when deciding on psych did you feel...

[eml]

---

Members don't see this ad.

hey everyone, I'd really appreciate your insight here, especially if any of this resonates w/anyone-I'm kinda struggling with this decision. I'll preface this by saying that I entered med school thinking I was going to go into primary care, didn't expect to love psych, and after my rotation this yr(and through many of the other big ones), it's really likely that I might chose psych(or neuro).

I found psych more interesting than almost anything else I've encountered, the patient relationships more meaningful, the research most interesting, and the potential for creativity/individuality in treatment options exciting(vs. say, "gold standard" treatments/algorithms in various other fields),and generally I tend to enjoy striking up conversations with strangers regarding how they view the world so this all seems like a logical decison now..Anyway, that being said, here goes: please, i would appreciate a reply to any of these...

-has anyone had a hard time potentially giving up physical diagnosis? it's been kinda unnerving to me...besides no longer being able to sorta have someone "show me how it hurts" or look for interesting "signs", it kinda makes me wonder why i bothered to goto med school(vs, i dunno, psychology)...

-this sorta is a big issue I've been thinking/worrying about(please someone help). I think I can assert that psychiatrists acquire expertise at dealing with inital patient encounters, by this I mean, I can see how psychiatrist would be the best people for C/L (something I absolutely loved), psych ER, or just ordinary initial patient encounters. However, what is sorta bothering me is what expertise is gained, during the 4 yr training, that might help patients after the initial diagnosis, that is well, unique to psychiatry and couldn't otherwise be handled by other mental health professionals? I'm a bit naive about what the acutal content of psych residency entails, obviously dealing with meds is unique, but from my observation, attempting medical therepy with inpatients/outpatients really doesn't seem to require much finesse...there has to be more that psychiatry has to offer, and perhaps its just hard for me to define right now(and its unique in that other fields overlap so much).....

-i've really enjoyed my inpatient psych experiences, it was interesting to attempt to diagnoise/ascertain what was going on with the patients on admission, and very meaningful to be there for them when they were in an acute situation/needed care most. however, i sorta questioned what the psychiatrist was doing for these patients once they were admitted to the floor(other than meds), or, well again, why a psychiatrist was needed to do it at all...

-on another note, I frequently feel a little guilty, or rather, selfish in my interest/decision regarding psych. for instance I find psychotic indviduals facinating, and research on schizophrenia very interesting, however, it bothers me that there is very little that can be done in my role to help these people..granted there are others I can help, and i did go into medicine to help people, but it kinda irks me that my decision might be based on what is "most interesting" and such...


hey, i regard you all as an insightful bunch, i've been lurking here for awhile and you've been of great help, i'd appreciate any responses on the above(encouraging ones are encouraged, heh.).

take care
eml

 

[Thewonderer]

Originally posted by eml

please, i would appreciate a reply to any of these...

-has anyone had a hard time potentially giving up physical diagnosis? it's been kinda unnerving to me...besides no longer being able to sorta have someone "show me how it hurts" or look for interesting "signs", it kinda makes me wonder why i bothered to goto med school(vs, i dunno, psychology)...

-this sorta is a big issue I've been thinking/worrying about(please someone help). I think I can assert that psychiatrists acquire expertise at dealing with inital patient encounters, by this I mean, I can see how psychiatrist would be the best people for C/L (something I absolutely loved), psych ER, or just ordinary initial patient encounters. However, what is sorta bothering me is what expertise is gained, during the 4 yr training, that might help patients after the initial diagnosis, that is well, unique to psychiatry and couldn't otherwise be handled by other mental health professionals? I'm a bit naive about what the acutal content of psych residency entails, obviously dealing with meds is unique, but from my observation, attempting medical therepy with inpatients/outpatients really doesn't seem to require much finesse...there has to be more that psychiatry has to offer, and perhaps its just hard for me to define right now(and its unique in that other fields overlap so much).....

-i've really enjoyed my inpatient psych experiences, it was interesting to attempt to diagnoise/ascertain what was going on with the patients on admission, and very meaningful to be there for them when they were in an acute situation/needed care most. however, i sorta questioned what the psychiatrist was doing for these patients once they were admitted to the floor(other than meds), or, well again, why a psychiatrist was needed to do it at all...

-on another note, I frequently feel a little guilty, or rather, selfish in my interest/decision regarding psych. for instance I find psychotic indviduals facinating, and research on schizophrenia very interesting, however, it bothers me that there is very little that can be done in my role to help these people..granted there are others I can help, and i did go into medicine to help people, but it kinda irks me that my decision might be based on what is "most interesting" and such...


hey, i regard you all as an insightful bunch, i've been lurking here for awhile and you've been of great help, i'd appreciate any responses on the above(encouraging ones are encouraged, heh.).

take care
eml

When I came into med school, psych was not even on my rador. I did think about neuro for a while since I always liked the brain and only knew about neurology (after all, psych still has this mysterious aura and stigma surrounding it). But after doing both rotations, they are very different fields! Neuro is more like the rest of the medicine: conducting tests (MRI, sleep deprivation EEG, nerve-conduction study, electromyogram, etc.) and making diagnosis and giving meds. However, psych is more about behaviors (rather than specific anatomic lesions) which I find much more fascinating. Plus, no other docs use psychotherapy which is a useful skill but nobody gets exposure to that during med school. So think carefully about neuro v.s. psych. It might be more socially acceptable to your parents or others to go into neuro instead but it is a totally different field from psych!

1. giving up physical diagnosis is a part of it. But you do still retain some if you do ER psych or admit pts to the floor. But it is similar to a lot of fields (ex. I am going into peds but that means I give up my knowledge on anyone above the age of 18!). In the end, if you are really concerned about physical dx, then only internist and family docs can brag while the rest of the dermatologists, radiologists, psychiatrists, anesthesiologists, orthopedic surgeons, etc. hide in shame.

As for, why not going into psychology instead, well, psych MD does know some stuff about physical illnesses that manifest with psych symptoms. The popular saying is that "when you only have a hammer, everything looks like nails." Therefore, if you are trained in psychology and psychotherapy training, then you will not be intuned to the possibility of chest pain secondary to cardiovascular etiology v.s. panic disorder v.s. GERD v.s. others, or psychosis secondary to alcohol withdrawal v.s. brief psychotic d/o v.s. other medical conditions. In the end, it is properly safer to have the pts seen by a psych MD before referrals being made to psychologists when psychotherapy is deemed the best treatment. Then of course, you would image that all medical conditions that would cause psych manifestations would have been screened out by the PCP (family docs, pediatricians, etc.) before PCP making the referral to psych MD. but that's not always the case.

2. psychiatrists do deal with a lot of medication follow-up's and much of the stuff can be learned by other mental health professionals IF they HAD gone through the training. It is like, heck, if nurse practitioners or physician assistants have gotten a year or two more training, why can't they replace family docs totally? after all, monitoring BP and blood glucose levels and finding pneumonia on CXR are not exactly rocket science. Or, why don't optometrists and nurse anesthesiologists just get more training so they can replace opthomologists and MD anesthesiologist too? Similar arguments. Psych MD simply get the most complete training in the mental health field (although their psychotherapy skills are probably rudimentary compared to most psychologists but psych MD can always undergo even more psychoanalytic training after residency) so they are in the position to decide either psychotherapy or psychopharm is indicated, or even figuring out the psych manifestations are simply stemming from a medical illness so the pts are better off seeing an internist from now on.

- in-pt psych. Acute stabilization is the key and meds are it. psychotherapy is intensive and takes repeated follow-ups. So for most inpt work, using meds to stabilize the pt so they are no longer suicidal or no longer so psychotic that they will buy themselves a bullet to their heads in the dangerous streets of L.A. or other random cities.

- i don't quite understand the question on schizophrenia, etc. For schizophrenia, antipsychotics are the only intervention to help them. So I don't know why you will not be helping them? There is also nothing wrong with going into a field because the pts are fascinating. Why do you think that radiologists and pathologists go into their fields? they love pathologies!


hope this helps. others will probably chime in soon.

 

[mdblue]

Well said

 

[axial]

I have been doing psychiatry for a couple of years now and this is what I think :
1) Its one of the fascinating subject if you like it and can be a nightmare if you dont.
2) Though Psychiatry is no rocket science ,the part i find most dificcult (consequently most interesting )is differntiating normal from abnormal) Once you learn that, the actual theraputics part is not very difficult.
3) it might not be as black and white as surgery but i love the shades of grey
hope this helps

 

[raspberry swirl]

eml, welcome to my world. i'm only an MS I but i have the same concerns. you're not alone, if that helps at all 😛 im just hoping once i get to rotations i'll figure it all out . . . . good luck 🙂

 

[whopper]

I too have the same worries.

In fact I just completed Family Practice and I loved it. I already sent out all my ERAS applications and its too late to do a combined FP/Psychiatry residency, but I would've done so had I done FP earlier because I loved it.

FP incorporates a lot of behavioral science and psychiatry into it. Most FP offices have a psychiatrist or psychologist working for them.

If you love the medical-physical diagnosis aspect of medicine very much consider FP or a combined FP-psychiatry program.

FP also has many characteristics which psychiatrists and future ones like myself like. FP is more laid back and empathy is a strong point.

As for Psychiatry, it is getting more and more biochemical and physical.

If you do choose to go into psyche without the FP look at the bright side. Thing I can't stand about Internal Medicine is no matter how many times I study it I forget a lot of important things. It requires so much dedication to restudy and keep on top of the new developments. Psychiatry comes much easier to me as I noticed it does with many other people who chose it. Psychiatry has many developments in progress as well, but it covers a smaller (though IMHO a more interesting) area, where as IM covers pretty much everything.


As for fellowships, I heard that geriatric psychiatry does incorporate a lot of internal medicine into it.