Armadillos

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Was curious how everyone's MS3 psych rotation changed how they view the field? If you loved psych beforehand and still love it, or thought it was stupid before and still think its stupid then thats not really what Im going for.

But for the most of us who really didn't know much about the field before medschool (except for the stuff you see on news or whatever), what did you think of your rotation? Did you come away with the feeling that psychiatry belongs in medicine as an MD field, or that it really shouldn't be part of medicine and instead be like psychologists or something?

Do you think more or less highly of the field after the rotation than you did going in?
 

jumpmanv15

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I am currently in my ms-III core psych rotation. I have much respect for the field and the psychiatrists that I work with but I sometimes find myself question the role of psychiatrists in medicine. Maybe its because these mental illness are so poorly understood, or that there is a level of subjectivity that goes into assessing a patients condition and making a diagnosis or maybe that it seems like a pharma game. My attending tells me that the number of beds nationally and statewide are on the decline in general and inpatient psych facilities are harder to come by so that may be an indicator of the state of things.

Also a quick google search brought this up so it seems like there may be encroachment in the near future
http://www.ama-assn.org/amednews/2011/03/07/prl20307.htm - i realize this article is from 2 years ago and I don't know whats been going on since then

i've only been in my psych rotation for 2 weeks so what do i really know though haha
 
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I am currently in my ms-III core psych rotation. I have much respect for the field and the psychiatrists that I work with but I sometimes find myself question the role of psychiatrists in medicine. Maybe its because these mental illness are so poorly understood, or that there is a level of subjectivity that goes into assessing a patients condition and making a diagnosis or maybe that it seems like a pharma game. My attending tells me that the number of beds nationally and statewide are on the decline in general and inpatient psych facilities are harder to come by so that may be an indicator of the state of things.

Also a quick google search brought this up so it seems like there may be encroachment in the near future
http://www.ama-assn.org/amednews/2011/03/07/prl20307.htm - i realize this article is from 2 years ago and I don't know whats been going on since then

i've only been in my psych rotation for 2 weeks so what do i really know though haha
I started psych (6 weeks last semester) with essentially no interest in the field and that is now a certainty.

Psychiatry in the most subjective, least scientific field in medicine. That being said the field is slowly moving forward, but is still held back by it's history. Some of the attendings I worked with were very scientifically oriented, while others were ardent in their support of "traditional" psychiatry. One even told us how he came very close to failing a resident who was a "receptor jock" and thus wasn't interested in the Freudian model of psychiatric disease that this particular attending held to.

Also, I felt terrible during that entire rotation. Everyone had a story about how their life was so terrible (and many really were) but i just couldn't deal with it all day every day.
 

jumpmanv15

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I started psych (6 weeks last semester) with essentially no interest in the field and that is now a certainty.

Psychiatry in the most subjective, least scientific field in medicine. That being said the field is slowly moving forward, but is still held back by it's history. Some of the attendings I worked with were very scientifically oriented, while others were ardent in their support of "traditional" psychiatry. One even told us how he came very close to failing a resident who was a "receptor jock" and thus wasn't interested in the Freudian model of psychiatric disease that this particular attending held to.

Also, I felt terrible during that entire rotation. Everyone had a story about how their life was so terrible (and many really were) but i just couldn't deal with it all day every day.
I feel terrible during the rotation as well. I don't know whether im listening to peoples bs that they are just to lazy to deal with or if its a real psychiatric condition that requires intervention... but maybe as an ms3 i can't sift thru the bs that well, but then again it requires subjectivity right and that is what i subjectively perceive as happening.
 

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I started psych (6 weeks last semester) with essentially no interest in the field and that is now a certainty.

Psychiatry in the most subjective, least scientific field in medicine. That being said the field is slowly moving forward, but is still held back by it's history. Some of the attendings I worked with were very scientifically oriented, while others were ardent in their support of "traditional" psychiatry. One even told us how he came very close to failing a resident who was a "receptor jock" and thus wasn't interested in the Freudian model of psychiatric disease that this particular attending held to.

Also, I felt terrible during that entire rotation. Everyone had a story about how their life was so terrible (and many really were) but i just couldn't deal with it all day every day.
That sounds depressing.
 
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I feel terrible during the rotation as well. I don't know whether im listening to peoples bs that they are just to lazy to deal with or if its a real psychiatric condition that requires intervention... but maybe as an ms3 i can't sift thru the bs that well, but then again it requires subjectivity right and that is what i subjectively perceive as happening.
Pt's complaints should not be taken as bs bro... and it's not that they are too "lazy" to deal with their problems. Psych illness is a real condition and every single physician should understand and look for it because it is always on the differential.


On topic, my opinion of psych increased after my rotation. It's hard to forget truly psychotic patients, the depression you treat and discharge only to find out in 2 weeks the patient committed suicide, the manic 65 yo patient who will not stop talking and walking around naked, etc. They are medical problems requiring medical treatments (and I think the field is evolving more in that direction as the old guards retire). So psych as a field definitely requires a medical degree.
 

survivordo

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Pt's complaints should not be taken as bs bro... and it's not that they are too "lazy" to deal with their problems.
Can you honestly say that during your rotation you didn't encounter AT LEAST a handful of in patients that were simply abusing the system and had no true psychiatric illness rather than "needsaswiftkickintheass syndrome"? Maybe its because I did my psych at a hospital with an attached methadone clinic but it seems like there were plenty of these patients that were essentially draining the system of resources needed by the patients with true psychiatric problems.

Survivor DO
 

Brent8927

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I was planning on going into psych, most likely addiction psych, for most of medical school until and end of my psych rotation. The rotation is what guided me down that road, and I rotated through almost every aspect of psych (inpt, outpt, consults, geriatrics, inpt rehab, outpt rehab).

To me, it psychiatry was a lot less subjective than I originally imagined and had more algorithms/criteria for diagnosis than appealed to me. I thought it was more "easy going," but the fact is psychiatry is a medical specialty, and the way it approaches diagnosis reflects that. But I just didn't enjoy the art of diagnosis in psych. I did really enjoy talking to my patients and getting to know their stories, but in general I had to work faster than I wanted and I never got to really focus on the patient as much as I imagined I would.

It also seems very strongly the future of psychiatry is more biological--more medication, more medication, less talk. I didn't like that at all, but I think it's a reality considering the shortage of psychiatrists. Psychiatrists are best at the medical aspects of mental illness. There are others who can handle the counseling/talking part much better and more cheaply, so the days of psychotherapy, in my attenedings' opinions, as well as my own, are coming to a close. With the exception for cash-based private practice, but that goes against everything I went into medicine for.

I've definitely met psychiatrists who say that psychotherapy is still alive, and I'm sure pockets of it will remain, but it's going to be much more difficult to keep your practice open and make enough to pay down your loans if you keep doing talk therapy. Now, if you've got no loans and don't care about your income, I think it'd be really rewarding...

Lastly, while I still liked psych, I just didn't love general psych. I did love working with some patients, but the field didn't energize me as I hoped. I found addiction psych the most fascinating, but I could tell I was going to get jaded if I went into the field. I think you really need to focus on what your personality can handle and thrive in (ie., can you really tolerate your young children dying in peds heme-onc?)

Plus, I found out about PM&R at the end of the rotation and that connected all my loves together--interest in the psychosocial needs of the patient, neurology, non-operative orthopedics, biomechanics, long-term care, focus on improving quality of life. It just seemed like a better fit. When I rotated through it the patients energized me, I loved the science behind the specialty, and the people. (Psychiatrists are pretty cool too. Some are a little cooky. But I thought that made it a bit more fun as well...)

Still, I think psych is a great field, and if I couldn't go into PM&R, the specialties I'd consider first would be FM and then psych. Despite everything I said, I think it's still a great field where you can make a huge difference in people's lives, helping others that are often shunned (even by the medical field). What it came down to for me is psych moved down my list because it wasn't everything I was thinking/hoping it would be, and PM&R was more. Well, that and I didn't even know about PM&R until the end of my psych rotation.

Anyway, you just gotta go with where you feel you'll be happy and thrive.
 

PrideNeverDie

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I am currently in my ms-III core psych rotation. I have much respect for the field and the psychiatrists that I work with but I sometimes find myself question the role of psychiatrists in medicine. Maybe its because these mental illness are so poorly understood, or that there is a level of subjectivity that goes into assessing a patients condition and making a diagnosis or maybe that it seems like a pharma game. My attending tells me that the number of beds nationally and statewide are on the decline in general and inpatient psych facilities are harder to come by so that may be an indicator of the state of things.

Also a quick google search brought this up so it seems like there may be encroachment in the near future
http://www.ama-assn.org/amednews/2011/03/07/prl20307.htm - i realize this article is from 2 years ago and I don't know whats been going on since then

i've only been in my psych rotation for 2 weeks so what do i really know though haha
i can give you a good reason why psychiatrists belong in medicine. a lot of neurological problems present as psychiatric disorders.

do you think a psychologist with a prescription pad would be able to properly refer their patients to a neurologist without med school?
 
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jumpmanv15

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i can give you a good reason why psychiatrists belong in medicine. a lot of neurological problems present as psychiatric disorders.

do you think a psychologist with a prescription pad would be able to properly refer their patients to a neurologist without med school?
I agree with above poster.

My psych attending sometimes looks at radiology reports of the brain in order to correlate clinical scenarios such as short term memory loss (hippocampal atrophy) or loss of gray matter etc. I am not sure a psychologist gets this same training.
 

Dharma

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i can give you a good reason why psychiatrists belong in medicine. a lot of neurological problems present as psychiatric disorders.

do you think a psychologist with a prescription pad would be able to properly refer their patients to a neurologist without med school?
:thumbup: even in the preclinical studies it appears as if psychiatric symptoms could be secondary to various pathologies that would require in depth understanding of and exposure to clinical pathophysiology. sounds like a physician would be the best person to get digging and decipher the truth.

http://www.psychiatrictimes.com/schizophrenia/content/article/10168/2117281

And in response to the comment made about "encroachment"... it's everywhere.
 
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This is really good topic. I had zero interest in psychiatry and thought there was zero chance of me liking it. After my rotation however, I immediately did a 180 and applied for psychiatry residency instead of surgery as intended. I really enjoyed learning about patients in detail and really getting to know THEM on a deeper level. It was a nice mix of medicine and personal relationships, both inpatient and outpatient. Plus the science of schizophrenia is utterly fascinating.
 

evilbooyaa

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Before the rotation: I had respect for psychiatrists, but did not think I would enjoy the rotation and would not consider it a career path.

However, I did enjoy the rotation quite a bit. Talking to patients with just horrible life stories (not even counting those that were noticeably psychotic), and seeing them brighten just after speaking to them. (it seems like a lot of depression I saw is loneliness that then gets solved with self-medication, spiraling down further)

Although I did enjoy the rotation, with a newer attending that chose his medications slightly more carefully, I wouldn't be able to do that for the rest of my life. The social issues and placement problems were so often the reason people were still in the hospital. There were also a share of patients who knew what to say so that they were forced to stay. On the other hand, there were also truly psychotic patients who knew what to say so that they would be allowed to leave by lawyers.

All in all, it's a difficult field, that I gained more respect for, but not something I could ever see myself doing for the rest of my life.

Luckily, I thought the shelf exam was the easiest I've taken all year as a MS3. Surprisingly, that's the one rotation so far I've done better than passing.
 

shan564

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This is really good topic. I had zero interest in psychiatry and thought there was zero chance of me liking it. After my rotation however, I immediately did a 180 and applied for psychiatry residency instead of surgery as intended. I really enjoyed learning about patients in detail and really getting to know THEM on a deeper level. It was a nice mix of medicine and personal relationships, both inpatient and outpatient. Plus the science of schizophrenia is utterly fascinating.
My experience was very similar to this. I wouldn't say I had "zero" interest in psychiatry, but it definitely wasn't one of my top choices. I had a lot of misconceptions about the field, which were cleared up by my rotation. After my rotation, I was 90% sure that I wanted to do psychiatry (I still had to rule out emergency medicine and pediatrics, which I was able to do after those respective rotations).

Previously, I was planning to go into pathology.
 

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I didn't like the material when I was a second year student, and in general hadn't really enjoyed my psychology classes in college. Felt the stuff was too subjective, like most people here who hate on psych.

Then I got on my rotation and it completely changed my mind. Inpatient psych is very fascinating, and I now have massive respect for the psych folks. It's an entirely unique skill set in medicine to manage the severely mentally ill. Anybody who thinks psychiatrists are unnecessary are clueless. Who else is going to manage psychotic patients?

I don't think modern psychiatry is any less scientific than, say, rheumatology. In both fields the diagnosis is based on a list of criteria. That requires very strong clinical skills when you can't rely on a gold standard test to make the diagnosis.

Not that I'm going into psych or anything, but it bothers me when people perpetuate weak criticisms of the field.
 

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I don't think modern psychiatry is any less scientific than, say, rheumatology. In both fields the diagnosis is based on a list of criteria. That requires very strong clinical skills when you can't rely on a gold standard test to make the diagnosis.
I'll admit that I know very little about the field, but couldn't the lack of objective criteria for establishing a diagnosis in psych be due simply to a lack of knowledge about the system (i.e., the brain)? Seems a little much to expect a rigorous set of tests for the mind when you compare our understanding of the brain to, say, the liver or almost any other organ system.
 

Kaputt

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I'll admit that I know very little about the field, but couldn't the lack of objective criteria for establishing a diagnosis in psych be due simply to a lack of knowledge about the system (i.e., the brain)? Seems a little much to expect a rigorous set of tests for the mind when you compare our understanding of the brain to, say, the liver or almost any other organ system.
Yeah, that's the point -- the criteria are there because there is no gold standard test because we don't have a way of measuring what exactly is happening because we don't know exactly what is going on. Same goes for Kawasaki's or Rheumatic fever. Lots of things in medicine are poorly understood. Psych may be the most misunderstood, but it's definitely not in a category all it's own.
 

hrandani

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I was extremely interested into going into psychiatry, for all the reasons listed above.

I did a third year in patient rotation under a very highly trained psychiatrist who was absolutely excellent, a rock star. I was pumped, it was amazing, I learned more than in any other rotation about the art of a patient interview. A true H&P. Medications, side effects, efficacy, cost. All that. He lived and died on the improvement of his patients conditions. I had lists of psych programs, was ready to match right there.

Then I did a fourth year elective a few months later. I was totally stoked about it, it was outpatient and within a few days completely, irrevocably destroyed any desire I had to go into psych. The attending was blatantly incompetent, patients couldn't understand him at all and he didn't care. When he did care, he gave just really awful life advice. Everyone got whatever the last drug rep had been pushing. Patients were not helped, and many were made worse. Sometimes he would refuse to diagnose or treat mania. Most of my interactions with him were rambling discourses on how awesome he was.

I realized that even the slight chance of having to train under someone like psychiatrist #2 would probably result in an early death from liver failure. It was the most depressing four weeks of my life. I would rather shot myself in the timbits than walk into that building again.

I'm going into IM. If I ever feel like practicing psychiatry a few years down the road there's basically nothing preventing me from prescribing whatever the hell psych meds I want and referring people to therapists.

Basically psychiatry needs to clean their house up if they want to be taken seriously. I am incredibly grateful for the people who have the emotional fortitude to do it and do a good job of it. But after asking around I am pretty confident those guys are incredibly rare. Most psychiatrists I have met are burn-outs, part-timers, or pseduo-intellectuals. It's a damn shame because psychiatry is arguably the most important medical field, and every patient walking in your door is a potential psych patient in some respects and should be evaluated as such.

But as it stands now in the US, psych is used mostly as a punitive measurement for sedating the people who failed out of the industrial education->work complex. Psych #2? That's the system working as intended. Nobody's coming for him. There's no insurance review coming after him, asking why his patients keep dying after refilling their third benzo prescription in a month. There's nobody asking him why he thought the bipolar trucker with episodes of explosive psychotic rage filled with paranoid ideations needed a prescription for amphetamines for his ADD.

I can't be a part of that. Kudos to those who can.
 

michaelrack

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I agree with above poster.

My psych attending sometimes looks at radiology reports of the brain in order to correlate clinical scenarios such as short term memory loss (hippocampal atrophy) or loss of gray matter etc. I am not sure a psychologist gets this same training.
Some psychologists can do this- neuropsychologists can do this better than most psychiatrists.
 

kindasorta

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I was extremely interested into going into psychiatry, for all the reasons listed above.

I did a third year in patient rotation under a very highly trained psychiatrist who was absolutely excellent, a rock star. I was pumped, it was amazing, I learned more than in any other rotation about the art of a patient interview. A true H&P. Medications, side effects, efficacy, cost. All that. He lived and died on the improvement of his patients conditions. I had lists of psych programs, was ready to match right there.

Then I did a fourth year elective a few months later. I was totally stoked about it, it was outpatient and within a few days completely, irrevocably destroyed any desire I had to go into psych. The attending was blatantly incompetent, patients couldn't understand him at all and he didn't care. When he did care, he gave just really awful life advice. Everyone got whatever the last drug rep had been pushing. Patients were not helped, and many were made worse. Sometimes he would refuse to diagnose or treat mania. Most of my interactions with him were rambling discourses on how awesome he was.

I realized that even the slight chance of having to train under someone like psychiatrist #2 would probably result in an early death from liver failure. It was the most depressing four weeks of my life. I would rather shot myself in the timbits than walk into that building again.

I'm going into IM. If I ever feel like practicing psychiatry a few years down the road there's basically nothing preventing me from prescribing whatever the hell psych meds I want and referring people to therapists.

Basically psychiatry needs to clean their house up if they want to be taken seriously. I am incredibly grateful for the people who have the emotional fortitude to do it and do a good job of it. But after asking around I am pretty confident those guys are incredibly rare. Most psychiatrists I have met are burn-outs, part-timers, or pseduo-intellectuals. It's a damn shame because psychiatry is arguably the most important medical field, and every patient walking in your door is a potential psych patient in some respects and should be evaluated as such.

But as it stands now in the US, psych is used mostly as a punitive measurement for sedating the people who failed out of the industrial education->work complex. Psych #2? That's the system working as intended. Nobody's coming for him. There's no insurance review coming after him, asking why his patients keep dying after refilling their third benzo prescription in a month. There's nobody asking him why he thought the bipolar trucker with episodes of explosive psychotic rage filled with paranoid ideations needed a prescription for amphetamines for his ADD.

I can't be a part of that. Kudos to those who can.
Strange to pick a specialty based on the impressions you had of preceptors. Especially since you seem to have had crappy ones. I chose my specialty based on what kind of physician I wanted to be and the types of problems I wanted to help patients through. I found a lot more internal motivation to put forward the proper effort when I was helping people with their mind rather than their elbows.
 

psychRA

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Some psychologists can do this- neuropsychologists can do this better than most psychiatrists.
Soon-to-be psychologist (in my last year of training) here - just chiming in to agree that neuropsychologists absolutely have the ability to do this. My understanding is that, due to the sheer depth and volume of training they receive, neuropsychologists are skilled at highly specialized assessment and are often just as effective as imaging studies when it comes to diagnosis of certain cognitive problems.

Also a quick google search brought this up so it seems like there may be encroachment in the near future
http://www.ama-assn.org/amednews/201...7/prl20307.htm - i realize this article is from 2 years ago and I don't know whats been going on since then
Speaking as a non-neuropsychologist, I personally have zero desire to prescribe medication. A solid PhD program will equip you with with a basic understanding of how the brain works, but that doesn't mean you have any business practicing medicine. In states where psychologist have gained prescription privileges, my understanding is that several years of postdoctoral training in psychopharmacology are required, so it's not like they're just handing out prescription pads to regular old psychologists. However, short of actually attending medical school, I don't think I'd feel competent to prescribe.
 
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music2doc

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Was curious how everyone's MS3 psych rotation changed how they view the field? If you loved psych beforehand and still love it, or thought it was stupid before and still think its stupid then thats not really what Im going for.

But for the most of us who really didn't know much about the field before medschool (except for the stuff you see on news or whatever), what did you think of your rotation? Did you come away with the feeling that psychiatry belongs in medicine as an MD field, or that it really shouldn't be part of medicine and instead be like psychologists or something?

Do you think more or less highly of the field after the rotation than you did going in?
So you basically just eliminated anyone that would have a legitimate perspective on the field, opting instead for highly biased perspectives based upon extremely limited data/experience. :rolleyes: I would think you would want to keep your question open to all.

Anyway, interesting responses, guys.
 
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kindasorta

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So you basically just eliminated anyone that would have a legitimate perspective on the field, opting instead for highly biased perspectives based upon extremely limited data/experience. :rolleyes: Congratulations...
I think the implication is there is less bias in an individual that changes their mind when compared to one than maintains their original conceptions. I'd love to here how someone with high bias would be better represented by your category of student rather than the OPs.
 

music2doc

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I think the implication is there is less bias in an individual that changes their mind when compared to one than maintains their original conceptions. I'd love to here how someone with high bias would be better represented by your category of student rather than the OPs.
Of course -- I understand the source of the request. I think both opinions are valuable, however. Someone with a background in the field (e.g., having worked as a tech in psych or as an EMT in a Psych ED) is going to have a different perspective on the patients and how psychiatrists work with those patients due to prior experience. S/he may also be more likely to really engage on the rotation early on and get his/her hands dirty from day 1 instead of wall-flowering it for awhile (like I saw some M3s do when I was a tech). I simply think both groups would have something to offer. There are people who have worked psych and have a lot of respect for it but have no desire to enter it (I would be in that group, for instance, and I do not expect my psych rotation to change that, although be sure to check back in once I have done mine).
 

kindasorta

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Of course -- I understand the source of the request. I think both opinions are valuable, however. Someone with a background in the field (e.g., having worked as a tech in psych or as an EMT in a Psych ED) is going to have a different perspective on the patients and how psychiatrists work with those patients due to prior experience. S/he may also be more likely to really engage on the rotation early on and get his/her hands dirty from day 1 instead of wall-flowering it for awhile (like I saw some M3s do when I was a tech). I simply think both groups would have something to offer. There are people who have worked psych and have a lot of respect for it but have no desire to enter it (I would be in that group, for instance, and I do not expect my psych rotation to change that, although be sure to check back in once I have done mine).
It's not that interesting to hear Tom Cruise's perspective of why he still hates psych after he rotates in it. Most people find a lot more value in hearing how someone who hated something grew to love it, or vice versa, because then you know genuine change took place, and almost by definition, it filters out the riff-raff or those with an agenda and ultimately provides for more interesting insights.

Either way, this is the internet. You're free to ignore the OPs request. you could even post pictures of balloons in this thread if you so choose.
 

Akali

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It's not that interesting to hear Tom Cruise's perspective of why he still hates psych after he rotates in it. Most people find a lot more value in hearing how someone who hated something grew to love it, or vice versa, because then you know genuine change took place, and almost by definition, it filters out the riff-raff or those with an agenda and ultimately provides for more interesting insights.

Either way, this is the internet. You're free to ignore the OPs request. you could even post pictures of balloons in this thread if you so choose.
I for one would love to hear from people who loved it and still loved it after the rotation and the same for hating it. I think there is plenty interesting insight to be gained from their perspectives as well.
 
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I for one would love to hear from people who loved it and still loved it after the rotation and the same for hating it. I think there is plenty interesting insight to be gained from their perspectives as well.
Nonsense. If you mean the Tom cruise type. For the same reason that you would be foolish to listen to Jenny McCarthy's opinion about pediatric practice.

I agree completely, though, if you mean someone who simply hated the field. I didn't like surgery before, during, or after my rotation. Someone like that for psych could participate reasonably in a discussion about the merits of their experience.

There's a difference. I didn't enjoy surgery for x, y,z. Very different from I have poured over the history of surgery, and I can tell you Matt, you haven't, and it's a criminal conspiracy of diabetic leg hackers, Matt.
 

NickNaylor

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Nonsense. If you mean the Tom cruise type. For the same reason that you would be foolish to listen to Jenny McCarthy's opinion about pediatric practice.

I agree completely, though, if you mean someone who simply hated the field. I didn't like surgery before, during, or after my rotation. Someone like that for psych could participate reasonably in a discussion about the merits of their experience.

There's a difference. I didn't enjoy surgery for x, y,z. Very different from I have poured over the history of surgery, and I can tell you Matt, you haven't, and it's a criminal conspiracy of diabetic leg hackers, Matt.
It's time to go home, you're drunk.
 
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Armadillos

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So you basically just eliminated anyone that would have a legitimate perspective on the field, opting instead for highly biased perspectives based upon extremely limited data/experience. :rolleyes: I would think you would want to keep your question open to all.

Anyway, interesting responses, guys.
What I really was trying to get at was wondering how the psych rotation is viewed by the "average" medstudent.

Everyone is free to share their opinions (or post funny videos :D ), was just trying to make the thread focus on those who didnt already have a firm opinion of the field


Thanks for everyone who took the time to respond!