Psychiatry - Do you Forget Medical Knowledge?

[lacrossegirl420]

I’m very interested in psychiatry, but a huge concern for me is that I won’t remember most of the medical knowledge I’ve learned in med school (this is extremely important to me). Other than that, I really like the specialty.
I’m also strongly considering radiology and ophthalmology right now. In terms of the “knowledge” aspect, radiology definitely seems to win. But, each specialty obviously has its own pros and cons and so I’m having a hard time deciding.
Would greatly appreciate hearing from psychiatrists or those who are familiar with the specialty. Matching into any shouldn’t be a problem. Thanks in advance!

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[DOswag]

Ultimately the answer is yes. Unless you have some crazy photographic insane genius level memory. You're not going to remember a lot of mundane stuff that you learn in the classroom portion of med school. You will retain those things that are pertinent to your specialty when you go through residency training. But that can be said about every specialty. I'm sure most ortho docs won't remember all the details of managing diabetes but they learned basics of it at some point along the way. You have to be knowledgeable about the medications in psychiatry as many can have medical risks associated with them and can interact with many other types of medications. I use up to date pretty regularly to look stuff up though that I can somewhat recall from med school but may not remember a specific detail about it. A family member recently asked me a medical question and I responded "If you had asked me 10 years ago I could've told you" but it doesn't really bother me that I've forgotten some stuff lol. Heck there's things in psychiatry that I don't encounter often that I have to look up from time to time. All that said I'm very happy with choosing psychiatry as a specialty.

 

[lacrossegirl420]

@DOswag - thanks for your response! Will definitely take that into consideration.
Another question - as a psychiatrist, have you ever felt unsafe/in danger after interacting with a patient? (E.g. physical violence, stalking, etc.) This would go for any psychiatrist, but especially as someone who is relatively skinny / looks very young this is particularly a concern. Have you ever felt this was an issue during your years?

 

[DOswag]

@DOswag - thanks for your response! Will definitely take that into consideration.
Another question - as a psychiatrist, have you ever felt unsafe/in danger after interacting with a patient? (E.g. physical violence, stalking, etc.) This would go for any psychiatrist, but especially as someone who is relatively skinny / looks very young this is particularly a concern. Have you ever felt this was an issue during your years?

I've had a couple of instances that I felt were a little riskier I guess. One was on an inpatient unit in residency and we had quite a few psychotic patients on the floor. One was kind of flipping out in the common room, I was standing in the doorway of another patient that I had been talking to. This other individual spotted me from across the room, we made eye contact, and he took off in a run right toward me. As he got right to me, he turned at the last second and ran down to the end of the hall. It all happened in just a few seconds but I looked back and realized he could've attacked me or tackled me, don't really know what made him come at me or turn at the last minute. Also, I'm a pretty good sized dude so I can imagine for someone of smaller stature it can be somewhat intimidating. It wasn't uncommon that we had to call extra staff in if patients were being unruly on the inpatient unit or if the psychotic patient won't calm down he'd need to get a PRN of haldol/ativan/benadryl.

A colleague of mine where I work now is a psychologist. He had a patient (also inpatient unit, psychotic) tell him that she needed to whisper something in his ear. When he leaned forward she stabbed him in the neck with a pencil. This was early in his training so he was somewhat niave in how to interact with psychotic patients (he's fine now, missed all the major stuff in the neck lol). Typically the inpatient units are where there's more risk because the patient population is more unstable. If there's ever any concern you can always ask a staff member to accompany you in a room, keep your distance from the patient, maintain a position closer to the door etc.

I'm exclusively outpatient now. I really enjoyed the inpatient unit but didn't really have an option for where I work now (military). Haven't really had experiences in the outpatient setting where I truly felt I was in danger. I've really only had one that comes to mind in the outpatient setting but he was 100% malingering psychotic symptoms so I wasn't super concerned about him.

 

[mistafab]

Psychiatric knowledge is medical knowledge. People often forget the basics of it when they start specializing outside the field. An orthopod is less likely to care about things not related to periop care or ortho problems. An ICU attending is less likely to care about obgyn problems. A pcp is not going to be sitting there trying to work up potential felty syndrome.

Fact is, you’re going to have to learn to stay in your lane. You cant be the master of everything. You need to decide what you want to master. Stop focusing on what you’re afraid of “losing” as it will get you nowhere closer to deciding what you want to do.

 

[annoyedpsychiatrist]

no matter what specialty you go into, you forget other things as well. Psychiatry requires having a grasp on medical concepts in general, i still have a good understanding of primary care stuff, and you still learn neurology in psychiatry. Medical school is broad exposure with lack of useful/specific details, whereas residency/specializing you focus on the specifics.

Ive only had one instance where i felt unsafe, that quickly resolved. When someone is psychotic or starts showing signs of potential for physical violence then you keep this in mind, you keep your distance, and leave if the situation escalates. You can always come back. But if someone is a significant risk then you always keep your distance. The amount of risk depends on the setting/facility youre working. In psychiatry you can work in an ER, an upscale private clinic, or community health center, etc. You choose your setting

 

[pyrrion89]

Psychiatrist here - I certainly have forgotten the details of obscure illnesses, embryology, the urea cycle, etc.
I think that USMLE and rotations do burn into your brain the core concepts though, and certainly I have a grasp of the bread-and-butter stuff (e.g., diabetes, heart failure, COPD, etc.), managing minor medical problems in a psych hospital, knowing when to call for a consultant.

 

[mrbreakfast]

huge concern for me is that I won’t remember most of the medical knowledge I’ve learned in med school (this is extremely important to me).

Yet you are interested in three rather "specialized" specialties.

You will forget a lot of what you learned in medical school, just as you have likely already forgotten most of your pre-med coursework. That will be replaced with more and more specialized knowledge the more you train. If you are concerned about not maintaining a general medical knowledge, you can do that on your own, but you need to decide what you want maintained through your daily practice. As a psychiatrist, or as a radiologist or ophthalmologist, no one is going to ask you to urgently assess an undifferentiated patient, or conduct a comprehensive outpatient visit, or fix someone's blood sugar, or whatever. The last time you calculate an anion gap will be intern year, if not before. On the other hand, they might ask you to do something no one else can do - quickly read a complex CT chest/abdomen/pelvis, do eye surgery, or admit a mentally unstable person to the hospital against their will and fix them. You can take some solace in those specialized skills.

If you want to maintain more medical knowledge, why not look into CL psychiatry? I'm not a psychiatrist, but some of the CL docs I know would probably be able to medically manage a straightforward inpatient general medicine patient, at least in some capacity. Just a thought.

 

[Dantes]

Yeah I would say other than psych, ophtho is up there for very specialized fields, so it's interesting you're considering those. Of what you mentioned, radiology is very broad in terms of needing to know pathophysiology and anatomy across multiple organ systems, but on the flipside you're not gonna keep up on a ton of pharmacology or management.

You're always gonna lose something so you have to figure out what you're ok with letting go. Is there a reason you're not considering a more generalist field?

 

[Fluidity of Movement]

Nothing is stopping you from continuing to review your Anki decks. xD

 

[mistafab]

Nothing is stopping you from continuing to review your Anki decks. xD

Except living a normal life lol

 

[hamstergang]

I'm a psychiatrist, and 3 years after I finished my child/adolescent fellowship, my boyfriend started PA school. I helped him study through pretty much everything, from the basic physiology/pathophysiology through the clinical portions. I found that there much I remembered even if I hadn't used it at all, and there was much I needed only a quick read or quick review to have a grasp of again. There was also quite a bit I'd forgotten, particularly the things I didn't know the best to begin with.

It also turns out that I know a lot about psychiatry. Every field will have you expand and deepen your knowledge of it at the expense of other things you've learned. There is no escape from this.

 

[NegativeMargin]

Is this even specific to psychiatry? Won't most of us forget the majority of what we have learned, in favor of knowing more about our specific specialty, with people who are very specialized forgetting more than generalists?

 

[VA Hopeful Dr]

Is this even specific to psychiatry? Won't most of us forget the majority of what we have learned, in favor of knowing more about our specific specialty, with people who are very specialized forgetting more than generalists?

Yep. And us generalists don't know the depth of what specialists know. No one can know everything so you pick which of those outcomes works best for you.

I didn't like the idea of narrowing what I know so I went FM. I like knowing at least a little about most every part of medicine (except rad onc, those people might as well be actual wizards given how much of a mystery that field is to me).

 

[sloop]

You will forget much of the general medical information you learn in med school. As has been noted, this is probably not much different than many other specialities. Depending on your practice setting you may retain more or less depending on the degree to which you are required to manage basic medical conditions.

With regard to the second question, almost every psychiatrist will have some experience where they felt less than completely safe. You do what you can to mitigate your own personal risk but some of this comes with the territory.

 

[HuskyMD Emeritus]

Actually, pulmonary-critical care is a specialty where you have to know about all specialties; one of my colleagues called it medicine on steroids.
We definitely deal with psychiatry patients in the ICU, along with all their medications (most of them have significant side effects), Ob-gyn patients (we fear these!), dermatology (think burns, Stevens-Johnsons), but not ophthalmology (although I have called ophthalmologist to see pts in the ICU for their expertise in fundoscopic exams). We read x-rays, CTs, MRIs often before the radiologists get to them.
Many of our outpatients have significant psychiatric issues especially those with long term breathing problems and of course the stress of dealing with lung cancer. In clinic, we also have to be familiar with various pathologic findings in biopsy specimens, and not infrequently visit our pathology colleagues to go over slides.
So, if you want to be in a specialty where you need broad medical knowledge, consider pulm-ccm, in addition to family medicine (the other specialty where you need to have broad knowledge base).

 

[lacrossegirl420]

Thanks for the responses everyone. Are there specialties that know a lot about everything? My impression was radiology best fit that bill, but wanted to ofc keep other options open

 

[mrbreakfast]

Are there specialties that know a lot about everything? My impression was radiology best fit that bill, but wanted to ofc keep other options open

Radiologists are, in general, going to know more than the average doctor about diagnosing diseases which can be diagnosed via imaging. They are going to know significantly less about treating said diseases, as well as clinical or laboratory diagnosis, etc, than the average doctor.

It all depends on your individual field of practice and how motivated you are personally in keeping your skills up. Those may or may not overlap. For example: I try to stay fairly up-to-date on my cardiology, emergency/critical care medicine, transplant, psychiatry, etc, because I end up seeing a lot of patients with those comorbidities. On the other hand, I can read skeletal plain films pretty well, despite the fact that it has little relevance to my job and no one would ever ask me to do it, simply because I find it a good skill to have. Etc.

If your goal is to find a field where you are required to know a good amount about many aspects of medicine, I would recommend either IM or GS, ideally going into critical care from either. There's an old saying that if you pick any random medical problem from all the possible problems out there, the single best doctor in the hospital for you is the general surgery chief resident.

FM and EM are broad knowledge base specialties on paper. In reality, this is probably only true if you are self-motivated and work in a rural/underserved area.

Finally, you may find that it is equally rewarding to know a lot about one thing than knowing some about several things. There are many subspecialties out there about which 95-99% of physicians know next to nothing and will be looking for assistance. It can be rewarding to play the expert role.

 

[InternistDO]

I’m very interested in psychiatry, but a huge concern for me is that I won’t remember most of the medical knowledge I’ve learned in med school (this is extremely important to me). Other than that, I really like the specialty.
I’m also strongly considering radiology and ophthalmology right now. In terms of the “knowledge” aspect, radiology definitely seems to win. But, each specialty obviously has its own pros and cons and so I’m having a hard time deciding.
Would greatly appreciate hearing from psychiatrists or those who are familiar with the specialty. Matching into any shouldn’t be a problem. Thanks in advance!

In any of those specialties you're going to lose a lot of general medical knowledge. You'll remember it in the "book knowledge" sence, but you won't feel comfortable managing diabetes or distinguishing pneumonia vs. heart failure, or resuscitating someone in real clinical practice (because you won't have to).

On the other hand you'll have a great deal of knowledge about topics that most doctors will struggle with. I'm a general internist and I certainly can't read a CT abdomen/pelvis and see anything but the most obvious pathology, or diagnose uveitis, or manage someone in florid psychosis (other than knocking them out with haloperidol). But on the other hand I know at least a little bit about most medical issues. That's kind of the trade off.

As others have said if you want to be a super generalist you need to look at IM, FM, general surgery and some of their fellowships, but even then you will forget stuff and you'll miss out on learning about super specialized stuff.

 

[GadRads]

If you enjoy psychiatry, then pursue that. Engaging in a career that you enjoy is more important than satisfying egotistical pursuits and letting that drive your specialty choice.

In terms of broad knowledge base, radiology and pathology fit the bill. I did a prelim internal medicine year before radiology residency, and most of intern year was routine (sepsis, CHF, AKI (pre-renal, etc), DKA, pneumonia, COPD exacerbation, osteomyelitis, decompensated cirrhosis with SBP, etc). When things got tricky, we called the appropriate consult. Radiology residency on the other hand felt like med school 2.0, and it was impossible to master of all of it, despite 2 hrs of routine daily studying. But by the end of training, we were generally comfortable talking to any specialist about most of the pathology they dealt with (neuro, IM, peds, cardiac, pulmonary, GI, etc). My wife is a specialist and was surprised as to how much I knew about her field.

Some of our more patient-facing brethren who think we don’t sometimes look at labs and clinical data (when available and if our reading list isn’t too long) to refine our differentials, really underestimate our training/knowledge. There’s nothing special about interpreting CBC with differential, BMP, and routine labs. We don’t do well with emergent/crashing patients though.