You are getting a long winded response from me... but you asked so I figured I'd keep responding with some more peeves of psych residency!
Or, depending on the oncologist, they will continue to offer the patient more and more clinical trials to enroll in and experimental chemo regimens to try without ever telling the patient that they have terminal cancer, leaving it to the on call intern cross-covering the patient at 3 am to explain to the family how it's possible that their mother who just started JQ3-33R4093 last week is actively dying.
Yeah, of course. That must be very difficult. I feel like this level of not-telling-the-patient-and-family-the-truth extends across medicine. We do it in psychiatry when we give people bogus diagnoses, such as when we put down "bipolar" for the borderline patient and then run them through the gamut of mood stabilizers which surpringsingly turn out not to work. I'm sure it's irritating no matter what field you're in.
I wonder what the irritations are for residents in surgery, radiology, etc. I'm not just talking about the obvious things like "surgeons work long hours" and "radiologists don't see patients" and "peds have to deal with the families" but the real annoyances at various stages in the professions. For example it doesn't bother me that "people don't consider psychiatrists real doctors" or "I'm not allowed to manage hypertension" (I'd probably get bored managing HTN even if I was in IM)--although I do mind that most psychiatric diagnosis are not very challenging to make, and there's only like 4 of them total in the world that you see daily and probably 7 others to round things out. These are not obscure endocrinological disorders we are dealing with. (Although I will say that when I've gone to case conferences with experts on personality disorders, they are amazing at identifying subtle pathology in a way that the DSM does not do justice to, which makes psych much more interesting!)
Back to my complaint about the lack of diagnostic complexity--even when uncertainty is justified it is not even particularly interesting, because it's almost always something that overlaps with mania or anxiety--i.e. activated catatonia (or whatever that term is) or pschomotor activated depression. If you ARE debating about a diagnosis in psychiatry, it's the SAME debate you had last week about a different patient. The differential diagnoses in psychiatry is hopelessly small, I'm afraid to say. The one in books is very exciting--you have Charles Bonnet, Capgras Syndrome and all, but that never, ever, ever happens in the real life of a resident. Again, psych patients are poor historians plagued by comorbidities and no one ever walks in clearly endorsing textbook symptoms of a rare or discreet psych disease. It seems to me that essentially we end up treating symptoms (of which I can only think of four that we really even treat: depression, mania, psychosis, anxiety; unless you count EPS sx) and often leave it at that. (However there's also delirium/dementia, which is a different game. Those are not boring. I am also not including child psych.)
I do think that things appear to get better after first year, when we can do consults, and when there are options like child psych and when outpatient therapy training begins.
I can't forget to make my biggest complaint of all about psychiatry--the use of subjective, seemingly (to me) pointless suicide risk assessment checklists which from what I can tell do nothing but lessen the anxiety of psychiatrists that they will get sued when their patient they d/c'd from the ER goes out and kills themselves. For example, I am required to ask all my patients whether they have a gun at home (and because nobody will intelligently tell me when or why or whom to ask, I ask them all, including the stretcher-bound demented elderly). It's dumbed down to the point of insanity! Because even if the patient doesn't have a gun, they could easily go out and buy one in my state. I have also never seen a clinical decision be made based on this question. I'm not saying this question should NEVER be asked, just that requiring it be checked off on a boilerplate form is one of the irritations of psychiatry. It's totally obvious that there are legal (as opposed to statistically proven scientific) powers operating behind these forms, and also I think it stems from a desire to create "objectivity" out of our inherently not-objective specialty. I guess this is our version of defensive medicine, but it is very irritating. The notes I write for medicine are so much shorter and less bogged down with checklists.
Oh, and while I'm at it, one-size-fits all approaches to pain medication and sleep medications... I.e. no on one on the psych floor can get ambien...
One thing I will say for psych is that psychopharmacology is very interesting to learn. Our meds are pretty intimidating and daunting to the uninitiated, and it's gratifying to learn about them. So is treating EPS, NMS; and delirium and dementia are interesting.
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