thinking about switching to psych...barking up the wrong tree???

[karl71]

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I'm a first year intern in family practice. I was very torn between psych and fp, but eventually settled on fp. I'm now ~5 months into intern year and feeling very disillusioned. I run around like a chicken with its head cut off non-stop, work really long hours, and feel the pressure to get through patients quickly in the clinic. I see my attendings also cranking the patients out. It feels like to make it in fp, you have to really see a large volume of patients, which means little time to sit down, talk, and deal with psych/social issues(when you have to address the 500 other medical problems going on).

I chose fp because I thought it would be a good mix of some basic medicine with a fair amount of psych/social issues thrown in. I really miss the psych. I feel like all I do is go over labs, screen for high cholesterol, dose BP meds, etc.(things I don't care much for), with only a rare opportunity to do any psych.

I'm tempted to switch to psych, but my fear is that I'm going to find the same thing there. 15 min med checks, not really getting to know patients well, having to see a large volume of patients, feeling overworked and exhausted, etc. etc. etc.

For those of you in the psych world, any input? Could I have picked the wrong field for me? Or am I chasing down a realm of medicine that doesn't exist?

Thanks in advance.

 

[whopper]

The 15 minute medcheck thing is more of a private practice/outpatient phenomenon. I work in a forensic psychiatric inpatient unit in addition to doing private practice. In the former, I can spend hours a day on a patient if I like.

What happens in the inpatient unit is many of my patients are stabilized but I cannot discharge them because only a judge can do so. He will not because of the severity of the crime. E.g. multiple murders. A judge will not let a guy out who was found not guilty by reason of insanity who cut up his family with a cleaver even if he's stabilized one month later. What ends up happening on my unit, in effect, is I have a bunch of stabilized guys, and my progress notes (that only need to be done once a week) are virtual carbon copies of the previous ones.

So when I do get a new guy, I can spend hours a day on that person until get to know them for real. E.g. order an MMPI, interview the person 3 hours a day, do lit-searches specifically geared towards that person's case. I had a guy who used multi-million dollar resources simply into stalking a particular individual. I was able to a lot of reading on stalkers, correlate it with the data I knew on the guy, and throw a battery of tests at him.

Okay, I'm digressing, but the point is depending on what area of psychiatry you may go into, things can highly vary. I would not be able to do this type of work in a short term care facility where patients are usually only in there a few days at a time.

 

[HMSPSYCH]

I feel like all I do is go over labs, screen for high cholesterol, dose BP meds, etc.(things I don't care much for), with only a rare opportunity to do any psych.

I'm tempted to switch to psych, but my fear is that I'm going to find the same thing there. 15 min med checks, not really getting to know patients well, having to see a large volume of patients, feeling overworked and exhausted, etc. etc. etc.

Sometimes when my head is spinning hearing problems after problems (physical and mental health, relationship, social/family/romantic/school stressors, etc) after a few pts, I do miss IM or FP and wish all I had to do is mindlessly going over labs, screen cholesterol, BP meds, vital signs. At least you can ignore the endless ranting.

I think the 15 min check is not really the norm, especially if you work in academic settings and comfortable making less than 200K annually. The 15 min checks are for those who make much more.

I think a colleague says it best 'everything in medicine kinda suck, but at least we have job security and people call us doctor".

 

[sella turcica]

Sometimes when my head is spinning hearing problems after problems

the answer is lexapro 😀

 

[peppy]

(when you have to address the 500 other medical problems going on).

In my opinion, a good FP program should teach you how to prioritize their problems and not expect you to address everything in one visit.
For goodness sakes, in my FP continuity clinic (as an intern) I once had a patient hand me a list of like 15 problems he wanted addressed (incidentally it was a young guy, not even a gomer who might very easily have managed to have that many things go horribly wrong over a long life). I would definitely look hard at if the problem you're having is the work itself or the residency program.
Still, in my opinion, the average day on a Psych ward does tend to be a little less hurried than an average day in most other forms of medicine since listening to the patient is such a big part of our assessment. If you did want to switch I think you could find a PGY-2 spot without much difficulty.

 

[Sneezing]

Psych won't necessarily be any better. You will yourself doing admissions for people who are suicidal, that really are only wanting a miniature vacation from their life. The have a half dozen kids, a partner who isn't a responsible adult, and they have socioeconomic issues up the wazoo. What they need is a dose of personal responsibility, coping skills, a bunch of money, and a vacation. None of that psychiatry can provide in today's setting, but you will go through the motions and increase their antidepressant a little.

People are being moved in and out of psych units not in 15 minute intervals but in 3 day intervals, that essentially aren't addressing all the above psychosocialenvironmental issues listed.

I believe the hope lies in private practice. Open up your own practice take cash only and make it they way you want it. Psychiatry or FP can both still do that, but while we are residents we will be 'moving the meat.' This is partly because the education system is still connected to the insurance system. Unless you are removed from it you will be entrenched in shortened treatments.

 

[dl2dp2]

The 15 minute medcheck thing is more of a private practice/outpatient phenomenon. I work in a forensic psychiatric inpatient unit in addition to doing private practice. In the former, I can spend hours a day on a patient if I like.

What happens in the inpatient unit is many of my patients are stabilized but I cannot discharge them because only a judge can do so. He will not because of the severity of the crime. E.g. multiple murders. A judge will not let a guy out who was found not guilty by reason of insanity who cut up his family with a cleaver even if he's stabilized one month later. What ends up happening on my unit, in effect, is I have a bunch of stabilized guys, and my progress notes (that only need to be done once a week) are virtual carbon copies of the previous ones.

So when I do get a new guy, I can spend hours a day on that person until get to know them for real. E.g. order an MMPI, interview the person 3 hours a day, do lit-searches specifically geared towards that person's case. I had a guy who used multi-million dollar resources simply into stalking a particular individual. I was able to a lot of reading on stalkers, correlate it with the data I knew on the guy, and throw a battery of tests at him.

Okay, I'm digressing, but the point is depending on what area of psychiatry you may go into, things can highly vary. I would not be able to do this type of work in a short term care facility where patients are usually only in there a few days at a time.

Man, you make forensic sound super awesome and a great possibility for a budding physician scientist like me.