When did you know Psychiatry was for you?

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judasreznor

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For the third/fourth years, residents, and attendings, when did you realize that Psychiatry was what you wanted to do? It seems that most people have a certain personality type that fits in with Psychiatry. Did any of you feel this way?

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Always had an interest in mental health but I think I knew psych was for me on my third year rotation when I realized that for once I was actually happy about going into work.
 
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3rd year rotation decided it for me. I really liked Psych, and I disliked or merely tolerated the other rotations.

The worst for me: Medicine, followed by Peds. The tolerable but still unacceptable: Surgery, OB/Gyn, Neuro.

I entered the process completely open minded, with a lean towards Neuro. The Neuro rotation cured me of that...

Let 3rd year be your guide.
 
I came into med school wanting to something like heme or endo, something with chronic illnesses and people with stories.

Pre-clinical years, psych had what I wanted with regards to chronic illness and went with a neuroscience research background. Neuro seemed like it might be neat, but the only folks in the neuro department that looked like they'd been laid in the past 20 years were the gay guys. And I look stupid in a bow tie. Medicine seemed boring and seemed like it was turning more and more into an assembly line and other people were clearly more into it, so I though, meh. OB/GYN sounded fun because I thought I could be subversive and do things that would make my parents disown me and never let me back in my home town, which sounded like a good thing. It seemed like a way to do surgery without being a surgeon per se. My wife was also a pretty heavy feminist, so I had fantasies of dying a martyr's death in a clinic explosion, which I thought would give me some great stories to share in "atheist/agnostic heaven," wherever that is. So I went into 3rd year thinking OBGYN or psych.

During third year, psych was fun, the OB attendings all hated every moment of their lives. I also thought being a surgeon in that respect would be fun, but later I found out they were really "surgeons", not surgeons. The sterile field was optional, which appropriate in some surgeries, and not appropriate in others. Seriously saw an attending adjust their mask during an open abdominal surgery (no poop involved), and nobody cared. Egads.

So then I was thinking psych vs family medicine, and was thinking really hard about doing 3 years of FM then 3 years of psych (because the combined programs looked entirely unattractive). Then I did a behavioral peds elective (basically child psych with more poop and less antipsychotics), and I dropped the FM aspirations in order to focus on child. Investigated triple board, but after the program director of one of the better programs told me I would be crazy to do it, I figured he knew what he was talking about.

And here I am.
 
:laugh: Good stuff Billy.

I came to Med school intent on being an ED physician. I'd been a ED tech for several years and those docs are the one's that turned me on to the idea of medicine as a career.

But then I got lucky. During a clinical externship as an M1 I was working nights in a busy urban ED where the attending assigned me to take histories on all her psych patients who were in no short supply. And for the first time I realized that what I liked most was taking a good history. And getting to know patients' stories in more depth than isolating one complaint and moving on. I got bit by the psych bug. Then followed up with a summer program in psych at VCU. And loved it. Never even thought of psych. But if you can make the most out of a combination of intuition and both sought and serendipitous experience the right answer can be found...it was for me.

So I have psych as my primary goal half way into 3rd year. Everything so far has been confirmatory.

And I want to make the point that 3rd year should be confirmatory at best and you're only source of information at worst. The fact that such advice passes as wisdom from our superiors, to wait until 3rd year to decide on careers, is a crime. That's like saying you should choose your wife from who you will meet on this one particular cruise to Jamaica. And be happy. Why that is not recognized as a similar type of arbitrary insanity as meeting only a fraction of the potential careers in medicine for only brief interludes colored by the few individuals who are your only abritrageurs of experience in a particular field, is mysterious to me. How has that held up over the years? How would I even know if I liked PM&R or not? Or palliative medicine? Or ENT? Based on the limited 3rd year menu.

Investigate psych and contrast it with anything else your interested in. That's what I'm doing now. Seeing if there's anything else that I have passing curiosities in. And how that compares to psych. As well as sensing the lives, not just the rhetorical message of my various physician educators.
 
For the third/fourth years, residents, and attendings, when did you realize that Psychiatry was what you wanted to do? It seems that most people have a certain personality type that fits in with Psychiatry. Did any of you feel this way?

medicine- fluids, fluids, ekgs, call, physical exams, antibiotics, chest x rays, some procedures, IVs and lines......blah.

all the IM subspecialties- would involve the above for residency first. Plus a bunch of other stuff I wouldnt like.

derm- yeah right...I would have had a better shot dating Jessica Alba. plus mostly procedures which I didnt want to do.

anything surgical- have enough trouble tying a decent fishing knot with two free hands and all the time in the world.

pathology- boring. everything about it.

radiology- too much anatomy. too much stuff which I didnt even come close to understanding. And it's becoming procedural.

neurology- too many needles, and too much boring 'hard' science(nerve tracts and such)

pediatrics- basically like medicine. see above.

so yeah, it was not a hard decision. I really would hate doing anything else. Maybe something like occupational medicine I suppose would be second, but is that even a real residency?
 
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I had no idea when entering med school what I wanted. In my 3rd year, I started with FM, peds, IM, then surgery, and more or less enjoyed them all. But it was clear that I wouldn't be a surgeon (one of the surgery chairs or something at one hospital said I seemed good for pediatrics) as I can't be that intense or that awake with so little sleep and I wasn't interested in the surgeries themselves (the overall management of those patients was interesting, but the procedures may as well have been black boxes to me).

Then I had my psych rotation and realized I was having more fun than ever before. I liked talking to these patients and discussing their management with the team. I liked that we seemed to actually care about the social issues that clearly impacted their care. I found myself fascinated and eager to learn more. My ob/gyn rotation after that didn't deter me -- while I found it interesting at times, L&D was such a repetitive bore that there was no way I would sign up for more of that.

The only thing that almost pulled me away was peds neuro. I enjoyed neuro overall as I find the nervous system interesting, and the whole "localize the lesion" thing was logical and enjoyable to me. But I like working more with kids than adults and peds neuro can get some really interesting conditions. Ultimately, I found that seeing seizure after seizure (stable on meds) in the clinic could get boring. And since peds neuro is an early match, I spent longing enough thinking about this that it just wouldn't be feasible, so psych took home the victory.
 
Thanks for the responses, everyone. I'd like to hear more people's stories. I'm personally on the fence because I find that I really enjoy neuro stuff, but also musculoskeletal. Were any of you ever seriously interested in Neurosurgery?
 
Wasn't interested in neurosurgery, at least no more than I contemplated rads for about a week. So much of medicine I find interesting, but interesting isn't enough when contemplating a career choice.

Psych was always on my short list, along with some IM subspecialties (heme/onc, ID). I even applied to a couple of med/psych residencies but ultimately ranked them lower.

For me psych was the rotation I actually looked forward to going to in the morning, and felt good about my work when I went home at night. I had been on an adolescent unit and doing some insight oriented therapy with the patients there, which skewed that experience in a positive direction. Felt more substantive than tuning up a COPD'r, though later I would come to realize the revolving door nature of so many specialties with heavy inpatient foci (child/adolescent psych included).
 
Always had an interest in mental health but I think I knew psych was for me on my third year rotation when I realized that for once I was actually happy about going into work.

This. My main reason was exactly the same.


judasrenzor said:
I'm personally on the fence because I find that I really enjoy neuro stuff, but also musculoskeletal. Were any of you ever seriously interested in Neurosurgery?
What stage in med school are you in? Neuro was really cool in 1st/2nd year, but I thought that real everyday neurology was just tedious. Check some tone, power, sensation, reflexes, localize the lesion, try to convince the student that there's some benefit to doing all of that instead of just looking at the MRI, then refer to occupational therapy.

Also, if you haven't done a surgery rotation yet, then that'll tell you whether you want to consider neurosurgery. Either surgery is for you or it's not. I don't think I've ever met somebody who, after doing both rotations, was still debating between psych and neurosurg. You may be treating the same part of the body (which makes 1st/2nd year fairly similar), but it's like debating between chess and football because they both involve strategy.
 
This. My main reason was exactly the same.



What stage in med school are you in? Neuro was really cool in 1st/2nd year, but I thought that real everyday neurology was just tedious. Check some tone, power, sensation, reflexes, localize the lesion, try to convince the student that there's some benefit to doing all of that instead of just looking at the MRI, then refer to occupational therapy.

Also, if you haven't done a surgery rotation yet, then that'll tell you whether you want to consider neurosurgery. Either surgery is for you or it's not. I don't think I've ever met somebody who, after doing both rotations, was still debating between psych and neurosurg. You may be treating the same part of the body (which makes 1st/2nd year fairly similar), but it's like debating between chess and football because they both involve strategy.

I'm currently a second year. I have a background in mental health from my undergraduate (Psychology) and training in Occupational Therapy. I have gotten the sense that I will feel about Neurology the way you do. Psychiatry, at this point, is intellectually interesting to me. I have done extensive shadowing in NS (realizing that that is not close to the same thing as a rotation/residency), and am interested intellectually in that, too, but for different reasons. For differing reasons, due to different parts of my background I guess, I'm interested in Psychiatry, Neurosurgery, and, to a lesser extent, PM&R.
 
Did you just shadow a doctor in neurosurg or did you actually scrub in to surgery? I think the two main things that define a person's level of interest in surgery are (1) the call of the knife and (2) the lifestyle. Almost everybody thinks that surgery is gratifying (the patient came in sick, you manually fixed them, and now they're healthy), but the question is if you love it enough to put up with the fact that it will own your life. I thought it was cool, but not cool enough to put up with the 40-patient ward rounds, the early mornings/late nights, the 2-minute consultations without any real feel for the patient ("have his bowels opened? is he producing urine? what antibiotics is he on? how much fluid did he get in the last 24 hours? is the wound infected? OK, next patient.")...
 
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I'm currently a second year. I have a background in mental health from my undergraduate (Psychology) and training in Occupational Therapy. I have gotten the sense that I will feel about Neurology the way you do. Psychiatry, at this point, is intellectually interesting to me. I have done extensive shadowing in NS (realizing that that is not close to the same thing as a rotation/residency), and am interested intellectually in that, too, but for different reasons. For differing reasons, due to different parts of my background I guess, I'm interested in Psychiatry, Neurosurgery, and, to a lesser extent, PM&R.

I enjoy surgery, but enjoying surgery and living surgery are two very different things. Especially with neurosurgery. You basically have to enjoy the work to the exclusion of most other things in your life. A huge residency where you will most certainly not have a life, then when you "graduate", a lifetime of sacrifice remains. I also didn't see neurosurgeons skipping down the hallways with excitement for their chosen career. What sounds cool as a young med student isn't so cool after 10 years of slaving away at it, while you watch your youth dissipate into an endless cycle of scrub and cut. At some point you wake up and you begin to question your motivations for getting into it, and was it all really worth it.

I believe there are published studies indicating that a large source of happiness in your life comes down to having control over your life. Neurosurgeons have very little of that. Psychiatrists have a great deal of it.
 
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Did you just shadow a doctor in neurosurg or did you actually scrub in to surgery? I think the two main things that define a person's level of interest in surgery are (1) the call of the knife and (2) the lifestyle. Almost everybody thinks that surgery is gratifying (the patient came in sick, you manually fixed them, and now they're healthy), but the question is if you love it enough to put up with the fact that it will own your life. I thought it was cool, but not cool enough to put up with the 40-patient ward rounds, the early mornings/late nights, the 2-minute consultations without any real feel for the patient ("have his bowels opened? is he producing urine? what antibiotics is he on? how much fluid did he get in the last 24 hours? is the wound infected? OK, next patient.")...

I did scrub in. The lifestyle part is definitely the big consideration. It's obviously a big change from intellectually being interested in something vs. having to do it every day. Maybe, as you say, it will just come down to whether or not I like the rotation. I also think I vacillate between enjoying extended patient interactions and not. In my former Occupational Therapy life, I enjoyed doing things for patients that helped them instantly, but also often liked getting to know them over a period of time.
 
i dont like touching ppl..im not a germaphobe...i just like to keep my distance..

:laugh: yeah. I hear you. Even though I'm the opposite and will miss tactile aspects like holding a baby for peds or OB, I also won't mind if I never had to experience a grossly hemorrhaging uterus shooting blood at my face and drenching my gown as I try not look like a deer in the headlights as my team is scrambling incomprehensively around me.

There are a whole heap of benefits to being in a field that deals with the mind. Not having my hands clumsily feeling about in people's crevices comes to mind.
 
I'm in 3rd year and haven't even done psych yet, but here's what I'm thinking so far:
Much prefer to take complete histories and have time to think about everything rather than make quick decisions based on limited information and do procedures.
All psych material that we learned about in didactic years really intrigues me and makes me curious to investigate further. This material is very enjoyable to study, whereas other material ranges from somewhat interesting to painful (esp anatomy).
Like pharmacology (almost went to pharmacy school).
I feel like I have a calling to provide high quality, non-judgmental care to individuals who may have been stigmatized by the rest of society
Value compassion, empathy, and strong doctor-patient relationships
Not a fan of the culture of fields like surgery with the military-like hierarchy and hostile pimping; prefer a more humanistic teaching environment
Desire to build relationships with patients over time
My manual dexterity ability is probably below average, so I want to avoid procedures
Controllable lifestyle
Highly introverted - not sure if this is a common personality type in psychiatry (I'm an ISTJ)
 
I started med school with the intention of becoming a medical geneticist or oncologist, primarily because they tend to have very close relationships with their patients. I've always enjoyed finding out why people do what they do, and how they ended up where they are in life. I thought that oncology or genetics would satisfy my interest in having deeper relationships with patients. Psychology/psychiatry had been a curiosity for me for years because of a variety of personal experiences, but for whatever reason I always dismissed it as a career choice in favor of the "harder" sciences.

Over the summer between first and second year I did a 6-week program which combined neuroscience research and clinical experience. It became very apparent that the medical part of medicine, while interesting, was not what I enjoyed most about patient care. I looked forward to talking to patients at length, and I especially liked working with the depressed, schizophrenic and demented patients in the geriatrics clinic. That summer I started reading books written by psychiatrists about their work (Naked Lady Who Stood On Her Head, Danger to Self, Weekends at Bellevue, etc.), and the more I read, the more I felt like it was a field I could enjoy.

I'm halfway through 3rd year now and very excited about going into psych. I have found a great deal of satisfaction in working with patients who have mental illnesses across all my rotations, psych and otherwise. Overall third year has been very helpful in confirming my career choice, and has also taught me a lot of important things about myself. I think it's good to go into clerkships with a mostly-open mind even if you have a specific interest already; the things you end up liking (or disliking) may surprise you.
 
That sounds like an astute process Daedra, but, it's this whole open mind thing.... It bothers me as a Rx. Sounds like you had a strong theme of what you wanted and psych fit the bill. Whereas the people advising medical students seem to think its reasonable to allow experience in clerkships to direct students entirely. It's like watching friends choose a mate that gets on their nerves and then seeing them get married, have a baby, and then get divorced. Ask them after the wreckage if the have open mind about who they will do it again with. But why does their have to be wreckage. I'm way too old to be doing a 2nd residency.

So an open mind is for suckers to me. I think there's really only certain people who will get a lot of satisfaction out of psych as a career. Finding that resonance is more knowing yourself than having your career course changed by a few weeks of limited experience.

Sorry, it's just a colossal failure or medical education. I see younger colleagues working with competing mythologies of the different fields in their process and telling them to keep an open mind is just more fuel for a bad decision.

Most of our psych rotations are inpatient glimpses. Easily distorted by an institution, a supervisor, and isolated patient experiences. A solid self-critical sense enables a better approach--procedures or no procedure, long term patient relationships or short term, generalist of specialist, any special endpoint that I'm missing that would be amazing, these types of things. I wouldn't describe that as open. I would describe it as reflective parsimony.
 
That sounds like an astute process Daedra, but, it's this whole open mind thing.... It bothers me as a Rx. Sounds like you had a strong theme of what you wanted and psych fit the bill. Whereas the people advising medical students seem to think its reasonable to allow experience in clerkships to direct students entirely. It's like watching friends choose a mate that gets on their nerves and then seeing them get married, have a baby, and then get divorced. Ask them after the wreckage if the have open mind about who they will do it again with. But why does their have to be wreckage. I'm way too old to be doing a 2nd residency.

So an open mind is for suckers to me. I think there's really only certain people who will get a lot of satisfaction out of psych as a career. Finding that resonance is more knowing yourself than having your career course changed by a few weeks of limited experience.

Sorry, it's just a colossal failure or medical education. I see younger colleagues working with competing mythologies of the different fields in their process and telling them to keep an open mind is just more fuel for a bad decision.

Most of our psych rotations are inpatient glimpses. Easily distorted by an institution, a supervisor, and isolated patient experiences. A solid self-critical sense enables a better approach--procedures or no procedure, long term patient relationships or short term, generalist of specialist, any special endpoint that I'm missing that would be amazing, these types of things. I wouldn't describe that as open. I would describe it as reflective parsimony.

Since I am one of, if not the only, poster to have said I entered med school with an "open mind," I have to say I don't know what the hell you are talking about, and I don't think you do, either.

By "open mind" I meant that I did not enter med school with a preconceived notion of what field I wanted to enter, namely because I had no such notions. I approached each experience and rotation with an open mind, but that isn't to say that I didn't form quick and decisive opinions about these rotations.

How far into med school are you, by the way? Sounds to me like the pompous musings of a first year...
 
That sounds like an astute process Daedra, but, it's this whole open mind thing.... It bothers me as a Rx. Sounds like you had a strong theme of what you wanted and psych fit the bill. Whereas the people advising medical students seem to think its reasonable to allow experience in clerkships to direct students entirely. It's like watching friends choose a mate that gets on their nerves and then seeing them get married, have a baby, and then get divorced. Ask them after the wreckage if the have open mind about who they will do it again with. But why does their have to be wreckage. I'm way too old to be doing a 2nd residency.

So an open mind is for suckers to me. I think there's really only certain people who will get a lot of satisfaction out of psych as a career. Finding that resonance is more knowing yourself than having your career course changed by a few weeks of limited experience.

I did very deliberately say "mostly-open mind." I would agree that your interests before 3rd year should absolutely help guide you to a decision, and to dismiss all of your previous goal because of one wonderful or horrible rotation is short-sighted. However, I think that in order to get the most out of third year it's important to give the various specialties a fair shot, and learn what you can from them (both about medicine and about yourself).
 
So an open mind is for suckers to me. I think there's really only certain people who will get a lot of satisfaction out of psych as a career. Finding that resonance is more knowing yourself than having your career course changed by a few weeks of limited experience.

The problem with your view is that you can't really know what a field is like just by reading about it. You have to experience it. You do have to be smart, though, and recognize the variability in a field. But with that real experience, you can then find out more about the field as a whole and have something to understand it by.

If you instead go in with a closed-mind, a preconceived notion of what the field is like, then you may miss out on an opportunity as the field may not be what you think it is. I don't know how anyone could seriously think this is a good idea.
 
Since I am one of, if not the only, poster to have said I entered med school with an "open mind," I have to say I don't know what the hell you are talking about, and I don't think you do, either.

By "open mind" I meant that I did not enter med school with a preconceived notion of what field I wanted to enter, namely because I had no such notions. I approached each experience and rotation with an open mind, but that isn't to say that I didn't form quick and decisive opinions about these rotations.

How far into med school are you, by the way? Sounds to me like the pompous musings of a first year...

Look...there's no need to make the discussion antagonistic. Your process worked for you. What I'm pointing towards is if the odd chance that a premed or m1 or 2 read this thread, is to more agressively and preemptively decide some things to cross examine during your clerkships. Your position is the dominant theme.

Perhaps I'm just more cautious--you read pompous...fine--and afraid that after lackeying for dozens of physicians I will have made the wrong choice. And so have done my digging before I even got to clerkships. Which I'm in right now.

Fair enough?
 
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The problem with your view is that you can't really know what a field is like just by reading about it. You have to experience it. You do have to be smart, though, and recognize the variability in a field. But with that real experience, you can then find out more about the field as a whole and have something to understand it by.

If you instead go in with a closed-mind, a preconceived notion of what the field is like, then you may miss out on an opportunity as the field may not be what you think it is. I don't know how anyone could seriously think this is a good idea.

Well let's think of it as process rather than semantically. The clerkship for me is a tool for rooting out any doubts and for discovering things that cause me to frameshift entirely. I'm looking for those pivotal experiences but so far everything has happened like I thought it would. Furthermore you can't frameshift on something you don't experience at all, like many, many fields of medicine during rotations. But I have thousands of hours of clinical experience is several fields, so maybe it's hard for me to backtrack my mind into a blank slate. But...

I still maintain my position, the vetting should be pursued early and confirmed during clerkships. Unless doing another residency is not a crushing thought like it is to me. It's fear of this that drives my thinking. And admittedly my incredulity that others don't share this fear.
 
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I have committed to psychiatry because psych is the context that makes all the rest of my medical education interesting, engaging, rewarding, and relevant. Any system or specialty can be one's anchor, as they all influence each other, and for me psych is the anchor. Memorizing anti hypertensives and anti arrhythmics in cardio made my eyes bleed, but when I saw an anxiety+depression patient with intractable hypertension and an arrhythmia, understanding the cardio SEs of psych meds and potential interactions with a cardiac drug regimen led me to dig into these topics with ferver. Also, the effect of mental state on the healing process and physical well being (and vice versa) are central to my interest in medicine. The medical and the psychological are inseparable to me, thus I know Psychosomatic Medicine and C/L are my calling.
 
I'm looking for those pivotal experiences but so far everything has happened like I thought it would.

Well it's great that you already understood what medicine would be like before your 3rd year, but I think that for most of us we didn't really have a good handle on what the experience would be like before experiencing it, and I know I didn't truly know/appreciate the differences between the specialties until I was in the clerkships.
 
Well it's great that you already understood what medicine would be like before your 3rd year, but I think that for most of us we didn't really have a good handle on what the experience would be like before experiencing it, and I know I didn't truly know/appreciate the differences between the specialties until I was in the clerkships.

You're misrepresenting my sentiment. My point was not to say look at me...but the opposite, don't be the poor student who arrives at the application point in a conundrum or the person applying to a different specialty after enormous sacrafice down a different road.

You see, doubting the common sense of my position, harms nothing. Whereas doubting yours is possibly useful. Not universally, but possibly. A possibility worth looking into. As anything involving the majority of wakeing hours on this planet is worth mulling over.

There are those who will abide the empty maxim and end up burned. I am speaking, out of turn, to them. Much can be gained from reading. It's never as simple as this or that thing does the trick. Which is precisely my point. To the Buddha, 40 days under the Bodhi tree and the bottom falls out of eternity. To me, a boring pain in the @ss.

I'm saying use all that you have to investigate. How does George Soros know how to play one currency against another to make billions. Patterns and insight. Something that we're all capable of when it comes to ourselves. Who knows you better than you.

I don't accept the wait and see proposition. Not for my life. I could be wrong though. But if someone thinks twice about waiting for circumstance to align perfectly I'm satisfied.
 
I have no idea what you are saying in this post or what you think I'm saying.
 
I have no idea what you are saying in this post or what you think I'm saying.

Whatever, it happens without nonverbal communications.

I don't want to derail the thread topic further, so back to it, for anyone who wants to pursue ideas of how people choose or have chosen psych.
 
in the incubator..

personally, i think you have to enjoy it at the book level and the patient level...
compassion/empathy for mental illness.. and an ability to understand/intellectualize it as well..(and a love for psychopharm)
many outside of psych say, "why would you want to deal with those patients."
I say, "why wouldn't I want to "deal" with those patients."

FM (backup specialty) pgy2 transfer into psych,
psychology background..
Chased sugars, pressures and lipids for a year and a half..no mas!
So happy to be here!
 
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