so just how much do psychiatrists have to love their patients?

[banannie]

I am a medical student, currently taking a year to do an MPH, then next year will be my 4th year. So I'm spending lots of time this year mulling over my residency decision. Definitely strongly leaning toward psychiatry right now. It's so right for me in so many ways. The other contender would be primary care IM, but right now I'd say my percentages are 80/20 respectively.

I keep hearing everywhere that to go into psychiatry, you should really be drawn to working with the psychiatric patient population. While I know for sure that I like working with people who have mood and anxiety disorders, I've also noticed that as the severity of the illness increases (i.e. more psychosis) and the axis II component increases, I become less empathetic and more uncomfortable/upset. Of course, I still find these psychiatric illnesses interesting on an intellectual level, so I tend to see the patients more as cases and less as people, which I guess sounds pretty horrible. One good thing is that I try very hard to monitor my reactions, and check myself to be aware of how my biases/societal stigma comes into play.

So is this something that most people feel when they go into psychiatry, and they get over it or find ways to adapt? Or is this really a sign that I'm just not cut out for psychiatry?

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[willow212]

Do I love all my patients? Gosh no, and I wouldn't expect it. I do think we all gravitate towards different types of patients.

I personally enjoy treating people with psychosis and mania - I find them fascinating and often humorous, though I think it took a certain volume of cases until I learned how to talk "on their level". I have a difficult time with substance abusers and Axis II patients, but part of that is that I don't know how to respond to them and they make me uncomfortable, so I'm working on that.

Half my clinic patients drive me a little nuts, with their lack of insight and demands for a "magic pill" that will cure all their life ills. But often it is these patients who really make me think and I learn a lot from working with them.

A lot of training and supervision is learning how to respond (both internally and externally) to patients who are difficult to deal with. Having negative reactions to patients is part of the game, and the more aware you are of your feelings, the better.

That said, I think the best way to figure out whether you want to be a psychiatrist is to expose yourself to patients (by doing additional rotations in various settings - ED, inpatient, consult service, maybe shadowing in outpatient clinic), and see if you enjoy the work. Talk about your reactions with other people who are on the team (nurses, social workers, other residents, attendings) and ask if they "love" all the patients and why they are in the field. It might give some perspective on your experiences.

Best of luck in your decision, and feel free to PM if you have other questions.

 

[Miklos]

So is this something that most people feel when they go into psychiatry, and they get over it or find ways to adapt? Or is this really a sign that I'm just not cut out for psychiatry?

Even the best practicing psychiatrists I've encountered have biases.

The question IMO is whether your biases get in the way of your professionalism and ability to treat your patients.

If they do, you may wish to consider another specialty with less patient contact.

 

[OldPsychDoc]

I am a medical student, currently taking a year to do an MPH, then next year will be my 4th year. So I'm spending lots of time this year mulling over my residency decision. Definitely strongly leaning toward psychiatry right now. It's so right for me in so many ways. The other contender would be primary care IM, but right now I'd say my percentages are 80/20 respectively.

I keep hearing everywhere that to go into psychiatry, you should really be drawn to working with the psychiatric patient population. While I know for sure that I like working with people who have mood and anxiety disorders, I've also noticed that as the severity of the illness increases (i.e. more psychosis) and the axis II component increases, I become less empathetic and more uncomfortable/upset. Of course, I still find these psychiatric illnesses interesting on an intellectual level, so I tend to see the patients more as cases and less as people, which I guess sounds pretty horrible. One good thing is that I try very hard to monitor my reactions, and check myself to be aware of how my biases/societal stigma comes into play.

So is this something that most people feel when they go into psychiatry, and they get over it or find ways to adapt? Or is this really a sign that I'm just not cut out for psychiatry?

I have all kinds of different reactions to patients--
empathy , anger , exasperation , boredom
It's all part of the job. And frankly, you'd run into the same thing in IM, or ER, or Gen Surg, or Peds....

You don't have to love them all to do what is clinically appropriate and provide appropriate quality of care.

Sometimes I just go into the back room and vent to a colleague (as with the borderline gal who tried sabotaging her discharge this week, or the narcissistic cop who gave me a hard time about being late for his Wellbutrin refill appointment because I was trying to help a lonely suicidal 60 year old woman get a visiting home health aide so she could get out of the hospital).

 

[banannie]

thanks all for your very insightful replies!

I definitely think that I do a decent job of trying to watch myself for negative reactions/biases, and correcting them or gaining insight through them. It's an issue I care a great deal about. So maybe that's the reason I'm more highly attuned to (and hence concerned about) it. I'll work my hardest to assure that any biases/negative reactions don't stand in the way of my professionalism and ability to care for patients.

What I'm really thinking about is finding a career where my day-to-day interactions with patients are more gratifying than they are draining. In my original posting, I guess "love" is a very strong word. And what I probably should be asking is the more open-ended question of what you all mean when you say you are "drawn" to working with psychiatric patients? is it that you truly, instinctually gravitate toward working with psychiatric patients, in particular, more so than working with other populations of patients? or is it that you enjoy spending more time with patients, and psychiatry enables you to do that? is it that you really care about mental illness, and are committed to treating it, and that makes it worth the aggravations you all mentioned above?

i am guessing all the above. but, thinking back, when you were in my position, was it simply a matter of enjoying psychiatry, and being more open-minded about it than your peers? or was it truly a calling, which could only be fulfilled by treating mental illness? or something else?

 

[OldPsychDoc]

thanks all for your very insightful replies!
...is it that you truly, instinctually gravitate toward working with psychiatric patients, in particular, more so than working with other populations of patients? or is it that you enjoy spending more time with patients, and psychiatry enables you to do that? is it that you really care about mental illness, and are committed to treating it, and that makes it worth the aggravations you all mentioned above?

i am guessing all the above. but, thinking back, when you were in my position, was it simply a matter of enjoying psychiatry, and being more open-minded about it than your peers? or was it truly a calling, which could only be fulfilled by treating mental illness? or something else?

I kind of went the other way--I was interested in behavioral disorders more as concepts, and I went into my psych clerkship really rather unsure if I would actually like the patients and want to work with them day after day.

Fortunately, it was a good clerkship!

 

[willow212]

When I say "drawn" to the field, I mean that I enjoy what I do on a daily basis.

I enjoy talking to patients about the aspects of their lives that have meaning to them. I like working on teams with other mental health professionals. I think it's fun to read about the mind and how it works (or doesn't). It feels right being in a collegial environment with other professionals who are open-minded and (for the most part) out to help those who are struggling. The future flexibility of doing a combo of research, policy, teaching, and/or clinical work, etc. (combos that many of my attendings are actually doing, with time to still go home to their families at a reasonable hour) fits with what I want for my life in general.

Of course, there are days that are frustrating, but compared with other fields of medicine, I saw many more rewards than frustrations overall in psychiatry for me.