Having a hard time deciding between the two. Any advice from people who may have had a similar problem?
You have to deal with a tremendous amount of psychopathology in EM. As much as you think you can side step it and be problem focused, you still spend much of your time "focusing" while trudging through strong & messy headwinds of psychopathology. Yes, the specialties are different, but I don't think they're nearly as different as the uninitiated think they are.psych
pros: lifestyle, salary
cons: you have to practice psychiatry
Yet psychiatrists, completely unbound by EMTALA, get to pick and choose which cash paying, upper middle class patients they want to see and decline seeing the rest, which inevitably filter through the ED at some point, with their festering psychopathological baggage in tow.This isn't even the first thread on SDN EM asking this. To diametrically oppose my colleague, above, psych and EM are very close, due to very many of the patients being, of some sort, psych.
I mean... yes we see a lot of psych but that doesn’t make us psychiatrists. The medicine is totally different. One specialty has tons of procedures. The other...what..ECT? The inpatient management is totally different and outpatient...we don’t even have outpatients. I think our exposure and management of psychiatric dz in the ED adds a false perception that we do a lot of “psychiatry” when in reality I don’t consider any of what we do to overlap with what I remember from med school psychiatry rotation.
Having a hard time deciding between the two. Any advice from people who may have had a similar problem?
Having a hard time deciding between the two. Any advice from people who may have had a similar problem?
Yes, there is a difference between "doing" psychiatry, which consists of treating a never ending stream of psychopathology, then watching & waiting for improvement, and "seeing" psych in the ED, which consists of being subjected to the effects of a never ending stream of psychopathology, without the hope or expectation of ever being able to treat it. Which is better, I suppose, is a matter of personal taste.I mean... yes we see a lot of psych but that doesn’t make us psychiatrists. The medicine is totally different. One specialty has tons of procedures. The other...what..ECT? The inpatient management is totally different and outpatient...we don’t even have outpatients. I think our exposure and management of psychiatric dz in the ED adds a false perception that we do a lot of “psychiatry” when in reality I don’t consider any of what we do to overlap with what I remember from med school psychiatry rotation.
Other alternative was signing up as a freshman in high school, or doing a MD/PhD.You've been a member since 2006
have over 1,500 posts
and you are still deciding between the two?
Are you in the 10 year medical school program?
Life has never been better for human beings since humans were created. 5,000 years ago we wore animal skin and lived in huts and caves. 200 years ago we had no electricity, running water, food was still scarce and all chores were done by hand. 100 years ago, antibiotics weren't invented and if you got a bacterial infection you either died or that organ system rotted out. 50 years ago the civil rights movement hadn't even hit full swing yet, cell phones didn't exist, nor computers or the internet.
The human condition has steadily, undeniably and dramatically improved and continues to do so. Despite that, psychiatric disease and the inability to deal with that life, appears to be as prevalent, if not more, than ever.
Life has never been better for human beings since humans were created. 5,000 years ago we wore animal skin and lived in huts and caves. 200 years ago we had no electricity, running water, food was still scarce and all chores were done by hand. 100 years ago, antibiotics weren't invented and if you got a bacterial infection you either died or that organ system rotted out. 50 years ago the civil rights movement hadn't even hit full swing yet, cell phones didn't exist, nor computers or the internet.
The human condition has steadily, undeniably and dramatically improved and continues to do so. Despite that, psychiatric disease and the inability to deal with that life, appears to be as prevalent, if not more, than ever.
To clarify, I respect the field of psychiatry greatly and I believe psychiatric illness is real and deserves care, attention and treatment. Psychiatrists do a great job helping patients in need and those patients deserve our utmost respect.Maybe I am misreading what you are saying, but it feels like you are throwing some subtle shade on psychiatry or people with psychiatric conditions. Almost feels like you are implying a lot of these diagnoses are not real somehow. Please correct me if I am wrong though.
But taking what you said at face value...
Cancer is also more prevalent than ever before. Not because cancer care or health in general has gotten worse, but exactly because they have gotten better. We live long enough to get cancer, and live longer with cancer.
Psychiatric disease is more prevalent in the 21st century in large parts because:
1) We now try to diagnose and treat things that people in the past would have to just suffer with. This is good. We are reducing suffering. You can say we are just arbitrarily changing definitions, but if the changing of definition to broaden a certain category leads to decreased suffering through treating more people, I'd argue that's a good thing.
2) We are treating but not curing (unlike with your example of infectious disease, which are on the decline). Maybe one day there will be a cure for some psychiatric diseases, but for now we are just treating. This is still better than not treating though.
3) People are surviving things that would have been unsurvivable in the past. If you had a severe thought process disorder to the point that you are not functional, at many points in the past you would just die because you are ostracized and unable to fend for yourself. Now many of these people have their symptoms controlled. Yes, it increases prevalence, but in a good way.
To clarify, I respect the field of psychiatry greatly and I believe psychiatric illness is real and deserves care, attention and treatment. Psychiatrists do a great job helping patients in need and those patients deserve our utmost respect.
I'm made an observation that probably has nothing to do with psychiatric illness at all, but likely does have a psychological explanation. I don't fully understand why, but it seems undeniable that the conventional wisdom in every generation is that "the world is going to hell," that "things just aren't as good as the good old days" that "the younger generation is ruining what the older generation built" and that "if things continue as they are today, life will be worse in the future." Yet, when you look back 25, 50, 100, 500 years, it's categorically, undeniably, proof positive true that the human condition has steadily and reliably improved. There's no reason to think it won't continue. Yet, look around, once again, the conventional wisdom is that "it's all going to hell." Clearly it's not and never has been. Things are getting better and will continue to. But that won't stop future generations from assuming the opposite, while in the moment.
So that phenomenon fascinates me and it seems to me that we, as human beings, should be able to harness this, at least a little bit, into feeling better than we tend to. Although it certainly does not guaranteed a good result for any one person, if you're a human being in 2018, there's never been a better time in human history (that we know of) where one had a greater chance of having it good. It seems to me that's got to be worth something. I believe it's a tremendous positive, if you choose to see it.
We have it better. And our kids will have it better than us.I completely agree with you on a big-picture humanity level, but as an American millenial, I get so salty thinking about just how good the baby boomers had it.
We have it better. And our kids will have it better than us.
Imagine paying your way through school being a real thing. Imagine being able to afford a house on a single middle-class income. No amount of cat memes can make up for the financial leg-up the baby boomers had on us at comparable ages.We have it better. And our kids will have it better than us.
To clarify, I respect the field of psychiatry greatly and I believe psychiatric illness is real and deserves care, attention and treatment. Psychiatrists do a great job helping patients in need and those patients deserve our utmost respect.
I'm made an observation that probably has nothing to do with psychiatric illness at all, but likely does have a psychological explanation. I don't fully understand why, but it seems undeniable that the conventional wisdom in every generation is that "the world is going to hell," that "things just aren't as good as the good old days" that "the younger generation is ruining what the older generation built" and that "if things continue as they are today, life will be worse in the future." Yet, when you look back 25, 50, 100, 500 years, it's categorically, undeniably, proof positive true that the human condition has steadily and reliably improved. There's no reason to think it won't continue. Yet, look around, once again, the conventional wisdom is that "it's all going to hell." Clearly it's not and never has been. Things are getting better and will continue to. But that won't stop future generations from assuming the opposite, while in the moment.
So that phenomenon fascinates me and it seems to me that we, as human beings, should be able to harness this, at least a little bit, into feeling better than we tend to. Although it certainly does not guaranteed a good result for any one person, if you're a human being in 2018, there's never been a better time in human history (that we know of) where one had a greater chance of having it good. It seems to me that's got to be worth something. I believe it's a tremendous positive, if you choose to see it.
I'm made an observation that probably has nothing to do with psychiatric illness at all, but likely does have a psychological explanation. I don't fully understand why, but it seems undeniable that the conventional wisdom in every generation is that "the world is going to hell," that "things just aren't as good as the good old days" that "the younger generation is ruining what the older generation built" and that "if things continue as they are today, life will be worse in the future." Yet, when you look back 25, 50, 100, 500 years, it's categorically, undeniably, proof positive true that the human condition has steadily and reliably improved. There's no reason to think it won't continue. Yet, look around, once again, the conventional wisdom is that "it's all going to hell." Clearly it's not and never has been. Things are getting better and will continue to. But that won't stop future generations from assuming the opposite, while in the moment.
Yeah, and people 20 years ago said the same thing.Disagree. Surveillance state, worsening totalitarianism, climate change. My parents definitely had it better than me, and I think the eighties were better than now. I think the millennials have it tough with jobs and debt.
Yeah, and people 20 years ago said the same thing.
We have it better. We just don't perceive it as better.
The reason so much mental illness, specifically anxiety, is around, is because we no longer have the need to stay vigilant to avoid the sabertooth cats. So our bodies invent something to be worried about. Same reason we have more autoimmune diseases, because we've killed a lot of the stuff that our bodies used to fight, so now it fights itself. When Parasites Could Be The Treatment Instead Of The Illness
So life expectancy went down recently because of overdoses, suicide, and a bad flu year: Why life expectancy in America is down againI agree that people tend to think things were better twenty years ago, and that many people have it great right now. It's certainly a far better time in the US for gay people and women than fifty years ago, and I think if you are an AI researcher it's probably a wonderful time. Widening income disparity has made many people's lives much harder in the US. The high cost of housing and raising a family has made it pretty hard recently for many working class Americans. American lives are actually decreasing in length, so not so great for those folks, either. Since the war on drugs and mass incarceration, not so great for nonviolent drug offenders. It's probably not a great time to be living in, say, Honduras (which was much more peaceful a generation ago) and there are increasing numbers of climate change refugees. Not so great for them. So, I think some people are having a better time, but many marginalized groups are having a harder time.
Looking at three generations of my family, I'd say the baby bust and baby boomer generations have had it best, and I think they'd agree.
Also, no, people were not as concerned about the surveillance state or totalitarianism twenty years ago. Quite the opposite, in fact.
"In the 25 years from 1990 to 2015, the extreme poverty rate dropped an average of a percentage point per year – from nearly 36% to 10%."I guess the problem is the future is not better for everyone, or it is MUCH better for some and minimally better for others.
75 years ago we didn't have near the income disparity as we did now. I would much rather get sick these days and be treated with in our modern health care than 75 years ago. but it's accessible by so few. The middle class is much worse off now than before. It's disappearing. Very interesting conversation.
I do feel like there are a lot of things, change for one, that are forced upon us. I used forced rather liberally as nobody has forced me to use a smart phone, but for all intents and purposes today's life necessitates you use a smart phone (for an example).
Bingo.We have it better. We just don't perceive it as better.
"In the 25 years from 1990 to 2015, the extreme poverty rate dropped an average of a percentage point per year – from nearly 36% to 10%."
Decline of Global Extreme Poverty Continues but Has Slowed: World Bank
So life expectancy went down recently because of overdoses, suicide, and a bad flu year: Why life expectancy in America is down again
That said, its still higher today (78) than 2000 (76) or 1980 (74).
Housing costs are higher that's true, but interest rates are way lower. My parents bought their current house in 1982 at a 18% rate. I bought my house last year at 4%. Just for fun I plugged those numbers into a mortage calculator. Let's say say my parents house cost 100k in 1982. At 16% interest over 30 years, they would pay around $1500/month (ignoring taxes and insurance). At 4% for the same monthly payment, I could borrow 325k. Weirdly enough, that's about the difference in price for what she paid for it and what its valued at now.
Gas in 1990 was around 1.30/gallon. Its now around 2.49. A dollar in 1990 is worth 1.92 today. So gas has more or less kept pace with inflation more or less. Most groceries have done the same, if not gotten cheaper.
The two main issues that my generation (1983) and younger are struggling with are a) student loans and b) housing prices in select markets. Outside of major cities, real estate prices aren't terrible. Almost all of my friends own homes, even the ones with solid middle class jobs (teachers, non-profit employees, mid-level government workers, public defenders). The ones who don't live in LA, NYC, Boston, DC, or similar.
Student loans are a huge issue. My wife and I are both physicians and we pay almost 5k/month on our loans alone (after refinance) and we were fortunate enough to have no undergrad loans and go to a state medical school.
Hahahahahaha no.Also, no, people were not as concerned about the surveillance state or totalitarianism twenty years ago. Quite the opposite, in fact.
Hahahahahaha no.
Enemy of the State (1998) - Release Info - IMDb
Stop letting negativity & fear weigh you down. Make it your greatest power:
(Watch at least 10 seconds of this)
A lot of the doom and gloom comes from the constant news cycle. Ask anybody older than 60 if they think crime is worse now than when they were kids. They'll say when they were kids, when there's a ton of evidence proving it wasn't. They just didn't know about it.
I suspect you grew up in one of those places I mentioned for that kind of increase in property values.I really, really like where I grew up. My parents paid 50k for their place in 1975. You could not buy a similar one for less than 3 million now. This means I cannot leave near my family. For me personally, this negates any perceived improvement in standard of living. Interest rates don't really make much difference at that level.
My uncle and grandfather were docs, and they certainly had better careers than are available to physicians these days.
I've noticed anecdotally that many people I meet who perceive life as better in 2018 are first generation college grads, which is what is really making their lives better. My parents and grandparents had much better opportunities as college grads/professionals than I do, and they could also afford to live in major cities and maintain a decent standard of living; they could afford to do it on one or one and a half salaries. Just not feasible these days.
It's somewhat sad to think how often I think about wishing I could live back in the 70's, be a happy hippie, follow the Grateful Dead around, smoke a little weed, listen to good music
To clarify, I respect the field of psychiatry greatly and I believe psychiatric illness is real and deserves care, attention and treatment. Psychiatrists do a great job helping patients in need and those patients deserve our utmost respect.
I'm made an observation that probably has nothing to do with psychiatric illness at all, but likely does have a psychological explanation. I don't fully understand why, but it seems undeniable that the conventional wisdom in every generation is that "the world is going to hell," that "things just aren't as good as the good old days" that "the younger generation is ruining what the older generation built" and that "if things continue as they are today, life will be worse in the future." Yet, when you look back 25, 50, 100, 500 years, it's categorically, undeniably, proof positive true that the human condition has steadily and reliably improved. There's no reason to think it won't continue. Yet, look around, once again, the conventional wisdom is that "it's all going to hell." Clearly it's not and never has been. Things are getting better and will continue to. But that won't stop future generations from assuming the opposite, while in the moment.
So that phenomenon fascinates me and it seems to me that we, as human beings, should be able to harness this, at least a little bit, into feeling better than we tend to. Although it certainly does not guaranteed a good result for any one person, if you're a human being in 2018, there's never been a better time in human history (that we know of) where one had a greater chance of having it good. It seems to me that's got to be worth something. I believe it's a tremendous positive, if you choose to see it.
Yet psychiatrists, completely unbound by EMTALA, get to pick and choose which cash paying, upper middle class patients they want to see and decline seeing the rest, which inevitably filter through the ED at some point, with their festering psychopathological baggage in tow.