Respect for Psych

[lovanima]

Hi everyone,

I have been getting a lot of bad vibe from my residents and attending after I told them that I matched into Psychiatry. I wonder if anyone has any recommendations of how to handle situations when people downgrade Psych.

Long story short, my resident keeps texting me rounding times instead of paging me, despite me telling her that my phone doesn't have good signal in the hospital. I missed a couple rounds during my SubI. I brought my concern to my course director. He said that she didn't intentionally make me look bad in front of my attending, that she probably thought I would not care about medicine since I'm going to Psych.

I was shocked. The course director advised me to talk to my resident to solve the problem, and then update him later. I don't feel comfortable talking to him anymore. I'm thinking to write something in the evaluation of the subI course and my resident. Did anyone have something similar happen to you after match?

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[enoughsaid12]

Hi everyone,

I have been getting a lot of bad vibe from my residents and attending after I told them that I matched into Psychiatry. I wonder if anyone has any recommendations of how to handle situations when people downgrade Psych.

Long story short, my resident keeps texting me rounding times instead of paging me, despite me telling her that my phone doesn't have good signal in the hospital. I missed a couple rounds during my SubI. I brought my concern to my course director. He said that she didn't intentionally make me look bad in front of my attending, that she probably thought I would not care about medicine since I'm going to Psych.

I was shocked. The course director advised me to talk to my resident to solve the problem, and then update him later. I don't feel comfortable talking to him anymore. I'm thinking to write something in the evaluation of the subI course and my resident. Did anyone have something similar happen to you after match?

Why fight this battle and make a stink when you are on your way out ? I would also wonder whether a lot of this is your own insecurity. Just seems like a nothing burger

 

[splik]

I was shocked. The course director advised me to talk to my resident to solve the problem, and then update him later. I don't feel comfortable talking to him anymore. I'm thinking to write something in the evaluation of the subI course and my resident. Did anyone have something similar happen to you after match?

you need to learn with dealing with interpersonally challenging situations in the workplace. I assure you, this wont be the last time you have to address such a situation. please talk to your resident about what happened rather than just putting it in the evaluation later. you still have to do half an intern year and going into psychiatry is all the more reason that you need to get as much exposure in other specialties as possible now. you absolutely should make a stink about it, when you pay so much for your education. the reason we end up with being at the bottom of the totem pole is precisely because psychiatry is full of conflict-averse weaklings who have no self-respect.

 

[deleted736562]

Consider this as an opportunity to get some training in handling interpersonal challenges. As splik said you're going to see questionable behavior (or behavior you don't like) all through out your professional career, regardless of specialty, and it certainly does not stop at residency. A lot of the time this will be coming from superiors, given the nature of the hierarchical system and our human tendency to bask in authority. You will need to stand up for yourself time and time again, and the quicker you learn to be firm and assertive the lesser the headache in the future.

ALso think about it this way: what if your resident really forgot what you told her? There's the slightest possibility that her intentions are completely benign, so putting that in the evaluation letter without first addressing it directly with her might actually be inappropriate in this case.

 

[NickNaylor]

As a medical student, my own approach was that this was not a battle for me to fight. You do not need to be a warrior for the specialty.

With respect to the resident, you did what you can do and there's not really much else you can do. You could talk with the resident directly - that would probably be the most direct way to potentially get this worked out - but I'm not sure what would change, if anything, other than feeling like you've said your peace. If you have the ability to fill out an evaluation then you could put your concerns there, but I agree with @fpsychdoc that giving the resident a negative evaluation without addressing it with them first is somewhat poor form.

 

[siliso]

Talk to your resident. Tell them: Hey I really want to be there for rounds and be part of the team and learn as much as I can from this rotation. When you texted me the time for rounds I didn’t receive it because of reception in the hospital and I felt really bad about missing it/being late. If this comes up again, could you please page me? Or is there another way we can catch up on plans like a set time to meet up in the team room? Or someone else on the team who could page?

Also with the course director: I was thinking about our conversation and I am concerned that anyone would think I don’t care about this rotation because I am going into psych. That is certainly not true; I want to learn and do well and be prepared to take care of my patients. How can I help to change this perception?

If you can’t do it or don’t get a satisfactory resolution, try the chief resident and/or the attending. Honest evaluations with factual information (this happened, this was said to me, don’t attribute bad motives) are also welcome. As a chief or attending I would be concerned if my resident didn’t know or care where the sub I was for rounds.

 

[SixStringPsych]

Preach splik. For so long I've just let things slide because I'm a medical student, but now that I've matched, I feel much more comfortable making sure people are held accountable for their jobs and getting what I need to get out of my training. A student or resident in any specialty needs to learn these interpersonal skills. It's not about making a stink, it's just about holding others accountable.

 

[justfolks]

Just a patient, but I work in a professional context with juniors who report to me. Your suggestion that maybe you might just not say anything to the resident, even though it is entirely plausible that she forgot your request that she page instead of text the meeting time, is incredibly immature and unprofessional. And your suggestion that you might double down on that poor behavior by giving a bad review when you never made an effort to speak with the resident directly, and don't really know what happened? If I ever found out that my psychiatrist indulged in this kind of awful interpersonal behavior, I would seriously question his ability to help me as a therapist, which is what I see him for. If people are giving you a hard time about going into psychiatry, the way to deal with that is to ignore their comments and focus on being the best doctor you can. If that means figuring out how to navigate uncomfortable interpersonal situations and advocate directly for yourself, then that is what you need to do. If you can't do that for yourself now, how will you do that for your patients starting next year (or even now!)?

 

[funtertaining15]

I think everyone else said it best. You're already matched and at this point you just need to pass. If you're not doing residency in that hospital, most likely you won't run into them again, so just talk to the resident. It'll be practice for if and when you have a similar situation happen in the future. Good luck; I sympathize with you as I really despise confrontation...unless need be.

Sent from my Moto G (5) Plus using SDN mobile

 

[lovanima]

wow, I didn't expect this many attention. I skimmed through everyone's comments, and I'll give some more info.

I think I summed up the story too short, and left out some important details. I did talk to my residents twice before coming to my course director. The talks with my resident went well, but she probably didn't get my messages.

My personal insecurity could be a factor. I am a med student, which means I am still a lay person in medicine. But I will argue that I'm pretty proud matching into a good psychiatry program.

On the other hand, I think discrimination against Psych at my institution is also a factor in this case. We do not have a Psych residency. There are technically only 4 psychiatrists here, and they only do psych consult for suicidal. This is not the first time an attending downgrades Psych. That's why I brought my story to sdn to see if anyone experience something similar and have any suggestions in order to make changes.

I already matched, and I'm finishing med school in 1 month. I could have ignored it, showed up to rounds late, and blamed on my phone lol. My evaluation at this point does not matter much anyway. Why do I care?

I feel obligated to change the environment here, but don't know how (too ambitious I admit). Thus I was thinking to write something on the evals hoping to address the issue (which probably won't be effective). By posting my story here, I was looking for some suggestions to fight for Psychiatry in the future.

I don't agree with some of the accusations in the comments, but I greatly appreciate the advices . Anyway, I will talk to my resident again, and if it doesn't work, it doesn't work. I should focus on moving and enjoying my last couple of months without clinical responsibility. Peace!!!

 

[nitemagi]

Biases absolutely exist in the world. Everyone generalizes from their experience, or passes on the false beliefs they themselves were taught. Unfortunately in medicine we protect our own from outside attack, yet let those within fend for themselves from bullies, apathy, and unrealistic expectations. And we wonder why there's an epidemic of physician suicide.

You are not alone in facing biases against psychiatry. Thank you for asking for help in this. Find allies close to you. The people of this board are some of them, though they're no will ever fight your battles for you. All we can offer is support.

The biases against psychiatry are real, but they're mostly due to ignorance, inexperience, and narrow mindedness. When you get very good as a psychiatrist, and when they need your expertise (for patients or themselves), you will get more respect than you could anticipate. That's been my experience, which I choose to now generalize from

 

[Candidate2017]

Did anyone have something similar happen to you after match?

No.

Probably because I picked electives that were suitable for my end of 4th year victory tour and peaced out most of the time. I've been in a few hospitals and everyone is respectful of psych except one med school clinical faculty. People usually say they couldn't do what psychiatrists do or say we need more psychiatrists.

In defense of the resident, you will soon realize they have 1,000 more important things to do than page a med student who has a shatastic phone. Get a better phone plan by July 1 and make your and everyone else's life easier.

 

[Candidate2017]

the reason we end up with being at the bottom of the totem pole is precisely because psychiatry is full of conflict-averse weaklings who have no self-respect.

That aspect is very annoying. But I've come to accept it's a necessary evil since pissing off patients and leaving a trail of resentful, recently discharged involuntary patients isn't a good thing when the hospital parking lot isn't patrolled by armed guards.

 

[Onions]

People usually say they couldn't do what psychiatrists do or say we need more psychiatrists.

Yeah, I hear this a lot, but I've also heard the bit about "not being real doctors" plenty also. Hospice/Palliative gets this a lot as well. I think the stigma attached to mental illness ends up rubbing off on mental health workers, leading to a bizarre, kind of borderline "I hate you don't leave me" sort of relationship with the rest of the medical sphere: psychiatrists are in some sense pariahs in the hospital, and at the same time, very much needed.

 

[Liquid8]

I think stigma regarding mental illness has decreased amongst the average layperson, but change seems to have been slower amongst health professionals - doctors in particular. We've had issues with junior doctors feeling like they can't seek help for any kind of mental illness concerns due to mandatory reporting laws and believing that it would count against them in terms of future career prospects. Part of this is probably due to psychiatry being viewed as a bottom of the barrel speciality amongst medical students and doctors, and a subconscious reluctance to seek help from those who you consider to be beneath you.

OTOH, I see a lot of people working in blue collar trades more supported and encouraged by their employers to seek treatment after disclosing mental illness problems: this definitely wouldn't have happened a generation ago.

 

[WisNeuro]

Once you get into the real world, none of this "who is respected more" stuff really matters. IME, the people really interested in the "pecking" order of things are fairly insecure and not the happiest people, just leave them to their own insecurities. Generally speaking, if you do good work and show your value, other providers will refer to you and keep you busy. As long as you have the respect of your referral sources and your patients, that's all that matters in the long run. Mostly.

 

[MacDonaldTriad]

Being awesome and showing humility is ten times more impressive than being a talented braggart. The latter are a dime a dozen in medical education. The only way to control what others think of you is to be impressive, kind, effective and humble. Demanding respect backfires pathetically. Actively seeking affirmation from others cheapens the honor considerably.

 

[SeniorWrangler]

You guys have it wrong. In the real world, when the surgical patient gets psychotic or the renal patient gets severely depressed, their doctors ask a psychiatrist to help, and if the psychiatrist helps the patient, the surgeon or nephrologist will usually appreciate it. I can't count the number of times a fellow attending has thanked me and said they couldn't do my job.

What actually affects the status of psychiatrists in medical centers is the crappy reimbursement we get, which makes many of the things we do hard to sustain over time, even though they are valuable to patients and other specialties. If you're going to worry about something, worry about this.

 

[J ROD]

Generally, I have found other specialties appreciate Psychiatry but they don't want to deal with the "crazy". I can only think of one instance where it was obviously a perceived "mine is better than yours". And it was someone I went to high school with and we are both doctors. He is an oncologist and I a Psychiatrist. He asked "why did I ever choose something like Psychiatry" in a very negative tone. I said "because I like it, probably why you picked oncology." He said something about it being a waste of my ability or thereabouts and I said I bet my saved lives to lost ratio was better than his. And reminded him the next time he had a depressed patient with cancer who he was calling for help.

 

[CingulateGyro]

He said that she didn't intentionally make me look bad in front of my attending, that she probably thought I would not care about medicine since I'm going to Psych.

Without knowing the context/anything about the perceptions of the parties involved in the conversation, you could probably substitute any specialty other than medicine for psych here. He may have just been commenting on 4th years being more lax about specialties they aren’t going into in general than making a snide remark.

I also did a medicine rotation after matching. I was asked why a few times “why?” but I think it mostly to start conversation. I always said something along the lines of wanting to be better prepared for intern year/being a better physician

 

[Salpingo]

Hi everyone,

I have been getting a lot of bad vibe from my residents and attending after I told them that I matched into Psychiatry. I wonder if anyone has any recommendations of how to handle situations when people downgrade Psych.

Long story short, my resident keeps texting me rounding times instead of paging me, despite me telling her that my phone doesn't have good signal in the hospital. I missed a couple rounds during my SubI. I brought my concern to my course director. He said that she didn't intentionally make me look bad in front of my attending, that she probably thought I would not care about medicine since I'm going to Psych.

I was shocked. The course director advised me to talk to my resident to solve the problem, and then update him later. I don't feel comfortable talking to him anymore. I'm thinking to write something in the evaluation of the subI course and my resident. Did anyone have something similar happen to you after match?

Realistically, this probably has more to do with you being a med student than your choice in specialty. As a resident you’ll see the most important attribute of a medical student is how much work they add to your day. A good med student doesn’t need to be tracked down or ask a million questions designed to impress the attending but ends up dragging rounds out another hour. A great medical student takes initiative to track down patient information, find reports, etc. If they actually SAVE you time and work, their likeness will be enshrined on the walls, their names eternal in house staff lore as the mythical one who disimpacted room 10A without being asked! Your resident isn’t paying you probably because paging you is just one more annoying thing they have to remember to do for the next few weeks before you leave and they have to deal with another student asking “anything I can do to help?”

As an attending, if I don’t see a student on rounds, I figure they’re at a meeting or were caught in a urinal avalanche in the supply closet. We have a lot of urinals in our hospital.

Honestly, going purely on specialty, the ones I find most impressive are those going into a prestigious program in a not so prestigious specialty (like CHOP peds or MGH IM). It shows me not only are they smart and accomplished, but they’re pursuing their interests. Yeah, I’ll be impressed with someone who was able to match ortho or derm, but that mostly reflects their scores and not necessarily their character. If a student matches into psych and they’re clearly into mental health, I’ll respect them.

tl;dr - med students are valued by the time they don’t take up much more than by their chosen specialty.

 

[Attending1985]

For me, stigma against mental health disorders and lack of respect for psychiatry are separate issues. I have seen so much crappy care in psychiatry that I have lost respect as well.