Saturday, January 30, 2010

Kevin might want to know watcha thinkin' about.

Time is winding down on my psych rotation and it’s given me plenty of time to reflect on the experience. I think it’s safe to say most students do not go into medical school with a yearning desire to enter psychiatry, quite a shame really. This little odd niche of medicine has quite a lot to offer.

3 Reasons to enter psychiatry

1) The sweet life
It’s no secret that the work hours in psych are awesome. As a medical student I got into the hospital at around 8:30, rounded with the attending and resident (no prerounding) until 11:30, wrote my notes and done by 2pm at the latest. Hey, they don’t call it psychation for nothing. This sweet life style extends to the residents as well. They all come in at around 8 and are done by 4 or 5pm. And EVERYONE is happy. I think in all my other rotations, people are always bitching about something related to their work hours (and I haven’t had surgery yet). It’s really no wonder our friend Jess is seriously considering psych as his future career as a way to maximize the amount of time for his video games.

2) Helping the underserved

Everyone says this during their medical school interview, but if residency match is any indication, most don’t follow through. The patients seen on psych truly are the most in need. These are patients who are so sick that they do not even know they’re sick. Combined with inevitable social and financial losses, these are the neediest group of patients any clinician will see. If you truly believe in the schpiel you gave to the admissions committee, you should take a good hard look at psych.

3) Hilariously bizarre
Mental illness is weird, I mean really weird. When schizophrenics develop bizarre delusions, they can be so bizarre it boggles the mind. I had one patient explain to me that she can see people’s sin by staring into their eyes and that’s how she knows her stepfather was a murderer. Hilarious. Although it became significantly less hilarious when she ran into their house with a knife…

3 reasons not to go into psychiatry

1) You’ll forget everything you learned in medical school

I feel bad for saying this but psychiatrists really don’t know that much about medicine. When you become so specialized in psychological illness, you end up forgetting a lot about physiological illness. At my hospital, we had to consult medicine/derm/neuro/etc for every minor medical issue. Morning blood sugar 180? Stat med consult. Odd looking rash on hand? Holy shit we need to page derm. Maybe this isn’t such a big deal for the future psychiatrists but I would feel like I wasted 4 years of medical school learnin’ by going into psych. Going along those same lines, there are only about 15-20 drugs that are ever used in psychiatry. What’s more interesting is that they all seem to be able to treat everything. I got the feeling that regardless of what your patient has, you can just shout out a random psych drug and there’s a greater than 50% chance you’re right.

2) Holy ambiguity

Mental illness is ambiguous. After all, what separates someone who is truly sick from someone that’s just a bit of an oddball? Psychiatrists tend to refer to the DSM-IV as their holy grail of diagnosis but even then, there are a lot of patients who are right on the edge who end up getting treated anyways. What’s more hilarious is that they are allowed to write things like “Possible Axis II features.” For those who don’t know, Axis II refers to the range of personality disorders people can have that can be maladaptive. But when you just say “possible Axis II features” it’s so ambiguous that you’re essentially saying the person is a bit of a douchebag but you’re not sure why.

3) Nonmedical BS

Treating acute mental illness is only half the battle in most patients. I would say a huge majority of the time and effort spent on patients is in finding appropriate living situations for them after discharge. This involves a herculean effort between social work, PT, OT etc etc to find the right place to live and the necessary financial support. This ties directly into point #3 in the other section. If you love that stuff, psych is perfect for you. If you want to enter tertiary or perhaps quaternary care, worrying this stuff will make you want to end it all, and ironically maybe bring you right back to the psych ward.


Anonymous said...

I like to pretend there's a diagnosis called "Mental Illness NOS" for when the patient is just a you can't really figure out what the deal is.
You are totally right about social issues having a huge impact on the rest of psych treatment. And I will add, as a primary care NP who has a caseload full of mentally ill patients, that psychiatric issues are the #1 reason why patients can't get their physical illnesses under control. You can't treat one successfully without the other.

K said...

Totally agree. It's hard to treat your diabetes when you think you're an angel sent down by God who requires no insulin

Albinoblackbear said...

"But when you just say “possible Axis II features” it’s so ambiguous that you’re essentially saying the person is a bit of a douchebag but you’re not sure why."


Psychiatrists/psyche nurses never want to admit that someone might just be an asshole. Nothing more, nothing less. They're 'borderline with anti-social traits' instead. Bah.

I liked acute psyche a lot and it served me well when I started working as an emerg nurse. Don't think I could do it for a career though.

liang said...

I just finished psych, too. Did you not feel like you were spending a lot of time arguing with patients, though? They all want to be discharged, and every time my attending set foot on the unit she was literally followed by at least 3 to 5 patients asking her the same questions about when they can go home. Tiring, much?
Also, psych is unique in that the DSM diagnoses are not traditional dx in the way that they're based on pathophysiology. All psych diagnoses are syndromes. As such, they don't even necessarily reflect common disease processes in different patients with the same dx. I think that's a mistake that almost everyone makes, thinking that "bipolar IS bipolar." Most of the time, the diagnosis is history-driven, and certain subjective evaluations of a person's behavior. So, one person's bipolar is another's major depressive disorder with psychotic features. I think that if you go into psych, you can't be so diagnosis-driven, because the DSM is a tool to summarize findings and predict outcomes. It's not a true label about any "real" disease.

limarzgm said...

My favorite/most ridiculous example of forgetting everything from med school was getting a med consult for a runny nose. Prescription? Flonase. Also the consult to figure out why the patient on two diuretics was slightly hypokalemic.

After psych, I feel like it's a field that is extremely interesting on paper. Psych case studies can be greatly entertaining, but when you actually have to deal with the nitty-gritty management of these patients it loses a lot of its allure. For me at least. I mean, getting saluted by a schizophrenic once in a while is great, but when you can't go down the hall without engaging in some bizarre ritual it starts to grate on the nerves.

That's why I want to look at pictures of people's insides.

liang said...

dude, you got maaaaad blitzed with the spam.

Jackie Savi-Cannon said...

You are in a time of your life that you are able to be able to help others.
Having been a psyc nurse it is not anyway.
Paranoia and far fetched ideas that are not real..
but to those suffering are devastating..
How about the patients family ..

K said...

Hey K..(I go by the same initial in the blogosphere!)...nice blog!

"I had one patient explain to me that she can see people’s sin by staring into their eyes and that’s how she knows her stepfather was a murderer."

I had to comment on this, because although schizophrenics are undeniable wackjobs, don't you find it creepy that some of the things they say actually have a kernel of truth? If you look at mug shots of convicted serial killers and other sociopaths, there *is* something strange and perhaps soul-less about their eyes. So maybe that patient had the right instints, but just could not act on them in a socially appropriate way. (Yes, murdering people is so socially inept, lol)

My point is, (through anecdotal evidence alone), I've observed that schizophrenics can be acutely perceptive of their surroundings.

Old MD Girl said...

Well, I loved my psych rotation. The hours were great, the people were nice, mental illness is fascinating, and you actually make people feel better if not permanently, at least over the short run.

That being said, forgetting all of medicine would be a hard pill to swallow. That and no other doctor takes you seriously.

Still, there are some definite pros. It's still on my list.

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