Why Did You Choose Psych?

[NachoPlatter]

Hi all, I was hoping for some advice.

I am currently an M3 who is having to make a decision on my speciality. I had set my sights on a surgical subspecialty (specifically with a strong oncology/reconstructive basis as I love the impact you can make with these fields) but when I did my Psych rotation I realized how much fun it can be (I adore schizophrenic patients) and how I enjoyed it. I love the way in both psychiatry and surgery you can truly make a huge difference in someone's life, and the immense trust you get from a patient in either scenario. I am a very hands on person by nature, but I am also very content giving that up professionally in psych as I could pursue it in my free time (with painting and drawing.)

Anyone here end up choosing between surgery and psych, and what made you choose psych?

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[Ironspy]

All the things you described. I'm happy to do "hands on" stuff in my spare time and ultimately realized that control over my time was important to me. I loved surgery but when you rely on the OR schedule which has to accommodate emergencies and other politics as well as unexpected events during surgery that extend your cases you never really know when you'll leave the hospital and it can be hard to have a life outside that requires any planning (friends, family kids etc). There are people who don't require a lot of free time outside the hospital but I'm not one of them. I am also interested in research and see no way that I could have done that during a surgical residency (I know others are able to do this but don't think I could). I do get wistful sometimes about what I'm missing but overall very happy with my current life and thankful for the career I chose.

 

[FlowRate]

I wasn't all the way on the surgery end of things, but I love doing procedures. I was also willing to give that up to do something I find more fulfilling. Do psychiatry if you want to talk to patients. Do surgery if you want to cut them.

 

[ziggyhope]

It is really interesting, and your dilemma is not at all rare. Several of my mentors/attendings were deciding between surgical specialties or psych, and I've had more than a couple of surgeons say to me they would have gone into psych if they didn't do surgery. At first, I was shocked at how common it was for people to debate between surgery and psych, but I think it is because in both specialties, the patients and families go into it trusting they or their loved ones will come out the other end better than when they started, often in profound ways. Personally, I started med school thinking I wanted to be a psychiatrist, loved anatomy, taught anatomy, published in surgery, thought I wanted to be a surgeon for a couple of years. However, when I was on my trauma surgery rotation, my personal relationships suffered immensely. That along with many other reasons was why I ultimately choose psych, and I do not regret it for a second! I always tell people that ask why I picked psych over surgery "If my only love in life is my work as a doctor, I would have been a surgeon, but being a doctor is not even my only professional interest! Being a psychiatrist gives me the flexibility to not only have a great work/life balance, it also gives me time to pursue other professional interests."

 

[Osminog]

omg are you serious, if it's your jam, then there's nothing quite like it, i still cant believe people pay me for this:
1. you can spend as much time as you like doing evaluations (depending on the settings). In forensic evals I can spend the whole day just evaluating one person taking a complete detailed history of all sorts of things people have never told anyone before.
2. beyond getting a window into the mind of the delusional, neurotic, and personality disordered you learn how serial killers, rapists, pedophiles, white collar criminals, stalkers and so on think - compelling and disturbing at the same time
3. there's no one explanatory model for the kinds of problems we deal with that span the breadth of human misery from problems in living, to behaviors, to disorders of thought and emotion, to frank diseases of the brain. We draw on multiple explanatory models (neurobiological, psychodynamic, cognitive behavioral, systemic, social constructivist, social realist, cultural etc) to make sense of people's problems
4. psychopharmacology is fascinating - the effects of drugs on mental experiences is one of the most understudied and compelling aspects of our fields, and some of the more experimental treatments including ketamine, psilocybin, LSD, and MDMA have been gaining renewed attention
5. catatonia is eminently treatable and the results so dramatic it is incredibly satisfying to see someone go from non communicative or frenzied to alert and calm with a little ativan or electricity
6. we can take the paralyzed and hypnotize them out of it (if the paralysis is an hysterical symptom!) - again extremely satisfying to treat.
7. working with couples and families gives you a fascinating windows of how much pressure there is to enact our roles, and how you need to treat the whole system if you want to get someone better
8. we are masters of building expectancy and offering hope. so often we see patients who are written off as hopeless and recalcitrant but a little love and care and reformulating the patient go along way.
9. i love testifying in court and the sparring and jousting of a good cross-examination
10. i love providing a valuable service to the courts and attorneys by educating them about mental health problems, often helping people in very tangible and concrete ways
11. i love the philosophical aspects of the field - what is mental disorder? how to we conceptualize people? are psychiatric disorders disorders of the brain, and if so, how does this affect one's free will? how do psychiatric drugs shape the experience of the self? etc
12. i love stories. patients present with stories: narratives of disillusionment, disharmony and despair as well as ones of resilience and recovery
13. i love language. psychiatry is all about language - whether it is the fact that some carelessly and cruelly deployed words in childhood can alter someone's trajectory, or in their power to heal.
14. i love connecting with people - people i might never otherwise get to talk to, to interact with, and learn their life story. even the most ostensibly odious person can become likeable when you see their scars and vulnerabilities.
15. while we palliate most patients, there are some things we can cure. panic disorder, phobias, and PTSD are all eminently curable, often with short-term treatment)
16. lots of different fellowship/subspecialty opportunities available including pain medicine, palliaitive medicine, sleep medicine, neuropsychiatry, child psychiatry, geriatrics, psychoanalysis, psychological medicine, CBT, family/couples therapy, group therapy, eating disorders, psychosexual medicine, LGBTQ mental health, HIV, clinical informatics, occupational medicine/psychiatry, addiction medicine/psychiatry, brain stimulation etc etc
17. there is no shortage of jobs. even in saturated cities there is plenty of work for psychiatrists and this is unlikely to change anytime soon.
18. you get to spend your days talking about sex with your patients.
19. the mind-brain relationship is extremely fascinating - cognitive neurology is a particularly fascinating area
20. there are lots of research opportunities because there are so many unanswered questions in psychiatry and neuroscience
21. our textbooks dont really go out of date. I have all these books from 100 years ago or more that are still full of rich descriptions relevant to this day
22. while a lot of it can be depressing, some patients are absolutely f'ing hilarious and will have you howling with laughter
23. there are lots of criticisms and controversies in the field but we mostly tend to talk about these things in an open manner (e.g. influence of pharmaceutical companies, illness mongering, psychiatrization of everyday life, overselling of neurobiology, coercion, alternatives to the medical approach to psychiatry etc)
25. you get to work with some of the most disadvantaged, marginalized and disenfranchized individuals (particularly in correctional settings) if you choose to
26. lots of opportunities for innovation: for example developing new psychotherapies, or using tech to enhance patient care or develop and disseminate new treatments
27. psych lends itself well to telemedicine so you can if you so wish see pts from the comfort of your own home, or even from another country depending on the contract
28. i love group therapy - working with groups is a lot of fun, adds a layer of complexity to the work and more importantly can be immensely therapeutic and healing. if therapy is not your jam, then you can do group psychopharm visits which are becoming more popular
29. you definitely grow as a person in this field, confronted with so much of other people's issues forces you to confront your own
30. it is very difficult to get successfully sued as an outpatient psychiatrist
31. it is very easy to diversify you practice and switch jobs, patient populations, settings etc multiple times over your career or have a portfolio career working in multiple settings contemporaneously
32. there are lots of things besides clinical care you can do to (expert witness work, consulting, mediation, teaching, public education, writing, advocacy, policy, research, administration, clinical trials, utilization review, quality assurance, MRO [medical review officer] etc) to break up the monotony

I could go on, but you get the picture. It's not for everyone (most med students are not suited to it) and sometimes i miss being a real doctor but i'm really quite happy for the most part and feel the field provides enough intellectual stimulation for me.

^ From: What do you love about being a psychiatrist? All credit to @splik, obviously.

 

[Armadillos]

One thing you have to be OK with in psych is you almost never get instant gratification from quickly healing someone. Some days I would love to work with someone for just one hour and then have their family sending me thank you cards. (Granted is a double edge sword as your also hearing from another group of patients lawyers).

 

[DisorderedDoc417]

One thing you have to be OK with in psych is you almost never get instant gratification from quickly healing someone. Some days I would love to work with someone for just one hour and then have their family sending me thank you cards. (Granted is a double edge sword as your also hearing from another group of patients lawyers).

IM haldol isn't instant. But it does the job pretty quickly.

 

[smalltownpsych]

One thing you have to be OK with in psych is you almost never get instant gratification from quickly healing someone. Some days I would love to work with someone for just one hour and then have their family sending me thank you cards. (Granted is a double edge sword as your also hearing from another group of patients lawyers).

In an ED, you can make a pretty big difference though. I love to walk into the agitated, psychotic, uncommunicative, or aggressive patients room and walk out with them calm, reassured, and willing to work with staff. It happens from time to time in my current setting. Another immediate benefit is when a patient says that they have never told anyone this before and trusts you enough to say it. From a medication perspective, I have seen quite a few dramatic shifts within a few days with severe depression, psychosis, or mania. Basically, the person goes from one day being obviously impaired and in severe distress and dysfunction to the next day being returned to fairly normal functioning. Sometimes it is so dramatic that it is almost creepy. These responses do tend to be the exception rather than the norm, but I don’t think they are that rare or unusual.

 

[Armadillos]

In an ED, you can make a pretty big difference though. I love to walk into the agitated, psychotic, uncommunicative, or aggressive patients room and walk out with them calm, reassured, and willing to work with staff. It happens from time to time in my current setting. Another immediate benefit is when a patient says that they have never told anyone this before and trusts you enough to say it. From a medication perspective, I have seen quite a few dramatic shifts within a few days with severe depression, psychosis, or mania. Basically, the person goes from one day being obviously impaired and in severe distress and dysfunction to the next day being returned to fairly normal functioning. Sometimes it is so dramatic that it is almost creepy. These responses do tend to be the exception rather than the norm, but I don’t think they are that rare or unusual.

Definitely true that we can improve symptoms quickly sometimes. I was referring more to how a surgeon has the potential to cut on you once and permanently fix whatever was wrong.

 

[DisorderedDoc417]

Definitely true that we can improve symptoms quickly sometimes. I was referring more to how a surgeon has the potential to cut on you once and permanently fix whatever was wrong.

Maybe in cholecystectomy, but even then they worry about the dreaded potential complications of the most common procedure. Chronic back pain and neurosurgeon? That patient has a lifetime of suffering ahead.

 

[MidwestMD2015]

I was in the same spot! I was thinking about different surgical subspecialties, in particular urology. What made the biggest difference for me was talking to people who knew me well. Having great mentors can be key. Here were a few of my thoughts:

1) The novelty of surgical procedures seemed likely to wear off for me, whereas the patients and work in psychiatry seemed like it would always be new and exciting.
2) In psychiatry, developing a deeper understanding of the arts and humanities (and any hobbies really) help you become better in your work and connection with patients. In surgery, those things would not necessarily lead to the same kind of professional enrichment.
3) The people who I saw with exciting careers and positions of leadership that I respected, and might even aspire to one day, were disproportionately psychiatrists. For example many medical school deans and leaders in academic medicine are psychiatrists, including the retiring President of the AAMC.
4) Anecdotally, it seemed that in my medical school, the community of people in psychiatry were warm, welcoming, supportive, and cared about you as a person. In surgery, there was collegiality and they were great people, but it did not feel as welcoming or supportive. My values were more in line with the folks I met in psychiatry.

Once I finally decided, and especially as I was on my interviews, it seemed almost surprising that I hadn't realized that psychiatry was the right fit for me all along. I'm lucky to have had great mentors. Talk to people in medicine who know you well; at the very least, they might be able to steer you toward experiences that will help clarify this for you!