Psychiatry as a profession and lifestyle?

[eastcoast]

Hi, interested in med students/psych residents/psychiatrists' view on practicing, benefits, pay scales, lifestyle, best areas of Canada to practice; really, anything you have found interesting while studying/practicing. I'm on the fence about psychiatry, because the material is interesting, but I'm afraid I would get bored not using a lot of clinical medical skills taught in medical school. Thanks for any information.

 

Edit: please don't reply with "this has been done before"; I've read the other posts, and I'm hoping for new/different information.

[Cnussey]

Then why not consider psychology if you are concerned with learning the medicine?

[eastcoast]

I think you misunderstand; I said I might be bored if I can't use the clinical skills taught in medical school (i.e., hands on diagnostic tests); my interest in medicine is what kept me from pursuing psychology.

[ELA]

If you think about it, psychiatry is the most clinical of all the specialties, your diagnosis is based 100% on what you can elicit on history and what you note on your mental status exam, no need for special blood tests or equiptment to tell you whats going on, unlike other specialities where you couldn't do your job with out them

[Cnussey]

I think you misunderstand; I said I might be bored if I can't use the clinical skills taught in medical school (i.e., hands on diagnostic tests); my interest in medicine is what kept me from pursuing psychology.

 

Ah, I see. It's the reversal.

[A-Stark]

If you think about it, psychiatry is the most clinical of all the specialties, your diagnosis is based 100% on what you can elicit on history and what you note on your mental status exam, no need for special blood tests or equiptment to tell you whats going on, unlike other specialities where you couldn't do your job with out them

 

Um, okay. It should be pointed out that psychiatric disorders are not diagnoses per se, but clinical syndromes defined by the detailed categorizations of the DSM-IV. I don't know though that this should be regarded as a strength or advantage - just the opposite, in fact, as certainty should derive from clinical judgement confirmed with ancillary information. Either way, most of any diagnosis comes from the Hx & Px.

[chemgirl]

You definitely have to be okay with uncertainty! We do diagnose people if you are going by the dictionary definition of the word, but some people like their medicine to be staring them in the face in the form of lab tests, psychiatry is okay diagnosing more fluidly based on symptomatology (although I see this evolving in the next 20 yrs or so to more imaging-based diagnosis as well-right now it is a question of cost and true need to do this). The diagnosis is not written in stone and is based on a multiaxial system (it will evolve as the patient does, so to speak), so we look at present symptoms and most likely diagnosis, past diagnoses, personality traits, social and medical contributing factors, and the degree to which the patients' functioning is affected.

 

I find it very rewarding. I won't miss doing physical exams. I always thought that was kind of odd... does someone going into ortho lament the fact that they won't be using their cardio exam skills? If you really want to do it, I don't think this will be a consideration.

 

I love many things about psychiatry. It is a challenge. If you are an impatient person it is not for you-some (most?) of your patients will be noncompliant with meds and suggestions. You will deal every day with the effect of stigma on others-which can be overt discrimination or as subtle as a patient's friend/family member convincing them that they don't need meds and nothing is wrong, even though time and again coming off of them leads to psychosis or mania.

 

Nobody wants a psychiatric diagnosis (except for people with certain personality disorders!) so you will spend a lot of time gaining the trust of your patients, and many will not give you that respect associated with being a physician that comes more easily in pretty much all the other specialties. So I think you have to be okay with that... it is a trivial thing, to me, but I know a lot of people who thrive off that sort of recognition. Thanks to media portrayal of psychiatrists that belongs more firmly in the 1960's than the 2010's, many people, even friends and family, will have strong opinions about what you do. I had a conversation with my sister yesterday where I realized she thought that I would lay people down on a couch, hypnotize them, and let them talk.

 

If you really enjoy history taking, you will not be bored. This is a specialty where you have a lot of time to elicit a history and really get to the nitty-gritty of the patient and where they are coming from. I think this alone makes psychiatry fascinating. If you work in the community, you will develop long term relationships with your patients lasting many years, which is rewarding. Keen observational skills are a must because some people will malinger and lie about their symptoms-either by downplaying them (I'm not that suicidal, but I have the gun loaded and ready to go) or exaggerating them.

 

Psychiatry is so diverse. I am having trouble deciding what I really want to do-child and adolescent, eating disorders, pre and post natal, general community, mood disorders, personality disorders, first break psychosis, addictions.... there is definitely more that I am missing. I don't have much experience myself, however the staff psychiatrists that I have spoken with in Alberta, BC, Manitoba and Ontario are very happy with their pay and lifestyle. In the city I am in, there are generalists who don't do any call past 10 pm. They are very happy with their lifestyle. The flexibility to make this career what you want hours-wise is very attractive. Pay is excellent in Alberta, but I can't speak for any other province.

[flying kumquat]

If you think about it, psychiatry is the most clinical of all the specialties, your diagnosis is based 100% on what you can elicit on history and what you note on your mental status exam, no need for special blood tests or equiptment to tell you whats going on, unlike other specialities where you couldn't do your job with out them

 

I disagree with this. Many diseases can present with psychiatric symptoms (e.g. brain tumours) and there are known physical complications of psychiatric diseases and medications (e.g. lithium). There is a reason psychiatrists need to have a background in medicine as opposed to learning the DSM-IV and nothing else.

[Who M.D.]

I disagree with this. Many diseases can present with psychiatric symptoms (e.g. brain tumours) and there are known physical complications of psychiatric diseases and medications (e.g. lithium). There is a reason psychiatrists need to have a background in medicine as opposed to learning the DSM-IV and nothing else.

 

I also note that clinical medicine, if done well, the diagnosis is mostly known before tests are ordered, and the tests are to confirm the diagnosis or to decide between 2 or 3 most likely ones. In psychiatry, you just don't do that confirmatory step, or you have to start treating not being completely sure between a couple of diagnoses.

 

The psychiatry residents I know are the happiest residents I know. I don't know anyone who regrets choosing psychiatry.

[hastin11]

Strange question--do psychiatrists still do physical exams on patients?

[Who M.D.]

Strange question--do psychiatrists still do physical exams on patients?

 

Rarely. They may examine for side-effects of psychiatric drugs being administered, to confirm that physical complaints suspected to be psychogenic in nature are in fact not true physical injuries, and to examine anything that may just catch the eye (e.g. examining a stuporous patient for signs of alcohol abuse).

 

As a matter of normal patient interaction, physical examination aren't done, and certainly a thorough physical exam is never done. This may be different in smaller centres though—I have no experience with that. In large centres, a patient is generally cleared of medical problems by another physician before psychiatry gets involved.

 

Something to bring up here: there are two fields of psychiatry where medicine is more important: consult liaison psychiatry and medical psychiatry. In the former, you consult on medical patients who also have psychiatric issues. You don't deal with the medial problems per se, but you need to understand them well in order to understand the patient's whole condition. In medical psychiatry, internists and psychiatrists jointly treat patients with co-morbid medical and psychiatric problems. Here knowledge and understanding of medicine is even more important, though once again, the psychiatrist is more concerned with the psychiatry. However both these fields would let you get more involved in the medicine and might allow you to do more physical exam, etc. (I don't know the details of how they work in practice).