What do you do when insulted?

[Cinnameg]

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Hey psychiatry community: a little advice or perspective needed here. I am doing a neurosurgery rotation, because (1) I'm curious & (2) a surgical subspecialty rotation is required for MS4s and I thought, hey, at least it's brains.

I'm only a week into it and it's been awful, mostly because the first question I get is always "what are you going into?" and when I answer "psychiatry" I get very unpleasant reactions. On the first day I was told since I'm not going into neurosurgery they don't really care what I do on this rotation. Also, every single resident I've met has asked me as a follow up, "why are YOU doing a neurosurgery rotation?" as if it is inconceivable that anyone not going into neurosurgery would dare to rotate on their service. I've been having a hard time getting anyone to teach me anything and when they do, it's always with cracks that this is my "last chance to do ___" as if I'm sacrificing all the fun medicine has to offer by choosing psychiatry.

Adding more insult, today I was in clinic with the chief of neurosurgery. He is greatly admired by his residents who consider him a great teacher and I was repeatedly told to do his clinic because he likes medical students and is a great pain expert. So, I went today hoping to learn something about pain. I didn't. He quizzed me entirely on neuroanatomy, saying repeatedly that I would only need this information so I could help my friends and family when they expect me to "be a doctor" and telling me over and over that psychiatry shares the board certification with neurology (which I already knew, I almost went into neuro) and so I needed to know this stuff for my boards. The implication was that I wouldn't need to know anything at all to be a psychiatrist.

More directly, he told me that I'll "need to know certain things whether you choose to be a psychiatrist or a real doctor," he asked me "do you know how to examine patients?" before agreeing to let me see one, and when introducing me to the one patient he let me speak to he warned them "watch out, this one is a future psychiatrist." He walked into the patient room with me supposedly to introduce me to the patient so I could then do the history and physical, but then proceeded to take the history himself while I was standing there, followed by quizzing me on things I didn't know in front of the patient and then telling me, step by step, how to do the relevant neuro exam. I'm actually very good at neuro exams. So, clearly he didn't trust me to even talk to his patient, much less touch them, even though I'm a 4th year and passed my boards etc etc . . . and at this point have as much training as a med student going into neurosurgery. I haven't specialized yet.

Anyway, I'm somewhat angry, and insulted. Has something like this happened to anyone else going into psychiatry? How did you deal with it? Did you speak up and defend yourself? I didn't, and I'm not sure that was the right choice. What do you think?

 

[kugel]

Ultimately, people like this are gnats - annoying but pretty inconsequential, unless you permit them to steal your time and concentration.

You can report such behavior to the physician in charge of medical education for that dept, and to the person responsible for setting up all the rotations (usu. someone like an asst. to the dean of students?). Other than that, there is little you can do to protect future students or patients from this attending.

Other than that, not much to do, except
Prove Him Wrong!

 

[tehdude]

I've talked about psychiatry with a few of my family members who happen to be doctors, and I've ran into similar insults. Most made comments about how psychiatry is not real medicine and how it's a specialty for those who can't match anything better. They bring up the low pay. They say psychiatrists are very socially awkward. They tell stories of how dumb psychiatrists are and how they saw one that did xyz and almost killed a patient. I have an interest in psychiatry, but it's a little discouraging to hear these types of comments from so many people. Psychiatry gets no respect.

 

[nitemagi]

I'd say pick your battles. I find a lot more benefit from strategic silence and ignoring someone, which usually leads to either escalation of their pressure to try to get you to confirm they're right, or a pause in their rehearsed speech which reaffirms their life choices and then an opening to insert other perspectives.

I don't recommend direct confrontation. At most I'd insert some strategic questions in an earnest way that might lead to realization they don't know everything, but which don't come off as challenging or undermining. Or just pick their brain for potentially useful stuff for psychiatry, such as behavioral neuro stuff.

--What signs might indicate a focal lesion causing behavioral or mental status changes, but might not present with other focal signs? [for learning useful stuff]
--What kind of head imaging is optimal in which circumstances?
--So do you actually carry around your stethoscope? [few surgeons do, and challenges the "real doctor" paradigm]
--7 years seems like a long time. Must be hard to go through surgery for that long. What is life like for most neurosurgeons after residency? [Seems empathic, but also challenges their lifestyle choice]

 

[Doctor Bagel]

--7 years seems like a long time. Must be hard to go through surgery for that long. What is life like for most neurosurgeons after residency? [Seems empathic, but also challenges their lifestyle choice]

I love this one. Neurosurgeons lives suck. I can't say their attitude is surprising, though, because these are people who pride themselves on working harder than everyone else. How miserable!

Also, the one consult I've gotten so far from neurosurgery was absolutely ridiculous, so they're not so much greater at this doctoring thing than the rest of us.

 

[Cinnameg]

Since posting this thread I got a PM from an MS3 asking what the expectations are for the neurosurgery rotation, as s/he's got one coming up, and -- of course -- why I would choose to do an "elective" in neurosurgery when I "could be on a much more relaxed rotation this close to the match.". Sigh. Wouldn't this have been a problem in ANY surgical subspecialty? I had to pick one.

 

[peppy]

You have to remember that surgeons need to believe they are better than other specialties to put up with their horrible lifestyles. 🙂 Who would put up with working the hours that a neurosurgeon works if they allowed themselves to believe that working 40 hours a week in psych was equally rewarding and/or "important"?
The attrition rate for surgery residencies is notoriously high and you probably heard about that recent news story on the rate of suicidal ideation among surgeons being higher than the general public. I respect surgeons, of course, but I would not want to switch lives with them!

I also think that people tend not to recognize the diversity of options in how to practice psychiatry. There are a lot of practice scenarios where psychiatrists should still have a good foundation in general medicine (if only to be able to recognize when someone's apparent mental illness is actually related to a general medical condition).
If you really miss being a "real doctor", you could look at subspecializing in psychosomatic medicine, neuropsychiatry, sleep medicine or pain medicine (although apparently the latter two are kind of an uphill battle for psychiatrists).

 

[pingouin]

Since posting this thread I got a PM from an MS3 asking what the expectations are for the neurosurgery rotation, as s/he's got one coming up, and -- of course -- why I would choose to do an "elective" in neurosurgery when I "could be on a much cyanide rotation this close to the match.". Sigh. Wouldn't this have been a problem in ANY surgical subspecialty? I had to pick one.

I have to pick one for next year, too- mandatory to do 1 surg sub-I, 1 med sub-I, and then pick a third from either of those. I think I'm going to go with either peds surg or an ambulatory combo of ENT and uro (both of which I don't like, but there's no OR time- all clinic).

The reason I won't do neurosurg next year is that I did it for a week of my M3 clerkship- by my choice- and although I learned a lot, it was probably the most intense and time-consuming week I've had thus far. The residents were generally nice, and overall accepted my answer of "psychiatry" without much ado. One of them noted that they probably needed a psychiatrist on their service... for the residents. I just smiled and agreed that the choice of a 7 year residency should give them pause to consider their definition of "insane". I did run into one of the seniors a month or so ago, and he asked if they made me cry while I was on rotation (I didn't). Said everyone who does it for a month cries at least once while on service. Not sure that's something for them to be proud of, but OK..

Our chair of neurosurg co-authored an article on depression and CNS malignancies with our C-L psychiatrist, so he definitely didn't give me any problems.

 

[Saluki]

The neursurgery residents were really nice to me when I was there (for a very brief time as part of my neurology rotation).....

The residents who supervised me on my gyn surgery week on the other hand..... 😱 One of them yelled at me for an hour for not getting a page *when the paging system in the hospital was down*..... And towards the end of it, I started crying, which is like blood in the water for the surgery folks. One of the attendings that I worked with for a total of two days was worse, because her meanness is permanently recorded in a written evaluation.

I don't really have any terribly good advice about handling the situation, but the thing that helped me the most was knowing that other students were also having the same experience. Not that I'm happy to see others miserable, but because I knew it wasn't me (or at least not all me- I do suck at suturing😛)

As far as picking for next year, I might suggest a general surgery or endocrine surgery rotation. Endocrine surgeons are super nice, and I got to see a case of lithium induce goiter! And the general surgeons seemed to like having me there and were glad to have someone to give the chronic swallower to🙂

 

[newpsych]

I spent my entire third year "proving them wrong." I studied harder, and knew more than most (residents included). I never stated my knowledge until they thought it'd be "funny" to see what the psychiatrist had to say about ______. After a few days of answering all questions/challenges correctly, and then asking a relevant follow up questions, all of the hating ended until the next rotation/attending. And, needless to say, their inappropriate behavior has made me a much more knowledgeable doctor. I think showing physicians with this preconceived notion of 'stupid psychiatrist' that we are JUST as capable as them in a respectful way does great things not only for our field, but for our patients.

 

[Doc Samson]

A couple of thoughts:

1) The future of neurosurgery is going to depend heavily on collaboration with psychiatry. Surgical intervention for adaptive brain function (think DBS for depression as the tip of the iceberg) is where their specialty is headed. For all kinds of ethical reasons, this will require a psychiatrist in a "superior" position to a neurosurgeon. Any neurosurgeon who can't see this writing on the wall is a deliberately obtuse jackass.

2) It does get better as an attending. The neurosurgeons in my institution know they will need my help, so no cracks about psychiatry or whether I'm a "real doctor" or not.

3) To paraphrase our esteemed colleague Whopper: you can always make the deal that they can poke as much fun at psychiatry as they like as long as you can kick them in the crotch as hard as possible whenever they need a consult.

4) Look at putting up with this type of screwaround as the minimal tax levied on a future career that is interesting, fun, and lets you have time for other interests.

 

[whopper]

It's wrong to stereotype any profession, but let's admit it, we see trends with demographics.

I know of a neurosurgery resident, a very nice guy. The guy has to deal with some very narcissistic neurosurgeons. One, for example, has a pen worth over $10,000. (No I'm not kidding) One day the guy left it laying around. the resident picked up the pen and gave it to the attending first opportunity. The attending became enraged and told the resident that no one was allowed to touch his pen, no one, even though the attending lost that pen. The attending's reaction of that of a immature defense mechanism, and I hate saying it, imagine the most nerdy, touch of Asperger's, OCPD, narcissistic guy with the most annoying voice you can imagine screaming out "no one touches my pen!"

(Oh, and by the way, such a person does great in medical school-the guy probably was a top scorer but had little other highly needed skills as a doctor. A guy that has great clinical skills, does only alright in exams, and has great compassion, forget about. He doesn't matter...)

Just the tip of the iceberg. The neurosurgeons he works with have some very strange personality characteristics, all of which they can get away with because, ahem, they are neurosurgeons. I don't want to detail the other characteristics because neurosurgery is a small world. If I detailed too much, I'm going to increase the risk one of those attendings will read this post and take it out on him.

It's interesting because medicine is all about treating disease, but it seems we've lost our way about promoting health, and putting people who can get the best grades and standout in a bell curve while forgetting about being able to interact with people.

I told the resident to try to remember that a part of being a good doctor is remembering compassion and treating people with respect. Too bad so many of our colleagues don't understand that.

The residents who supervised me on my gyn surgery week on the other hand.....

A lot of this will vary by the local culture. Slowly but surely, many doctors and programs are dropping the "We need to make their lives hell because ours were." IMHO, residency should be hard, but it should be hard in a manner that promotes learning and respect for care. I got no problem with a PD chewing out a resident for being late, making the same mistake more than a few times, etc. Getting the attending his coffee the way he likes it and suffering from an attending clearly meeting a legal definition of harassment, being told bullcrap statements by non-psychiatrists that could've come out of the mouth of Tom Cruise, "Mental illness doesn't exist" shouldn't be part of the medical culture, but it has been, and still is the norm in many areas.

What do you do when insulted?

Well, I hate saying this, but you really may just have to deal with it. All things being equal, things like this should not be tolerated, but as a medstudent, and being the bottom of the barrel, you could be making things far worse for yourself by complaining. If the medical school has a way for to you rate your experience in the rotation, try to politely and constructively mention what happened without trying to make it sound like you're a complainer.

Besides that, learn from this and try not to be that type of doctor.

 

[silas2642]

I've talked about psychiatry with a few of my family members who happen to be doctors, and I've ran into similar insults. Most made comments about how psychiatry is not real medicine and how it's a specialty for those who can't match anything better. They bring up the low pay. They say psychiatrists are very socially awkward. They tell stories of how dumb psychiatrists are and how they saw one that did xyz and almost killed a patient. I have an interest in psychiatry, but it's a little discouraging to hear these types of comments from so many people. Psychiatry gets no respect.

I think that part of this kind of treatment results from discomfort with the entire field-- people are uncomfortable with what they don't know. There are so many intangibles in psychiatry and at this point it is more of an "art" than a science, although that is changing. There aren't a lot of algorithms to follow in this field-- you have to be comfortable with a decent degree of uncertainty and be okay with delayed gratification.

I also believe that psychiatry tends to be one of the more challenging fields because it is impossible to be exposed to psych patients without thinking at some point or another, "Jesus Christ, that could be me..." Who hasn't seen or heard of the over-achieving, ivy-league student who had so much promise but then crashed and burned? It's scary, the countertransference is very intense, and most people don't know what to do with it.

But for me, that's what I love most about the field-- you get to get your hands dirty, learn the most intimate details of a person's life, and stick with them when no one else can or will. You see these patients when they're at their lowest of lows and you get to help them using the skills that many other physicians don't have. And I don't think I've seen more grateful patients than psych patients who are doing well. It's really rewarding-- they may be few and far between, but to see someone get their life back is an unbelievable experience.

 

[Cinnameg]

Thank you for those who wrote in to say how much they love psychiatry. Adding to the career frustration that was yesterday, an MS1 at my school wrote an email to everyone to inform us of an upcoming talk in town by a "psychiatric whistleblower" who believes that the "rise of psychiatry" has had more to do with economic factors than the reality of mental illness or any medical need. The guy clearly hasn't read his history -- I recommend Grob's "The Mad Among Us" or Shorter's "A History of Psychiatry" for an overview of all of the ways we've tried to treat our mentally unstable for the past couple of centuries, and proof that mental illness isn't in any way a modern invention.

On a different note, the neurosurgeons have decided they'd like me to do a 20-minute presentation on the history and current methods of psychosurgery. Any resource suggestions?

 

[Doc Samson]

Here's a start:

http://neurosurgery.mgh.harvard.edu/functional/psysurg.htm

Be sure to add something about DBS:

http://www.psychiatrictimes.com/display/article/10168/57011

http://www.medicalnewstoday.com/articles/68526.php

http://findarticles.com/p/articles/mi_hb4345/is_11_35/ai_n29395029/

And if you really want to drive home a point, you can point out how this is the cutting edge of neurosurgery being pursued at top centers like MGH, Duke, Emory, and the Barrow, and the clinical set-up requires strong collaboration between psychiatry and neurosurgery since without psychiatry's approval, neurosurgery cannot operate on the pt.

 

[Bartelby]

I had a similar experience with an ortho doc who berated me for an entire morning for wanting to go into psych ("hope you enjoy your meager paycheck," "do you want to lay on a couch and talk about it," "crazy people-- takes one to know one!," "why would anybody want to go into psych?," etc etc). Here is my two step process:

1. Envision driving home circa 5 PM thinking about some interesting patient I just helped out and then spending a fun evening with my family, reading a couple of journal articles I actually find interesting after dinner, and then spending some quality time with my wife after the kids are in bed because I don't need to be into the office until 8 tomorrow.
2. Envision him continuing the 5:30 AM to 6 PM grind Monday through Saturday (okay, fair is fair, shorter day Saturday), sticking scopes into knees long after it stopped being challenging or novel and living with the results of his "abrasive d-bag" personality.

Fortunately most of the doctors I have worked with have been pretty respectful about my choice, and seem to think of Psychiatry as essential to modern medicine. Experiences like the above have been rare for me. In the end though that guy's approval isn't going to sustain me for the forty or so years I will practice, so I need to just go ahead and do what I want to do.

It also helps to remind myself that I have the CV to get into pretty much any specialty I want and I am choosing psych; even though we shouldn't feel the need to 'prove' ourselves it's nice to have the personal satisfaction of knowing that we are going into it simply because we find it most satisfying professionally and personally.

 

[notdeadyet]

I think it's also healthy to keep in mind that a significant number of residents and physicians sacrificed a lot of their lives to get where they are. Many were emotionally awkward even in high school, never went to the dance, never got kissed, and comforted themselves in books and wrapped themselves with their intelligence. In college, lots of them threw themselves into their studies and sacrificed a social life for the sake of getting good grades. They finally got to medical school and found a culture with lots of people very much like themselves and finally had the opportunity to flex some "muscle" and look down on others that they felt they could now view as somehow socially inferior.

They become residents and physicians and continue the trend by putting down other specialties. They talk smack about what they view as inferior programs, schools or degrees. They can virtually ignore the presence and contribution of allied health and nursing staff. They tend to be the overbearing and malignant attendings that healthy people prefer not to work with.

I think it's fairly easy to ignore, as its far from unique to psychiatry. The Emergency Medicine folks get slammed by everyone on any ward in the hospital for questionable admits, and they console themselves by not wearing a pager and working 36 hour weeks. The Anesthesiology folks get derived by surgeons as gas-passers, but they share the same standard of living while the gas passers get to watch their kids grow up. The Radiology folks are asked when they've last touched a patient, but they can't hear that over the sounds of bushels of money being tossed at their feet. And Psychiatry folks are derided for not being "real doctors" while they enjoy the most interesting and interdisciplinary field in medicine that is advancing faster than any other.

 

[zenman]

I dare you to tell him this story.

Internationally known neurosurgeon on trip in Peruvian jungle talking with Shaman:

Neurosurgeon: And what do you do?

Shaman: Well doctor, I have my flock of Lamas and I raise a little bit of corn and I do a little bit of healing. What do you do, doctor?

Neurosurgeon: I will cut open a man’s head and cut through the bone and pull out a tumor the size of a walnut, and throw it away and then sew their head back up and that man will live. Can you do that?

Shaman: No doctor, I can’t do that.

Neurosurgeon: Well, what do you do then?

Shaman: Well doctor, if someone dies and it’s not their time yet, I can follow their soul through the first, the second and the third level of the spirit world and right before they arrive back home I can catch it the way one catches a butterfly and bring it back and blow it back into them and they will live. Can you do that?

I'll send you $50 if you post it where he'll see it, lol!

 

[Cinnameg]

I think it's fairly easy to ignore, as its far from unique to psychiatry. The Emergency Medicine folks get slammed by everyone on any ward in the hospital for questionable admits, and they console themselves by not wearing a pager and working 36 hour weeks. The Anesthesiology folks get derived by surgeons as gas-passers, but they share the same standard of living while the gas passers get to watch their kids grow up. The Radiology folks are asked when they've last touched a patient, but they can't hear that over the sounds of bushels of money being tossed at their feet. And Psychiatry folks are derided for not being "real doctors" while they enjoy the most interesting and interdisciplinary field in medicine that is advancing faster than any other.

It is a little unfair, however, that psychiatry is the only profession with an entire religion out to get us (scientology).

Thanks for the links, Doc Samson! Really great stuff. 🙂

 

[whopper]

I remember right after a round of exams in grad school (hadn't hit medschool yet but the grad school was in a medschool), a bunch of guys and I went to a local bar. A townie found out I was hoping to become a medical doctor and he gave me a warning.

He told me that as an air conditioner repairman, he had about a dozen trophy wives married to physicians (usually surgeons), stock brokers, and lawyers he could call up at any moment and get some coitus. (Hey this is a medical forum, let's use the scientific terminology). This was right outside of NYC.

Turned out the husbands were so into their careers and their wives were so lonely that they would call for this guy to show up to fix something in the home (and nothing was broken except the marriage) and then literally throw themselves at this guy. He'd get paid about $100 to perform coitus to a doctor's wife for about an hour. After being in the business for some time, he developed his own black book of several women who developed a "relationship" with him.

As a grad student I thought he was full of it. As an attending and having seen that many doctors are socially awkward, land a hot babe wife because of their social standing and not because of their personality or good looks, then after about a year or two of marriage, the marriage is either ending or in a state of dysfunction that could last years, I found his story very believable. Trust me, I've seen the typical doctor with no social life and not being able to relate to his wife story several times. I've seen the blue collar guy being exposed to the unhappy wife of a rich guy getting it on with blue collar guy several times. Now the story is very believable.

So next time that idiot egocentric doctor gives me that "oh you're a psychiatrist" attitude, I just imagine the air conditioner repairman getting it on with that guy's wife, and I get a smile. 😉

The neurosurgeon screaming "how dare you touch my pen" guy, I can just imaging who his wife is playing around with. Seriously, I really wonder what that guy's life at home is like.

 

[OldPsychDoc]

...So next time that idiot egocentric doctor gives me that "oh you're a psychiatrist" attitude, I just imagine the air conditioner repairman getting it on with that guy's wife, and I get a smile. 😉

The neurosurgeon screaming "how dare you touch my pen" guy, I can just imaging who his wife is playing around with. Seriously, I really wonder what that guy's life at home is like.

So I guess it's not the size of the pen.... 🙄

 

[CTR]

I recently completed my first surgical rotation and had a similar experience. Although the surgeons were all very nice about it, when they learned I was interested in psychiatry they basically said things like "ugh--why would anyone want to go into psychiatry?" (While I thought to myself, "why would anyone want to go into surgery?") Even one of the anesthesiologists gave me a bad time about it. I just ignored their derogatory comments and laughed along with any jokes they cracked about psychiatry.

By the end of the rotation, however, my main preceptor thought I was a pretty good student and said he felt like I would make a good surgeon.

My experience with other physicians (family practice and internal medicine docs) has been much more pleasant; they seem to recognize the value of psychiatry but simply see it as something they weren't interested in. It's nice when people can see the importance of all specialties and politely say it just wasn't for them.

Next year, though, I will have to complete another surgical rotation. I thought about doing neurosurgery, like you, because of it's involvement with the nervous system. I guess I'm having second thoughts about that now... but what else would be a good one to do for a future psychiatrist?

 

[Cinnameg]

At my school you can opt to do anesthesia as your ms4 surgery rotation. My classmates seem to have been happy with that choice, although some have complained that the residents are nice to you and then write mean evaluations. But as ms4s that does't bother them so much.

 

[loveoforganic]

http://www.youtube.com/watch?v=p1F7hZzIckA

 

[MDchouette]

Just wait until internship. Psychiatry residents are happier and better rested than almost any other specialty. I can't tell you how often I thank my lucky stars that I love psychiatry instead of cardiology or trauma surgery. On psychiatry rotations, I have a normal-ish life and can talk about my work to non-medical friends (within the constraints of HIPAA, of course) without killing the conversation.

I did ENT during my fourth year for my surgical subspecialty and really enjoyed it. They actually see a number of somatic complaints in clinic (look up phobic postural vertigo - fascinating) and have a lot of substance abuse and depression in their head and neck cancer patients.

 

[whopper]

Something I noticed that disarms the annoying attitude mentioned above is as an attending, get to know your fellow colleagues. While I was a chief resident, while I was not an attending, I was working side by side with attendings in other departments and it was to the point where I was on a first-name basis with many of them. I also had a better working relationship with attendings outside the psychiatry dept. vs most of the attendings.

And something I noticed...

Some of the non-psychiatric attendings had a lousy opinion of psychiatry because the psychiatrists they were working with left a lot to be desired. For example, I worked with some gastroenterologists that were having problems with Pegasys-induced depression and psychosis. I talked to them about handling depressed patients, using a depression scale, and telling them they could feel free to ask me for advice. They told me I was more helpful to them than any of the psychiatrists that worked with them in the hospital and they invited me to be a consultant for their highly profitable group outside the hospital. They never ever pulled the "holier than thou" attitude with me.

(Well too bad I moved outside of NJ. That would've made a lot of money had I stayed!)

But I think all of you get the point. The above was just one example. I did a lot of extracurricular work with the IM dept on the hospital and was building bridges with several other depts. and attendings. I actually had some regret about leaving the area where I did residency because I laid a nice groundwork of connections had I stayed in South NJ.

The ignorance of doctors about other fields will always be there, but aside from the obvious (nonpsychiatric doctors don't understand mental illness), some of it is because some psychiatrists don't exactly represent the profession in the best light to other doctors.

Which leads me to another piece of advice to residents. If you do a good job, that will build a lot of roads. Don't develop an attitude of entitlement that as a doctor, you somehow deserve to be given money and respect for only the title.

 

[john182]

Hey psychiatry community: a little advice or perspective needed here. I am doing a neurosurgery rotation, because (1) I'm curious & (2) a surgical subspecialty rotation is required for MS4s and I thought, hey, at least it's brains.

I'm only a week into it and it's been awful, mostly because the first question I get is always "what are you going into?" and when I answer "psychiatry" I get very unpleasant reactions. On the first day I was told since I'm not going into neurosurgery they don't really care what I do on this rotation. Also, every single resident I've met has asked me as a follow up, "why are YOU doing a neurosurgery rotation?" as if it is inconceivable that anyone not going into neurosurgery would dare to rotate on their service. I've been having a hard time getting anyone to teach me anything and when they do, it's always with cracks that this is my "last chance to do ___" as if I'm sacrificing all the fun medicine has to offer by choosing psychiatry.

Adding more insult, today I was in clinic with the chief of neurosurgery. He is greatly admired by his residents who consider him a great teacher and I was repeatedly told to do his clinic because he likes medical students and is a great pain expert. So, I went today hoping to learn something about pain. I didn't. He quizzed me entirely on neuroanatomy, saying repeatedly that I would only need this information so I could help my friends and family when they expect me to "be a doctor" and telling me over and over that psychiatry shares the board certification with neurology (which I already knew, I almost went into neuro) and so I needed to know this stuff for my boards. The implication was that I wouldn't need to know anything at all to be a psychiatrist.

More directly, he told me that I'll "need to know certain things whether you choose to be a psychiatrist or a real doctor," he asked me "do you know how to examine patients?" before agreeing to let me see one, and when introducing me to the one patient he let me speak to he warned them "watch out, this one is a future psychiatrist." He walked into the patient room with me supposedly to introduce me to the patient so I could then do the history and physical, but then proceeded to take the history himself while I was standing there, followed by quizzing me on things I didn't know in front of the patient and then telling me, step by step, how to do the relevant neuro exam. I'm actually very good at neuro exams. So, clearly he didn't trust me to even talk to his patient, much less touch them, even though I'm a 4th year and passed my boards etc etc . . . and at this point have as much training as a med student going into neurosurgery. I haven't specialized yet.

Anyway, I'm somewhat angry, and insulted. Has something like this happened to anyone else going into psychiatry? How did you deal with it? Did you speak up and defend yourself? I didn't, and I'm not sure that was the right choice. What do you think?

Neurosurgery and psychiatry do joint work in centres here for the clinical assessments and reviews for Deep brain stimulation, impanting electrodes and also anterior cingulotomies for treatment-resistant depression. Maybe your colleagues who are making such comments are not at the level for working with neurosurgery for psychiatric conditions, and so have only worked at a more generic neurosurgical level. Perhaps you could focus your rotation on aspects of DBS.

 

[gbv]

Good stuff by all. To cinnameg, basically what I would suggest is to 1: be an ultimate professional--almost to a fault, and let the wisecracks roll of your back, and 2: Ask good questions that indicate that you read and are a good student (which it sounds like you are).

I think the perception of the field of Psychiatry as a whole by others is something that is hard for a medical student or early trainee in Psychiatry to change. What an individual CAN do is to let others see more and more that people who go into Psychiatry are smart, prepared, inquisitive, and not petty. That is something you can control and the more that others see that "that student going into Psych" is smart and sharp and professional, they will start to slowly show respect to you and hopefully their view of the field as a whole might be modified.

It's funny how we ALL have these types of stories as we move through the medical education process. I remember it use to really annoy the heck out of me, but as time went on, I found it really comical and invariably at the end of your rotations when you do a good job you'll get some verbal back-patting from some of the attendings/residents who have had a chance to work with you.

Like someone alluded to earlier, look at it all as a small cost of doing business.

 

[zac16125]

Wow, who would have thought neurosurgeons would be pompous and condescending? Actually the only neurosurgeon attending I have ever personally spoken too was very pleasant and a pretty down to earth guy. So there are some quality people in the field, but theres a reason they have the reputation they do.

It kind of sounds like you are just rotating at a program full of *******s. I am just a 3rd year, but I'm most likely going to end up in psychiatry, and when I tell people that they usually give me a strange look/jaw drop. And there's been some friendly joking about how I must be crazy myself (probably true), etc etc. All in good fun though, then most people tell me something along the lines of, "I could never do that", or "Thats a tough field to be in". Most residents and attendings I know have a great deal of respect for psychiatrist, mainly because they know they personally can't handle the clientle, situations, and dealing with mental illness in general. It seems like the comorbid psych patients are their least favorite ones, so they respect the psychiatrists for going in and trying to clean up the mess. Then again, I am at a program that is very non-malignant and full of really good and friendly residents and attendings, who seems to be happy with their careers and not miserable people.

Also, maybe you are being a little two sensitive. If you are confident with your decision and your future profession, you shouldn't be bothered by the things people say that you know aren't true (psychiatrists aren't real doctors, only people who can't match in other specialties go into psych).

 

[Cinnameg]

Thank you for all the advice! Actually things on this rotation have gotten a lot better since that post. Yesterday I was scrubbed in on a case with one of the chiefs and she said the problem they have is that they don't usually get medical students on this rotation who want to do anything unless they are going into neurosurgery. So, it may have been that part of the problem was simply that I'm not going into neurosurgery, and they don't know what to do with non-sub-I medical students. That said, the department chairman was still out of line in clinic, but if the residents have little contact with medical students, I imagine he has almost none. I don't know that I'm making future psychiatrists look brilliant -- I do (unintentionally) ask questions that they think are dumb -- but I'm not making us look terrible either.

 

[Doc Samson]

Did you do your presentation yet?

 

[Cinnameg]

Did you do your presentation yet?

No, that's this Wednesday. Why, any other resources or suggestions? I'd love to hear what psychosurgery topics you'd cover. They don't want to hear about ECT or anything that we already do regularly in this country.

 

[skybliss]

Thank you for all the advice! Actually things on this rotation have gotten a lot better since that post. Yesterday I was scrubbed in on a case with one of the chiefs and she said the problem they have is that they don't usually get medical students on this rotation who want to do anything unless they are going into neurosurgery. So, it may have been that part of the problem was simply that I'm not going into neurosurgery, and they don't know what to do with non-sub-I medical students. That said, the department chairman was still out of line in clinic, but if the residents have little contact with medical students, I imagine he has almost none. I don't know that I'm making future psychiatrists look brilliant -- I do (unintentionally) ask questions that they think are dumb -- but I'm not making us look terrible either.

perhaps i should make a note to self to not be so vocal about my hope of doing psychiatry... seeing that there is so much flack that we get about it...

I bet that the neurosurg rotation guys would love me if I simply fibbed a little to them and told them I am curious about going into neurosurg. hahaha.

problem solved =). Who says a psychiatrist can't **** with a neurosurgeon's brains too? haha

 

[notdeadyet]

perhaps i should make a note to self to not be so vocal about my hope of doing psychiatry... seeing that there is so much flack that we get about it...

There's not. If you're on a medicine specialty and mention you're going into a surgery sub-specialty, you'll also get some flack. And vice versa. There is just a certain breed of med-student/resident/physician that gets their kick putting down anyone that isn't in their tribe. Big brains but small minds.

I bet that the neurosurg rotation guys would love me if I simply fibbed a little to them and told them I am curious about going into neurosurg. hahaha.

Be cautious about falsely expressing interest. You get a lot of "Since you're interested in this stuff..." and sometimes given exposure and scut that adds up to a lot more hours.

 

[Cinnameg]

Be cautious about falsely expressing interest. You get a lot of "Since you're interested in this stuff..." and sometimes given exposure and scut that adds up to a lot more hours.

I second this. Don't express false interest, it'll backfire. Also, you CAN express genuine interest that isn't the same as saying you want to be a neurosurgeon. As it is, they know I'm interested in learning but not interested in being a neurosurgeon, so I have a reasonable amount of work on this rotation. If I were going into neurosurgery, they would be having me spend much less time in surgery and much more time doing scutwork. Not that I don't want to work at all, I just admit that I'm the medical school equivalent of a second-semester senior and there's a limit to how much work I want to do to learn stuff about neurosurgery. For the neurosurg residents? There is NO limit to how much they work. None. They are over work hours every week and brag about it. I don't need to do that for a month.