference in every field.

In endocrinology, you will have a lot of diabetics that are not managing their health with many hospitalizations and possibly early deaths. They aren’t going to hold back from discussing their life concerns with you.

Oncology - for me would be 1000x more emotional than psych.

Even dermatology has many long-term anxious patients awaiting biopsies, cancer treatment, bad news, etc.

I’m child psych and I love it. Getting to see depression lift can be immensely rewarding. The daily rewards outweigh the daily struggles and I choose to focus on the accomplishments.

 

[whopper]

I found geriatric psych and jail psych emotionally taxing.

The problem I had with geriatric psych was too many no-win situations. Most of the time I had patients whose disorders I couldn't significantly treat. E.g. Alzheimers. I also found it irritating to involuntarily commit extremely elderly people (e.g. 99 years old) who just wanted to go out in a manner of their choosing.

Jail psych-the problem was several patients were not allowed to get decent treatment. E.g. I had less than 5 minutes to see many patients, many meds weren't available, and some patients needed interventions the jail wouldn't provide. Add to that many of the correctional officers were bullies (some however were good guys). E.g. the only med that worked on a guy was the $800/month med and the jail refused to allow him to get it.

Othewise I didn't have a problem with psych. A big major reason why I was able to sleep at night was being able to answer a simple question. Did I do what I could to get that person better? In geri and jail psych the answer was often times no, but not because of me, but because I didn't have the power to do what I felt what was right by factors outside my control that violated the standard of care or due to my own personal disagreement with the existing system.

 

[Evidence Based]

We should have a stickied thread on this as this is a topic that seems to come up all the time. I posted the below last month:
I've personally found the internal medicine and neurology portions of my internship to be much more taxing on my mental health than the psychiatry rotations. Part of this is work hours, but part of it is the reality that caring for sick people (no matter what your specialty) is taxing on your mental health. Psychiatry has its own difficulties, but is not unique.
All of medicine will tax you and be "emotionally difficult" at times. I personally don't think dealing with other people's mental health problems is inherently more taxing than treating patients with strokes, heart attacks, cancer, or any other bread and butter condition you see in another specialty. You just have to find the specialty that's the most rewarding to you!

This is the previous thread just FYI: How damaging is being a psychiatrist to your mental health?

 

[WisNeuro]

Any healthcare niche can be depressing, taxing, etc. Kind of depends on what you focus on. If I only focus on the evals where I have to tell someone that they most likely have a certain neurodegenerative condition, it can get depressing, although there is also plenty to do with helping those patients, even if we aren't there to try and cure their condition. Focus on the positives, like getting someone's medications cleared up (sedatives. anticholinergics) and a proper sleep eval and CPAP, and seeing their cognition and mood improve dramatically. Same thing in other areas, unless you choose to only work with the worried well, you're going to see a lot of people stay the same, or even get worse, largely independent of anything you can do. Focus on the victories and always getting better at what you do and you'll be fine. Focus on the negatives in the system and with patients who have no desire to change their maladaptive health choices, and you'll burn out pretty quickly.

 

[hamstergang]

Especially with child psych where you would come across many abuse cases.

Depends on the setting. I deal with very little child abuse.

 

[NickNaylor]

I agree with @TexasPhysician - feelings toward patients, terrible stories, etc. are par for the course of medicine. Psychiatry is different because we're overt about talking about it and including those responses in our understanding and treatment of patients.

It can be taxing, I suppose, though I experience it more as a numbness over feeling of fatigue than a clear feeling of emotional distress.

 

[Stagg737]

At the end of the day, you do take all that home with you.

This is something you have to learn to deal with if you want to enter psych. I honestly take very little home with me. I'm able to compartmentalize very well and when I leave work my brain is off of my patients unless I'm on call. I did take a little home on child inpatient rotations in med school, which is tough, but ultimately helped me practice compartmentalizing the really tough cases.

If you're someone who takes everything home with you, it may not be the best field. However, I think a lot of people are able to develop coping mechanisms and learn to leave work at work and decompress when they leave. Yes, there will always be that occasional case that just hits a note that sticks with you (unless you're a sociopath), but developing the ability to not dwell on patients when you leave is something that I've found immensely useful in many aspects of life, especially in this field.