Skill Atrophy

[hebel]

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How much should we weigh patient pathology and demographic variety in our decision to work in certain positions, especially as a newer attending? I'm not sure if I'm overestimating how much working only with certain patient populations might make me unable to work with others in the future (e.g. treating higher functioning people making it harder to treat SMI in the future, working with an ethnically homogeneous community limiting the kinds of people or pathology I'm exposed to, etc.)

For example, I'm considering a switch to an interesting new job position with the only potential negative being that's is a relatively narrow patient population culturally. This would be outpatient.

 

[Monocles]

Do what's best for you in terms of work/life balance, overall happiness, and financial considerations. If everything else about your job seems great then by all means go for it.

You'll continue to grow during your 1st year out of training. And honestly very few psychiatrists are "jack-of-all-trades" these days.

(Disclaimer: I'm biased and only work w/ teens in a very narrow SE range though, lol)

 

[Merovinge]

Depends on how long you do it, how up to date you stay with things, etc. I have only treated a handful of patients with schizophrenia since being full-time CAP and I'm certainly not as current on recent research as I was during adult residency. I compensate for this by asking colleagues who know more than me, but certainly wouldn't pretend to be a psychosis expert.

I will say that high SES folks tend to have just as much psychopathology, certainly more ED's, bipolar d/o, and possibly more SUD's. I was worried about moving to an area with a higher proportion of high SES and it has barely (if at all) changed the psychopathology I treat.

 

[whopper]

No matter what you do in this field, if you haven't done it in a long time you'll be very rusty. While I worked in academia we could pretty much see it all-consults, inpatient, outpatient, ER, VA, etc. Even when I did something regularly but not everyday such as ER a few months out of the year the month I came back was an adjustment for at least a few days. If you're out of it for years it could be weeks. IF you were never good at it you might never get good at it.

 

[WisNeuro]

No matter what you do in this field, if you haven't done it in a long time you'll be very rusty. While I worked in academia we could pretty much see it all-consults, inpatient, outpatient, ER, VA, etc. Even when I did something regularly but not everyday such as ER a few months out of the year the month I came back was an adjustment for at least a few days. If you're out of it for years it could be weeks. IF you were never good at it you might never get good at it.

Probably moreso with higher technical complexity stuff. I'd need to do a lot of refresher work were I to get back into heavier research stats again.

 

[whopper]

I've seen some top researchers not be able to do ER. ER you got to have street-smarts and be able to discharge people who are screaming at you while still being able to put your foot down.

I've seen some doctors work ER for months and still not gain that skill. What happened in situations like this was the chair could then tell this person will likely never get good at ER and stick them to the other stuff. I've seen most doctors be able to more or less acclimate over time but the ER thing I've seen lots of doctors never be able to do it.

A sign of a bad department is there's not enough good doctors to at least put the doctors into areas where they were good. E.g. while at U of C we had plenty of great doctors and if one didn't excel in a niche they still had enough valuable skills to be used elsewhere. At another place they couldn't get people to fill in needed spots so they put in doctors into bad niches cause that was better than not having the minimum needed to keep the department going.

 

[deleted1100659]

Community psych the issue tends to be polypharmacy, lots of medical comorbidities, high rates of SUD, etc. Majority of my patients are SUD, personality disorders that are severe, schizophrenia, bipolar type illness. Maybe 1/3 perhaps even 1/4 are anxiety/depression. I will say it is a lot easier to refill zoloft 50mg every 3 months than to see 10 patients this morning (like I did) try to reduce some of their medications, usually at least 5, and figure out the history (which is hard as patients here arent great historians). So those reasons there can be a large degree of burn out. One positive about higher functioning patients is they tend to be better historians, it can be like pulling teeth to get information sometimes in my current setting. Higher functioning you're probably working a lot more with anxiety/depression/SUD/personality disorder. Community you probably substitute the first two for schizophrenia and bipolar disordres. So it really depends on your passion I suppose.

 

[jbomba]

Do what's best for you in terms of work/life balance, overall happiness, and financial considerations. If everything else about your job seems great then by all means go for it.

You'll continue to grow during your 1st year out of training. And honestly very few psychiatrists are "jack-of-all-trades" these days.

(Disclaimer: I'm biased and only work w/ teens in a very narrow SE range though, lol)

I was just kind of thinking this. Just started my pgy4 year and it's amazing how comfortable I feel in some environments compared to others. I feel somewhat inadequate on consults but very comfortable in the ER or inpt setting.

This sometimes gets me down and I wonder if I should really know more than I do at this point. I thought this kind of overly harsh negative self talk would have stopped after medical school... I guess not.

 

[hallowmann]

I was just kind of thinking this. Just started my pgy4 year and it's amazing how comfortable I feel in some environments compared to others. I feel somewhat inadequate on consults but very comfortable in the ER or inpt setting.

This sometimes gets me down and I wonder if I should really know more than I do at this point. I thought this kind of overly harsh negative self talk would have stopped after medical school... I guess not.

I feel like the further you get in medicine, the more you recognize it for what it is, no one knows for sure what they're doing with confidence, they just learn to act like they do, know where to go for help, and get more comfortable being uncomfortable.

 

[jbomba]

I feel like the further you get in medicine, the more you recognize it for what it is, no one knows for sure what they're doing with confidence, they just learn to act like they do, know where to go for help, and get more comfortable being uncomfortable.

Yeah that's good to remember.

I mean, I can't be the only one who has to look up starting doses, etc of medicines still....right?

 

[hallowmann]

Yeah that's good to remember.

I mean, I can't be the only one who has to look up starting doses, etc of medicines still....right?

Honestly, I always look stuff up in the room, whether I'm sure I know it or not. Invariably there is something that has changed or that I skimmed past the other day, and even when there isn't it just helps to be sure. I also pull it up in front of patients and show them adverse effect info frequently.

 

[deleted1100659]

I frequently look up dosing on uptodate, medscape, etc. Some of the older drugs I forget. I do have a a good bit of stuff memorized because I ANKi everyday. I turned BTB into anki cards, and personal notes into anki cards and converting kaplan and saddock into anki as well. Anki helps me retain stuff well which is nice, highly recommend it as an attending. Only spend like 20-30 mins a day on reviewing and can do it between patients.

 

[yanks26dmb]

I frequently look up dosing on uptodate, medscape, etc. Some of the older drugs I forget. I do have a a good bit of stuff memorized because I ANKi everyday. I turned BTB into anki cards, and personal notes into anki cards and converting kaplan and saddock into anki as well. Anki helps me retain stuff well which is nice, highly recommend it as an attending. Only spend like 20-30 mins a day on reviewing and can do it between patients.

I anki'd like crazy in med school. Worked well for me. Never thought to keep doing it now. Would you mind sharing a deck so I can see what kind of stuff you're prioritizing?

 

[forchinet121]

I frequently look up dosing on uptodate, medscape, etc. Some of the older drugs I forget. I do have a a good bit of stuff memorized because I ANKi everyday. I turned BTB into anki cards, and personal notes into anki cards and converting kaplan and saddock into anki as well. Anki helps me retain stuff well which is nice, highly recommend it as an attending. Only spend like 20-30 mins a day on reviewing and can do it between patients.

Agreed if you would share any deck you’ve made that would be super helpful