Stigma/lack of respect from "society"?

[JDoc9]

Hello board,

I am an undergraduate student who is currently open minded (as I should be) in regards to specialties to pursue in medicine (including psychiatry, which is why I come to you today). The question I am presenting to you has more to do with my own general curiosity than anything. To put it simply, have any of your aspiring or currently practicing psychiatrists received any sort of lack of respect or stigmatization from people who have learned of your career/prospective career in psychiatry? Have you come across any "Oh, you have to go to medical school to become a psychiatrist?" or experienced less "respect" than you would expect someone who is going into, say, family medicine, would receive?

I am aware that this "doesn't matter", and that we should do what we love, and I completely agree with this notion. However, I can't help but be curious about this.

Thank you in advance for your contributions to this thread!

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[postbacpremed87]

Respect from other people is overrated. Live your own life...don't seek the McMansion or a new beamer for "respect"...focus on family and friends and making people's lives better in your job...do enjoy your coffee in the morning as your drop your kids off at school before you go to your practice (something other specialties won't allow you to do). Enjoy the hobbies that you were be able to do as a result of psychiatry being lifestyle friendly. I could go on but you get the point.

 

[wolfvgang22]

Never faced any "stigma" for being a psychiatrist from anyone I'd want to associate with or care about hearing from. Never, ever, have I gotten any disrespect from medical colleagues of any specialty for choosing psychiatry.
The sooner you quit worrying about "respect" from your parents, neighbors, relatives, colleagues, prospective partners, and whoever the hell else and just be the best damn professional you can be in your field, the better off and happier you will be, and you will naturally get the respect you deserve.

 

[Psych56]

A few of my family members expressed disappointment when learning about my specialty choice. Most of them have grown to respect it after some conversations about what the field is all about and why I enjoy the patients so much. Now they are excited about it and are very empathic towards those suffering with mental illness. In the end, my friends and family are proud of me for pursuing a field I am so passionate about. In turn, I've been able to teach them about how to take better care of their mental health and now there isn't a week that goes by that a friend or family member doesn't thank me for helping them in this way.

 

[smalltownpsych]

Never faced any "stigma" for being a psychiatrist from anyone I'd want to associate with or care about hearing from. Never, ever, have I gotten any disrespect from medical colleagues of any specialty for choosing psychiatry.
The sooner you quit worrying about "respect" from your parents, neighbors, relatives, colleagues, prospective partners, and whoever the hell else and just be the best damn professional you can be in your field, the better off and happier you will be, and you will naturally get the respect you deserve.

 

[smalltownpsych]

A few of my family members expressed disappointment when learning about my specialty choice. Most of them have grown to respect it after some conversations about what the field is all about and why I enjoy the patients so much. Now they are excited about it and are very empathic towards those suffering with mental illness. In the end, my friends and family are proud of me for pursuing a field I am so passionate about. In turn, I've been able to teach them about how to take better care of their mental health and now there isn't a week that goes by that a friend or family member doesn't thank me for helping them in this way.

Some people get what we do, many don't. From what I have seen, the ones who are most resistant to what we do are the people who are too scared to look in the mirror. Sort of like the dynamics of homophobia. I don't spend much time with people like that either in my personal life or even in my practice. Why waste my time with that level of defensiveness?

 

[MacDonaldTriad]

Although I have had to endure a rare teasing remark from non-psychiatric physicians, these have never come from a physician that I respect. They seem to only come from insecure specialists who are the most incapable of dealing with our patients. The more senior I become, the less it happens. The most likely place to have this happen is when you tell your classmates you are going into psychiatry. It seems medical students are the closest to the competitive mode that rewards comparative measuring and encourages putting others down. Medical students are so easy to model, they only need to hear one snide remark from a surgeon and poof, they are making snide remarks about psychiatry.

The patients that dump on psychiatry have an axe to grind over some perceived bad experience with us. Most patients have no knowledge or interest in what one type of doctor thinks of another type of doctor. They come to us for help and want us to help them. It would be very threatening to believe anything other than your physician is one of the best.

As far as friends and family, sometimes you will be asked if you ever wanted to be a real doctor. Most of this is a combination of ignorance and a denial defense. Most people who have never seen a psychiatrist try hard not to empathize with those who do because after all, we need to believe there are millions of reasons this can happen to them but not to us.

 

[JDoc9]

Thank you so much for your responses thus far. If I figure out that psychiatry is what I genuinely want to do, I certainly would not allow any outside influence or superficial pressure to dissuade me from pursuing my passion. I'm in the school of thought that promotes "get to medical school first and experience things before declaring what specialty you want to pursue", however, I know that I love the "people" aspect of medicine and believe that psychiatry would certainly fill that desire. I was just curious about people's experiences in the "outside world". Its refreshing to read some of your positive experiences.

 

[nitemagi]

I prefer:

Which, by the way, I find to be true. I socialize with a lot of non-medical folks, and I get much more raised fascinated eyebrows at psychiatry than other medical specialties. n=1.

 

[Frazier]

IMO, the highest concentration of disrespect for the field (outside of pure anti-psych/scientology resources) will come from SDN forums...

There are a lot of premeds that think they have it all figured out as to what "real medicine" is before even starting day 1 of medical education.

There are a lot of med students that think since they did a whopping whole 4-6 week rotation on inpatient psychiatry, maybe even honored it, that they are now authoritative figures about the field as a whole and everything encompassing mental health.

Also, add on anonymity inherent to Internet forums and the boldness of troll's claims will border almost on hyperbole.

 

[Indodo]

I think people may be painting the picture a little rosier than it really is.
I have been disrespected, many times. The "you're just a psychiatrist" kind of attitude. Also, I have had many patients not realize that a psychiatrist is different from a psychologist. The overwhelming majority of it is innocent and I wouldn't call it disrespect. Sometimes it's anger or irritability for something else (often me preventing a dump) being vented, this is where I used to see it from medical staff, especially ER and ICU. Rarely, it's hostility directly from someone who has been hurt/feels they've gotten bad care previously or has an agenda: This is usually in non clinical settings and it is disrespect, pure and simple but I have never found it to be troubling.

On the whole, I have gotten disrespect simply for being a physician more than for being a psychiatrist. But I also get a lot of gratitude for being a psychiatrist and a physician.

 

[deleted480308]

have you found a way to spend respect from strangers? I haven't

 

[MacDonaldTriad]

When lay people don’t understand the difference between psychiatrists and psychologists, I would be hard pressed to guess which group should feel they were shown a lack of respect (or were disrespected in today’s vernacular). {Good God, I always thought respect was a noun, but my spell checker accepted this}

 

[Frazier]

When lay people don’t understand the difference between psychiatrists and psychologists, I would be hard pressed to guess which group should feel they were shown a lack of respect (or were disrespected in today’s vernacular). {Good God, I always thought respect was a noun, but my spell checker accepted this}

 

[TexasPhysician]

Never faced any "stigma" for being a psychiatrist from anyone I'd want to associate with or care about hearing from. Never, ever, have I gotten any disrespect from medical colleagues of any specialty for choosing psychiatry.
The sooner you quit worrying about "respect" from your parents, neighbors, relatives, colleagues, prospective partners, and whoever the hell else and just be the best damn professional you can be in your field, the better off and happier you will be, and you will naturally get the respect you deserve.

I'm going to kind of disagree in that I notice medical professionals ragging on other fields all the time.

IM is always upset that EM doesn't work-up problems better.

Surgeons harp on anesthesia.

I've seen peds and plastic surgery insulting each other to no end.

There will always be someone telling you to switch fields regardless of what you choose. Just choose what you love.

 

[wolfvgang22]

I'm going to kind of disagree in that I notice medical professionals ragging on other fields all the time.

IM is always upset that EM doesn't work-up problems better.

Surgeons harp on anesthesia.

I've seen peds and plastic surgery insulting each other to no end.

There will always be someone telling you to switch fields regardless of what you choose. Just choose what you love.

As a med student I did a little training in a hospital that had some of this toxic atmosphere where different departments blamed one another for anything and everything and looked down their noses at each other. I think that attitude trickled down from hospital administration. It was a long year.

 

[jakeislove]

Aside from the occasional "Are you sure you want to waste your life helping those people?" I don't get too much razzing.

 

[smalltownpsych]

I'm going to kind of disagree in that I notice medical professionals ragging on other fields all the time.

IM is always upset that EM doesn't work-up problems better.

Surgeons harp on anesthesia.

I've seen peds and plastic surgery insulting each other to no end.

There will always be someone telling you to switch fields regardless of what you choose. Just choose what you love.

Of course each specialty would think theirs is the best. That doesn't necessarily equate to a lack of respect. In my experience, the other docs are always impressed when what we do works and is needed. Different specialties need us more than others, Path and Radiology don't seem to know or care much about us; Family, Emergency, and Peds deal with us more and respect us when we do a good job. The best way we can lose respect of not only docs but also teachers and police or whoever is to empathize too much with a patient who is doing upsetting things and not enough with the person who is being disturbed by their behavior. Especially if they feel minimized or invalidated.

 

[Shikima]

For the OP - When people learn that I do Psychiatry, it usually comes in the form of some kind of relief with the sentiment of "Oh good, now I can send people to you [which I cannot manage behaviorally]."

 

[Trismegistus4]

Hello board,

I am an undergraduate student who is currently open minded (as I should be) in regards to specialties to pursue in medicine (including psychiatry, which is why I come to you today). The question I am presenting to you has more to do with my own general curiosity than anything. To put it simply, have any of your aspiring or currently practicing psychiatrists received any sort of lack of respect or stigmatization from people who have learned of your career/prospective career in psychiatry? Have you come across any "Oh, you have to go to medical school to become a psychiatrist?" or experienced less "respect" than you would expect someone who is going into, say, family medicine, would receive?

I am aware that this "doesn't matter", and that we should do what we love, and I completely agree with this notion. However, I can't help but be curious about this.

Thank you in advance for your contributions to this thread!

Are you Indian?

The only people who have this idea of a "prestige hierarchy" of medical specialties in their minds are people within the medical profession. The lay public is just impressed that you're a doctor.

The most common reaction you'll get from members of the non-medical laity is not disdain at your choice of specialty, but a complete and total misunderstanding of what psychiatrists do. Most people seem to think all we do is have people lie on a couch and talk about their childhood family dysfunction. They think we do "psychoanalysis," but they completely misunderstand what that is. They think it means "reading someone's mind and gleaning all kinds of intimate details about their deepest thoughts and motivations just by looking at their face or hearing them utter two words." E.g., the cashier in a store will say, "are you psychoanalyzing me right now?"

 

[FranzLO]

Psychiatry is one of the things I am thinking about. I mentioned it to my parent's ENT and I suggested I was worried about what people might think about the profession. I will translate what he said for the G audience: "Forget 'em"

 

[Leo Aquarius]

I was a groomsman at my friend's wedding, and during the bachelor party the groomsmen would introduce me as "a doctor" to random girls at bars. The rest of the time they asked for my advice on everything from how to live healthier to sailing small boats. The groom told people I was the smartest person at the reception, and I had a few uncles coming up to me afterwards asking for my business card. I went in not telling anyone what I did, and came out feeling like a celebrity unintentionally. Sometimes you get too much attention for being a doctor.

Respect and disrespect are highly experience based. In my experience, people have had a positive reaction to my being a psychiatrist. I had one attending appear flabbergasted when I told him I wanted to go into psychiatry, but that's about it and he supported me once I explained why.

Now that I'm older, I've realized your job should take up at most 8 hours in a person's day, and the more time you have for building a family, seeing the world, and being creative or involved in volunteer activities/hobbies/church while taking care of people as a profession the happier you are. Psychiatry gives you everything, except mad respect from other doctors (and yourself in the medical hierarchy aspect - as former med students we have to re-discover measures of self-respect). That trade-off is a no-brainer as far as I'm concerned.

 

[smalltownpsych]

I don't know if it is the same as respect, but chicks dig psychologists and psychiatrists. Before I met my wife in undergrad, there were girls who wanted to "lie on my couch" and tell me their sexual fantasies after they found out I was going to school to become a psychologist. That was before I even became the highly skilled listener that I am now.

 

[freemontie]

I don't know if it is the same as respect, but chicks dig psychologists and psychiatrists. Before I met my wife in undergrad, there were girls who wanted to "lie on my couch" and tell me their sexual fantasies after they found out I was going to school to become a psychologist. That was before I even became the highly skilled listener that I am now.

Not to be a downer but that's practically a college flirting cliche. 'You're majoring in psychology? Oh, does that mean you're psychoanalyzing me?' *smile*
In actuality, the image of a male psychologist or psychiatrist is usually a slightly chubby old bastard with a big gray beard and spectacles. Because it seems readily accessible to the lay person it's good fodder for conversation, but not attractive per se.
This: http://newsfeed.time.com/2013/08/30/survey-surgeons-are-the-most-attractive-doctors/
Predictably, women prefer to date surgeons, somewhat apprehensive of dating shrinks.

 

[smalltownpsych]

Not to be a downer but that's practically a college flirting cliche. 'You're majoring in psychology? Oh, does that mean you're psychoanalyzing me?' *smile*
In actuality, the image of a male psychologist or psychiatrist is usually a slightly chubby old bastard with a big gray beard and spectacles. Because it seems readily accessible to the lay person it's good fodder for conversation, but not attractive per se.
This: http://newsfeed.time.com/2013/08/30/survey-surgeons-are-the-most-attractive-doctors/
Predictably, women prefer to date surgeons, somewhat apprehensive of dating shrinks.

lol I guess it helped that I wasn't a chubby old bastard! As far as being cliche, when I was a young adult I used whatever strategy that worked whether it was cliche or not. The truth is that musicians get the chicks.

 

[MacDonaldTriad]

Nice guys get spouces. Bad boys get the chicks.

 

[Bea5T]

Not to be a downer but that's practically a college flirting cliche. 'You're majoring in psychology? Oh, does that mean you're psychoanalyzing me?' *smile*
In actuality, the image of a male psychologist or psychiatrist is usually a slightly chubby old bastard with a big gray beard and spectacles. Because it seems readily accessible to the lay person it's good fodder for conversation, but not attractive per se.
This: http://newsfeed.time.com/2013/08/30/survey-surgeons-are-the-most-attractive-doctors/
Predictably, women prefer to date surgeons, somewhat apprehensive of dating shrinks.

"Survey conducted by uniformdating.com"

Yea, not representative of the general population in the least. Also, I'm guessing people that are on that site are attracted to their romanticized idea of a certain profession or how much money they make more than anything.

 

[jakeislove]

Surgeons probably project one of the things women love; confidence.

Someone claimed psychiatrists have a pretty high divorce rate. Not sure if it's true but I wouldn't be surprised.

 

[Bea5T]

Surgeons probably project one of the things women love; confidence.

Someone claimed psychiatrists have a pretty high divorce rate. Not sure if it's true but I wouldn't be surprised.

I've heard the opposite. Long hours in the OR leading to surgeons having the highest divorce rate.

 

[hamstergang]

I've heard the opposite. Long hours in the OR leading to surgeons having the highest divorce rate.

Unfortunately, people do throw around claims of how they think things should be without knowing how things actually are.

This question was already dealt with on SDN: http://forums.studentdoctor.net/thr...ge-of-divorce-rate-and-or-no-marriage.457014/

which linked to this article that showed psychiatry to have the highest divorce rate: http://www.nejm.org/doi/full/10.1056/NEJM199703133361112

 

[OldPsychDoc]

...
which linked to this article that showed psychiatry to have the highest divorce rate: http://www.nejm.org/doi/full/10.1056/NEJM199703133361112

In 1997.
Based on a "longitudinal cohort study of 1337 persons who entered the Johns Hopkins University School of Medicine from 1944 through 1960."

Whether or not that reflects the current psychiatric workforce or not is left as an exercise for the reader...

 

[freemontie]

"Survey conducted by uniformdating.com"

Yea, not representative of the general population in the least. Also, I'm guessing people that are on that site are attracted to their romanticized idea of a certain profession or how much money they make more than anything.

Yeahh...that rolling laughing emoticon is out of place unless the simple presence of a .com is enough to send you in a incredulous tizzy. Obviously not a Gallup poll, but I assume the the professional journalists at TIME magazine think its meaningful enough to publish. On the other hand, to state the obvious, the opinion of a "Bea5T" on "studentdoctor.net" would not be.

Also, duh @ people accept dates based on romanticized generalizations, including that of a potential suitor's profession. That's the point of the poll and my earlier comments. What do you think I'm talking about?

 

[whopper]

I've developed a theory as to why several non-psych physicians don't respect psychiatry.

1-Our curriculum doesn't teach the theoretical mechanisms of several psychiatric phenomenon.
Most psychiatrists I know don't know the mechanism of why Clozapine causes agranulocytosis, why people sundown, what causes UTI induced delirium, yet in other fields of medicine the mechanisms are almost always taught.

Yes, the mechanisms of these issues are established in many regards with evidence, yet we do not teach them in a medical school curriculum. I've never known why.

Leaves students with a taste in their mouth that we can't substantiate what we do.

2-Several psychiatrists use very unprofessional methods when it comes to diagnosis and treatment. How many of you know of an attending that diagnosis virtually everyone with bipolar disorder? Gives the same meds to everyone? They make all of us look bad.

3-Psych attendings (in general) don't put up a fight with other fields when they try to dump their non-medically stable patients to us and can't come up with enough of an argument to stand up to the other docs cause they let their own medical skills deteriorate to virtually-effective impotence. Again this is not all attendings but enough of them. A demographic where I've not seen this happen are with psychiatrists that have good geriatric training or dual IM or FP training in addition to psychiatry.

As most of you know, I love psychiatry and do not believe the field is BS, but the above does happen.

 

[smalltownpsych]

I've developed a theory as to why several non-psych physicians don't respect psychiatry.

1-Our curriculum doesn't teach the theoretical mechanisms of several psychiatric phenomenon.
Most psychiatrists I know don't know the mechanism of why Clozapine causes agranulocytosis, why people sundown, what causes UTI induced delirium, yet in other fields of medicine the mechanisms are almost always taught.

Yes, the mechanisms of these issues are established in many regards with evidence, yet we do not teach them in a medical school curriculum. I've never known why.

Leaves students with a taste in their mouth that we can't substantiate what we do.

2-Several psychiatrists use very unprofessional methods when it comes to diagnosis and treatment. How many of you know of an attending that diagnosis virtually everyone with bipolar disorder? Gives the same meds to everyone? They make all of us look bad.

3-Psych attendings (in general) don't put up a fight with other fields when they try to dump their non-medically stable patients to us and can't come up with enough of an argument to stand up to the other docs cause they let their own medical skills deteriorate to virtually-effective impotence. Again this is not all attendings but enough of them. A demographic where I've not seen this happen are with psychiatrists that have good geriatric training or dual IM or FP training in addition to psychiatry.

As most of you know, I love psychiatry and do not believe the field is BS, but the above does happen.

What causes the delirium in UTI and why is it so dramatic in many elderly patients? Having the answer to that might help when the IM docs are accusing geriatric patients with UTIs of malingering or exaggerating symptoms for secondary gain. They seem to really have strong reactions and poor judgement when it comes to malfunctioning neurological systems.

Sundowners is because of fatigue has always been my understanding and that damaged brains whether through disease or TBI are more easily fatigued or maybe more affected by fatigue would be more accurate to say. Why does the impaired brain get affected more? Not sure about that one. I don't think we understand brain fatigue nearly as well as muscle fatigue. After all, I learned about the mechanism behind that sophomore year in high school.

All I know about agranulocytosis is that it has something to do with white bood cells and that it can be a potentially life threatening side effect of clozapine. Probably caused by how the medication binds to specific receptors on those cells.

Although I didn't go to medschool, still love biology and always want to know the mechanisms behind most everything in the body, especially when it comes to the CNS. I am always amazed at people in this field who don't whether they are psychiatrists or psychologists although I always assumed it was worse for psychology. I always want to stab myself with a scalpel when I hear psychology student say, "I'm not very interested in all that neuro stuff." If I heard a psychiatrist say that I might stab them with the scalpel.

 

[whopper]

The delirium in the elderly is theorized to be due to interleukins. It's established fact that interleukins, in vitro, reduce neuronal firing when placed in a solution that is keeping an in-vitro neural network alive.

The theory is that in the elderly or otherwise extremely compromised patient, the IL-decreased neuronal firing leads to delirium. While younger people won't experience this, I'd bet if you gave a very sensitive cognitive test to a younger person with a UTI they'd likely not do as well on it had they not been infected.

The theory with sundowners is that direct sunlight stimulation activates the frontal cortex. So when the sun comes down, the little frontal cortex activity that was needed to keep the already unhealthy patient from becoming confused is snapped. It's also my own personal theory as to why people thinking a train hitting a watermelon and the watermelon splattering was funny at 1AM when Dave Letterman used to be on NBC and not funny when Letterman was on A&E at 5 PM, and why people seeking wild times do it at late night.

As for Clozapine, the theory (and there's data to support it as with all the ones I mentioned above) is that it directly interferes with the production of myeloperoxidase in the bone marrow that is an effective anti-oxidant. The stem cells, particularly the ones that produce neutrophils then undergo extensive free-radical damage. There's a rare genetic disorder called myeloperoxidase deficiency where patients suffer from neutrophil deficiencies similar to that of those on Clozapine. There's no known treatment for the latter and if there were it could potentially be used to treat the agranulocytosis experienced in Clozapine using patients. I've even called up some notable Heme/Onc doctors and were told there were no treatments just to make sure I wasn't missing something I could use on a Clozapine patient.

 

[hamstergang]

I've developed a theory as to why several non-psych physicians don't respect psychiatry.

1-Our curriculum doesn't teach the theoretical mechanisms of several psychiatric phenomenon.
Most psychiatrists I know don't know the mechanism of why Clozapine causes agranulocytosis, why people sundown, what causes UTI induced delirium, yet in other fields of medicine the mechanisms are almost always taught.

Yes, the mechanisms of these issues are established in many regards with evidence, yet we do not teach them in a medical school curriculum. I've never known why.

Leaves students with a taste in their mouth that we can't substantiate what we do.

I'll agree with this. I don't hear much of the mechanisms discussed, but I'm always wondering about them. I look this stuff up every now and then as I feel it's important to know, but it really would make more sense for it to be a standard part of our curriculum. Any ideas why it isn't?

 

[notdeadyet]

In part because of the frequent use of the term "theorized." We don't have as sure a grip on mechanisms that other fields do. It's part of the ambiguity that folks have to be comfortable with. For now.

That said, I'm all for more teaching of the mechanisms. You'll find it varies by program. Many actually get into this fairly deep. It's more common at programs that embrace psychiatrists as physicians who specialize in mental illness rather than seeing psychiatrists as a totally unique entity.


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