Psychiatry vs. Emergency Med - Which would you do and why?

[Ms MD]

Current 4th year here. Thought I would love Psych, but now having 2nd thoughts. I enjoyed EM, so I was wondering if I could get other people's takes on both specialties.

Only have a few short months to decide what I'll be doing!

Thanks!

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[Kuba]

Ton of psych in EM. So if you aren't totally set on psych all day every day, a pretty good choice. I know that's obvious, but I thought I'd throw it out there anyway.

 

[Ms MD]

Good point, I'm glad you brought it up! I almost overlooked that fact. There were a lot of psych patients when I did my EM rotation too.. I enjoyed seeing those pts in the ED.

 

[st2205]

You'll see the same populations but as EM, from my limited understanding, you're more focused on getting them off your hands because they're taking up a bed.

Have you looked into an emergency psych rotation? I entered medical school because of an interest in psych, but EM becomes more attractive periodically. When I really think about it, however, the idea of doing psych in an emergency setting seems more interesting than dealing with shoulder dislocations or fractures. Not my bag.

 

[Rendar5]

I'm an EM resident and I had a natural affinity for psychiatry too, at least emergency psychiatry. I will say that asking what othe0r people's pros and cons are is meaningless to you. It's why people are happy in different specialties What's "eh whatever" to one person is "oh my god I can't stand this I want to shoot someone" to another.

Psychiatry has a lot of different areas and what you love in one you'll hate in another. You are dealt a huge number of overlapping diagnoses and have to contend with a lot of "is this axis I or axis II"?. You have to deal in a lot of subtleties. I'd post in the psych forums asking what they consider the pros and cons of the various fields. And honestly think about whether you care about those or not.

For EM i'll tell you what some pros and cons are. Realize that some of the cons simply don't exist for me because I don't think twice about them.
Emergency cons:
1. You deal with a lot of drug seeking patients and you have to treat them pain actively and work them up unless they are 100% obvious (not all drugs are narcotics either).

2. You have to admit patients you really don't want to admit (social admits e.g. or people who are in intractable pain who you cannot prove are seeking).

3. Doctors will send patients to you to receive pain meds, to get CT's, etc. and they will argue with you if you do not do what they ask even though you are their doctor at that moment.

4. You will be second guessed on every patient by someone who has more time, more history, more lab and radiology results, more time for the illness to present itself, more focused expertise. Whatever antibiotic you ordered for the patient once they get to the ICU will be changed because it's the wrong one

5. You only get to "indict" the diagnosis, rarely do you get to convict it.

6. You will not get to see patients recover from illnesses needing admission to workup and treat.

7. Frequent fliers coming in for the same reason all the time demanding the same workup all the time that will invariably be negative.

8. You get the crap for pushing through admits (at least academically. community it's not an aggravation) on stuff you know will be absolutely nothing 95% of the time, but you will not get credit for it for the 5% of the patients who did have what you were concerned about.

Pro's:
1. You get to treat people who will die within a couple hours of arrival otherwise.
2. You get to know the medical problems of every single field of medicine: Only FM gets to see as much a variety of medicine as EM.
3. No patient continuity unless you want.
4. You work 3 days a week.
5. A couple unique fields of medicine that you will be more expert in than the team you are admitting/discharging to, e.g. toxicology, wound care management, etc.
6. For a non-procedural field you learn a huge variety of procedures that you get to use once every couple shifts.

 

[Rendar5]

You'll see the same populations but as EM, from my limited understanding, you're more focused on getting them off your hands because they're taking up a bed.

Have you looked into an emergency psych rotation? I entered medical school because of an interest in psych, but EM becomes more attractive periodically. When I really think about it, however, the idea of doing psych in an emergency setting seems more interesting than dealing with shoulder dislocations or fractures. Not my bag.

A word about emergency psych:
They are similar in a limited sense. Both fields you establish general diagnoses that may be proven or disproven later. Both fields you treat with more generalizable meds that sometimes treat symptoms, not conditions. Both fields have the same initial and secondary goals: 1. stabilize the patient. 2. Establish a disposition. Admit, discharge, or extended observation. Neither field cares much about subtleties that don't play into those 2 goals.