Wife supportive, but a little nervous about psych

[RaistlinMajere]

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Hi all,

I'm sure there are similar threads on this, but searched and couldn't find them.

I'm an MS3 whose excited about going into psychiatry. My wife is on board with this decision and in general is very supportive. She does have two reservations which are:

1) that I'm putting myself more in harms way by choosing psych over IM, ED or neuro. I'm not sure that this is even true compared to these other specialties. And there's probably no real data to support it either way, but I'm curious to hear any opinions you might have.

2) I enjoy hearing patient's stories, but she is worried that most of these stories are "sad." I know that I can handle this aspect of psych. I enjoy helping people with sad stories to turn them into more positive ones. And I'm able to compartmentalize my work versus family life. Plus, I bet I'd improve my coping skill in residency with practice and training. My wife is concerned that my work might spill over to her where she does not have the training.

I'm still going into psych and she overall is very supportive. How best can I put her at ease regarding these fears?

 

[Thewonderer]

That's a tough one. I mean, going to psych in no different than becoming a fireman, police man, etc. It is simply a career choice. It is not that you are becoming a plumber (nothing wrong with being a plumber though) 😉

But more seriously, I don't have any stats on psychiatrists being attacked v.s. other specialties. But these psych pts are seen by other specialists too. In a psych setting, pts are more contained. I would rather see these folks in psych rather than in emergency medicine setting where needles, etc. are lying around. And most other docs, esp primary care, have no concept of how to keep themselves safe.

However, imagine that you are a psychotic pt. You are paranoid that the FBI or aliens are coming after you. The first thing you think about is running away from everyone including the doc. You are more concerned about that than attacking the doc. In addition, I believe that most attacks probably happen due to 1) pts are under the influence of drugs and 2) these pts are antisocial. Remember that being antisocial is NOT mutally exclusive with being bipolar, being schiozophrenic, being depressed, etc. I am actually more worried about pts under the influence of GHB, cocaine, speed rather than a true schizophrenic pt.

I am sure that some of the press is out there due to these folks being "psych" pts. I am no doubt that internists, emergency room docs, etc. are attacked by pts periodically, esp. considering the lack of boundaries some of these docs exhibit.

There are incidents of resident physicians being punched. But for the most parts, docs don't deal with restraints. Docs do the orders and nurses and nurse tech's carry them out. When things escalate, you just stand behind the nurses. There are attendings who have been practicing for 20+ years, and they have never been touched. So it is a matter of being alert and if something doesn't feel right on the back of the neck, just jet out the room and do the interview later.

The bottomline is that becoming a psychiatrist is simply a career choice. It is nothing more, nothing less. Learning to do psychotherapy and family/couple's therapy, also makes you more in tune with human emotions and interactions. You can sell that to your wife!

 

[Solideliquid]

I had similar questions before starting as a PGY I.


1. Well, the short answer is yes, you can say that there is an increase in risk of personal injury on a psych ward. The patients that are usually admitted may be hallucinating, demented, and as a result very frightened and reacting to internal signals/stimuli. That being said, I have never been assaulted personally, but several of our nurses have been punched in the face, a patient hit another patient in the head with a chair in the dining room, etc. A medical student was also punched in the face sometime last year. These are the major headlines I've heard from staff for the academic year of 2007-2008 so far.

Let me say that if you "learn to mind your surroundings" (which move is this from ? LOL) and keep your wits about you, there's a good chance you won't have to fill out an incident report while you are in residency. However sometimes things happen that are out of our control, you will always have ready staff and security how are ready to help and defuse these violent situations. That being said a psychotic patient is usually watched carefully by staff in order to minimize these occurances. The other portion of the patients can be admitted for substance abuse, suicidal thoughts/depression etc and these pose less of a risk.

You should consider that there are risks involved in IM, ED as well. You are more exposed to bodily fluids and as such at higher risk of becoming infected with HIV, HBV, pneumonia, TB, etc. I'd rather get punched out (and get some sick time in the bargain lol) than HIV any day of the year! Don't forget that the majority of violent patients FIRST arrive and are the problem of the ED before they are stabilized and transported to psychiatry so the majority of the risk is in the ED I think.

2. Sad stories are a part of medicine. Sad stories can be found in virtually every patient room of the hospital. Don't you think the 45 year old non-smoker dying of lung cancer with a wife and four young kids is a downer for the medicine team? How about the woman with twins who doesn't survive the delivery? This isn't exclusive to psychiatry.

 

[billypilgrim37]

2) I enjoy hearing patient's stories, but she is worried that most of these stories are "sad."

Threaten to do pediatric oncology, and then go kick a few puppies. Psych will seem suddenly bright and cheery. 😉

 

[michaelrack]

I agree with the previous posters regarding physical danger: It is dangerous to be a pscychiatric nurse, but not too bad for psychiatrists. I would estimate that there is more risk to being an ER physician. I formerly practiced general Internal medicine and have stuck myself with a needle several times. I have never been injured as a psychiatrist.
As a psych resident on the wards, you'll learn to quickly get away from the situation if the patient starts escalating, and let the nurses handle it.

 

[Faebinder]

Seriously, what is not dangerous in medicine? You can't run from danger in medicine. HIV needle (happens in surgery all the time), TB coughing ICU patient, psychotic patients, angry not-so-desperate housewives, radiation from xrays and nuclear scans?

 

[RaistlinMajere]

Thank you all for your advice. I'm sure over time she will grow more comfortable with my chosen profession, but it's nice to get more insight on this topic.

 

[xanthines]

On the subject of danger, as very well-known forensic psychiatrist told me that pyschiatrists are more likely to be stalked by by their patients than an other specialty. However, he also told me that plastic surgeons are more likely to be killed by their patients than any other specialty. 😱 Not sure if that's commentary on the docs or the patients! 🙂

Just sayin'...

-X

 

[Faebinder]

On the bright side, buying a kevlar vest as a psychiatrist is probably tax deductable... as it is part of the equipment used for work. 😉

Oooooh.... i wonder if you can claim the house alarm and car alarm as part of the security bill necessary for work as a psychiatrist? Use that fact that you are most likely to get stalked as an excuse if you get audited. hehe.

 

[futuredo32]

Interestingly enough, they're discussing the dangers of EM in that forum.http://forums.studentdoctor.net/showthread.php?p=6311237#post6311237
I'm just a student, but I agree with others who have said that there are dangers in any medical specialty.

 

[U4iA]

in my psych rotation they made a big point of how emergency medicine is so much more dangerous than psych. it kinda makes sense because any psych patient that is unstable is typically treated and stabilized in the ER before coming to the inpatient psych unit.

 

[whopper]

If I missed someone covering this area, I apologize in advance..

I enjoy hearing patient's stories, but she is worried that most of these stories are "sad."

Every field of medicine has sad cases. Telling someone they have metastasized cancer, telling a family a loved one will most likely die, have permanent brain damage etc. Of course psyche differs in the sense that we need to listen to people's stories, but that if anything should make our job more fulfilling.

Once you have done your psyche rotation you will get a very good idea if you can handle the listening aspects of psychiatry--where you have to listen to others. In fact, every field of medicine should have doctors listening to their patients, just that I guess in the other fields, they got so many other things to worry about they don't do it as much.