Robin Hood Posted July 5, 2011 Report Share Posted July 5, 2011 +1 well said Welcome back! Link to comment Share on other sites More sharing options...
apache Posted July 5, 2011 Report Share Posted July 5, 2011 ditto, friend Welcome back! Link to comment Share on other sites More sharing options...
A-Stark Posted July 6, 2011 Report Share Posted July 6, 2011 this comes back to one of the big things i hate about pre-med, it's almost impossible to get experience in the medical field until you're in medical school. my only experience was in psych, so i knew i wanted that, but realized in med it wasn't worth all the bs i didn't care about (why does a psychiatrist have to do a clerkship in surgery, seriously? i've worked with innumerable psychiatrists and the majority know the cursory basics of medicine insofar as it allows them to safely practice psychiatric medicine) just to get to that end. I think it's lamentable that psychiatrists in particular seem to prefer to avoid "medical" issues, "hanging up" their stethoscopes after R1 and the like. The MD provides generalist training and knowledge and - crucially - the prescription pad. Considering that psychoactive drugs can cause serious permanent side effects and life-threatening reactions or consequences in overdose, I think it is eminently reasonable and appropriate that they be familiar with the relevant pharmacology and - in at least a cursory sense - common medical conditions and side effects. And, really, having to do a month or two of surgery clerkship rotations is NOT the onerous thing you seem to think it is. Yes, there are some long hours and you might be pretty tired, but it's a pretty short time in your life and education. Conversely, I'd say that anyone planning on NOT going into psych will still get a lot out of their psych rotations - I know I did. (I admit I'm curious why you're thinking of dentistry of all things rather than, say, clinical psych - and it is Doctor of Dental Surgery to be sure.) Link to comment Share on other sites More sharing options...
apache Posted July 6, 2011 Report Share Posted July 6, 2011 Hey, I never implied it was onerous, but I don't think psychiatry should fall under the auspices of medical training. I believe that people wishing to go into psychiatry (or, biological clinical psychology) should, like some dentistry students, receive the same pre-clinical education as medical students, and then branch off to pursue four-six years of biologically responsible psychology training which addresses medical issues relevant to psychiatric practice (i.e. thyroid issues, other endocrinological issues, diabetes, pharmacology and potential interactions) just as a dentist or general practitioner has sufficient understanding of medical issues to know when to consult a specialist regarding a potential issue. I also feel that this would allow students to develop more psychologically oriented skills in addition to medical skills they pick up. I really enjoy clinical psychology and psychiatry, but I realized that my primary coping style with dealing with people with extreme mental illness is superficial empathy and internal detachment that carries on in my everyday life, something I find undesirable (I found out a friend committed suicide and I didn't really feel anything, a few years ago I would have been mortified, but I've just become habituated to the process, and I don't like being that way). I still haven't closed of the door to doing an MA in counselling after I'm done dentistry and working half time at each as an associate but after a lifetime of dealing with the mentally ill I'm not sure I'm comfortable with my adaptive strategies. I never quite had an idea of what dentists do until I got a chance to shadow in their office, and I actually found it to be really kind of neat. Contrary to popular belief I actually enjoy medicine, including surgery etc. I just don't like the lifestyles and world-views seen in certain specialties that I would otherwise find desirable . I think it's lamentable that psychiatrists in particular seem to prefer to avoid "medical" issues, "hanging up" their stethoscopes after R1 and the like. The MD provides generalist training and knowledge and - crucially - the prescription pad. Considering that psychoactive drugs can cause serious permanent side effects and life-threatening reactions or consequences in overdose, I think it is eminently reasonable and appropriate that they be familiar with the relevant pharmacology and - in at least a cursory sense - common medical conditions and side effects. (I admit I'm curious why you're thinking of dentistry of all things rather than, say, clinical psych - and it is Doctor of Dental Surgery to be sure.) Link to comment Share on other sites More sharing options...
A-Stark Posted July 6, 2011 Report Share Posted July 6, 2011 I never implied it was onerous, but I don't think psychiatry should fall under the auspices of medical training. I believe that people wishing to go into psychiatry (or, biological clinical psychology) should, like some dentistry students, receive the same pre-clinical education as medical students, and then branch off to pursue four-six years of biologically responsible psychology training which addresses medical issues relevant to psychiatric practice (i.e. thyroid issues, other endocrinological issues, diabetes, pharmacology and potential interactions) just as a dentist or general practitioner has sufficient understanding of medical issues to know when to consult a specialist regarding a potential issue. I also feel that this would allow students to develop more psychologically oriented skills in addition to medical skills they pick up. In other words they should do a medicine clerkship including internal medicine, pediatrics, family medicine, emergency medicine, and - since they must know indications in a general sense - surgery (and throw in obs/gyn I suppose too). After core rotations they'd be free to do any additional electives in psych or related areas. So.... I'm not sure what you're looking to change here. "Psychologically-oriented" skills can be developed in residency, clerkship, and pre-clerkship communications skills sessions (to take one example). You don't get the (mostly) unrestricted Rx pad without the MD. I really enjoy clinical psychology and psychiatry, but I realized that my primary coping style with dealing with people with extreme mental illness is superficial empathy and internal detachment that carries on in my everyday life, something I find undesirable (I found out a friend committed suicide and I didn't really feel anything, a few years ago I would have been mortified, but I've just become habituated to the process, and I don't like being that way). I still haven't closed of the door to doing an MA in counselling after I'm done dentistry and working half time at each as an associate but after a lifetime of dealing with the mentally ill I'm not sure I'm comfortable with my adaptive strategies. I don't really know what to say to that. But there's something to be said for not overdetermining your own self-analysis. Anyway, I guess the key thing is finding your own way. I never quite had an idea of what dentists do until I got a chance to shadow in their office, and I actually found it to be really kind of neat. Contrary to popular belief I actually enjoy medicine, including surgery etc. I just don't like the lifestyles and world-views seen in certain specialties that I would otherwise find desirable . But you do like psych, right? (family?) Fortunately clerkship only provides small tastes of the lifestyles of different specialties, and you needn't absorb the world-views of every rotation. I certainly won't be doing psych... Link to comment Share on other sites More sharing options...
apache Posted July 6, 2011 Report Share Posted July 6, 2011 I favour a psychologist-prescriber model as seen in new mexico/us military with pre-clinical education medical education. Psychologically oriented skills aren't emphasized in many psychiatric residencies, if your really want to master ipt, cbt, mindfulness meditation, behavioural therapy, humanistic reflective approaches, dbt, depth psychology, positive psychology, social psychological and sociological effects on mental disturbances, somatic therapy (breathing techniques etc.), existential therapy, gestalt therapy, radical deconstructive therapy... you have to realize that the medical model of mental illness and it's subsequent heavy objectification is a protectionist model crafted in the 70's when psychiatrists after the famous thud experiment showed that psychiatrists were no more astute at delineating the mentally from sane. In order to maintain the status of a profession you need specialized knowledge (i.e. of the law, cardiac disease etc.) which is why the dsm became highly objectified, to take the person out of the interpretation, the only problem is, objective criterion are still interpreted subjectively by the reader, any one who has taken any hermeneutics or read any wittgenstein knows this. So I'm afraid that the inclusion of psychiatry within medical practice may be more for economic benefit of those in the profession than for best practices and patient results as extensive medical training creates a lens in which you see syndromes, which are really most just deviations from social norms, and implicitly pathologize them as disorders on the same level as a surgical problem, which has high inter-rater reliability, construct validity, and productivity of outcomes (or behaviour in psychiatry) relatively. When your mainly prescribing: Benzodiazepines (Clonazepam, Lorazepam, Alprazolam, Oxazepam Temazepam, Diazepam etc.) Anti-Convulsants (Lamotrogine, Valproic Acid) Z-Drugs (Zopiclone et al.) Naltrexone for Opiate Dependence, Methadone Atypicals and Typical Anti Psychs Lithium Modafinil Stimulants (Dexedrine, Adderall Salt Combinations, Methylphenidate, Methamphetamine, ER versions of methylphenidate like Concerta etc.) SNRI's, MAOI's, SNRI/SSRI combos (Effexor) NMDA antagonists (Memantine off label) Clonidine in conjunction with ADHD medication for behavioural management B-blockers for situational visceral anxiety. There's no excuse not to know every bit inside and out of these drugs, all possible medical interactions that could occur and all the pertinent conditions that could occur. But this doesn't require the extensive medical training we give people who want to pursue psychiatry/biologically-oriented psychology. Your training should be sufficient to interpret all relevant investigations sent to you by the persons attending physicians (lab work, ekg's for prescribing stimulants etc.) but i believe a lot of the "tradesman-like work" examining eye's, ears, doing a full physical neuro workup when you can just as easily interpret a report is unecessary as it takes away from the time needed to develop psychological skills which are just as important, if not more important than peripheral medical expertise that is not relevant to mental health issues (thyroid) or possible interactions with medications psychiatrists typically prescribe. In other words they should do a medicine clerkship including internal medicine, pediatrics, family medicine, emergency medicine, and - since they must know indications in a general sense - surgery (and throw in obs/gyn I suppose too). After core rotations they'd be free to do any additional electives in psych or related areas. So.... I'm not sure what you're looking to change here. "Psychologically-oriented" skills can be developed in residency, clerkship, and pre-clerkship communications skills sessions (to take one example). You don't get the (mostly) unrestricted Rx pad without the MD. Link to comment Share on other sites More sharing options...
anxious_101 Posted July 10, 2011 Report Share Posted July 10, 2011 It's a meaningful career with both personal and interpersonal rewards. It's also a financially stable career - no need to hide this second point. In fact, the vast majority of my friends, and myself, that went into medicine would admit the importance of the financial stability in choosing medicine. It's taboo to bring it up in interviews of course, but it is the truth. For most people that gun for medicine, you're kidding yourself if you think money didn't matter. Of course, there are certainly people who genuinely go in to medicine for the altruistic/admirable reasons. Perhaps an interesting poll would be how many people would still pursue the long road to practicing medicine if the pay scales were similar to that of a high school teacher. Link to comment Share on other sites More sharing options...
Mithril Posted July 10, 2011 Report Share Posted July 10, 2011 Perhaps an interesting poll would be how many people would still pursue the long road to practicing medicine if the pay scales were similar to that of a high school teacher.I wouldn't. 7-8 years of post-secondary followed by another 3+ years of residency. Are you kidding me? Anyone going into medicine for truly altruistic purposes are deluding themselves. There are a multitude of factors for my going into medicine with the pay and being able to pay off debt being two of them. Call me selfish if you want but I'm more of a pragmatic person than an idealistic one. A physician's job is just that: a job. The pay for the amount of work and schooling physicians have to do has to be justifiable. Link to comment Share on other sites More sharing options...
bumbaclot Posted August 17, 2011 Report Share Posted August 17, 2011 Well, i actually wanted to be a doctor up until I actually learned more about the process. Seriously, you have to pretty much give up your life from what i've read. Lets see: 4 years of undergrad - you're 22. (Not to mention, you have to pretty much spend all your free time doing EC's to be competitive) 4 years of medical school - you're 26 or older if you apply late. (Gruelling curriculum where you have to basically study all day unless you're a natural born genius. Ive also read that the last 2 years are killer) and then the medical school acts like its doing YOU a favour(lol) You finally graduate but you still arent even considered a physician. 3-6 years of residency. You're 29-32. ($hit pay with $hittier work hours. From what ive read: upwards of 75 hours/week[WTF?] and a little over $40g-$50gs a year[WTF?!]). Once you do become a full blown physician, you still have killer work hours but at least the pay is decent. (Dont forget all that debt you accumulated.) You also have to pretty much study the rest of your life to stay up to date I just dont see how anyone can go through with this. I mean, you have to REALLY REALLY feel the need to help others. I never expected it to be a walk in the park but i didnt think it was this retarded. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 17, 2011 Report Share Posted August 17, 2011 dnftt. 10char Link to comment Share on other sites More sharing options...
bumbaclot Posted August 17, 2011 Report Share Posted August 17, 2011 dnftt.10char huh? 10dwarfs Link to comment Share on other sites More sharing options...
SpicyNoodles Posted August 17, 2011 Report Share Posted August 17, 2011 Yes, the information you have there is pretty accurate. But if you still want to pursue a career in medicine despite all of that, maybe you're in it for the right reasons. It also helps to weed out the people who are in it for the wrong reasons? Link to comment Share on other sites More sharing options...
Leon Posted August 17, 2011 Report Share Posted August 17, 2011 4 years of undergrad - you're 22. (Not to mention, you have to pretty much spend all your free time doing EC's to be competitive) Or you might just happen to enjoy those ECs rather than padding your resume I just dont see how anyone can go through with this. I mean, you have to REALLY REALLY feel the need to help others. There's also the fact that, you know, some people might just enjoy studying about the biology of the body and keeping up to date on new medical advances rather than seeing it as a chore Link to comment Share on other sites More sharing options...
Leon Posted August 17, 2011 Report Share Posted August 17, 2011 Also: 1) Don't bold an entire post. It defeats the purpose of bolding 2) Don't edit an original post once a thread is progressing as it misleads and derails people reading the thread. Cheers Link to comment Share on other sites More sharing options...
Clever Posted August 17, 2011 Report Share Posted August 17, 2011 huh?10dwarfs dnftt = do not feed the troll But you are entitled to an opinion. Advice: Do dent Link to comment Share on other sites More sharing options...
thehumanmacbook Posted August 17, 2011 Report Share Posted August 17, 2011 Hmmmm, information is pretty accurate. Don't forget that if you didn't get in during your fourth year or you're entering at a non-trad age, your timeline shifts right as well. Like Spicy says, you really have to be in it for the right reasons - but there are advantages as well. Job security is one of them, and the pay isn't bad compared to the median line (in fact, many would argue that doctors make SO much more than anyone else...depends on what speciality and where you work, really). Striving to make a difference in the lives of others, especially in times of illness, can be its own non-monetary reward. Link to comment Share on other sites More sharing options...
phosgenic Posted August 17, 2011 Report Share Posted August 17, 2011 I don't think he's a troll. I think he's voicing the thoughts that a lot of premeds try to mindlessly and/or senselessly throw dirt on as they embark upon their ambitions to become a doctor only to waste 4, 8, 10 years, maybe their entire lives doing something they don't enjoy out of a distorted perception of the field, a misguided sense of propriety, pressure from parents, friends, self, unscrupulous(perhaps a little strong, using the word loosely) reasons such as prestige, money,etc... Though the flavor of his delivery is unseemly, I appreciate his candidness in raising this touchy issue and hope that those with knowledge in this area will be able to respond with constructive and insightful answers. Link to comment Share on other sites More sharing options...
phosgenic Posted August 17, 2011 Report Share Posted August 17, 2011 Another question I would like to graft onto the thread would be what else would you rather do? I mean, for me, doctors have all of the power... everyone else is duking it out for scraps while docs are basically the king cocks of the medical community... I dunno. I'll probably pose that question, in greater detail, in a fresh thread sometime down the road. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 17, 2011 Report Share Posted August 17, 2011 Well, ok. I think the above posters summed it quite well. If you enjoy your work and find meaning in it, then it's not "giving up your life," it's living it in a purposeful and meaningful way. So what if you're in your late 20s as a resident? Life isn't a race to the end. Everyone I've met in medicine seems to enjoy learning for its own sake, so if lifelong learning is unappealing to you, medicine may not be the right field. To sum up, it's about *intrinsic* motivation - this is what will carry you through. Link to comment Share on other sites More sharing options...
Illuminant Posted August 17, 2011 Report Share Posted August 17, 2011 What if the speciality you get after all that time of suffering is something you enjoy to do every single day .. do we know whether a specific speciality is in our interest or not .. no .. that's why you should make an assumption about whether you will like it, then try it. In order to get to this stage .. you need 4 yrs UG .. MCAT .. 4yrs Med .. the process is annoying and lengthy indeed but there could be a rewarding outcome out of it IF you end up enjoying the speciality Link to comment Share on other sites More sharing options...
thehumanmacbook Posted August 17, 2011 Report Share Posted August 17, 2011 What if the speciality you get after all that time of suffering is something you enjoy to do every single day .. do we know whether a specific speciality is in our interest or not .. no .. that's why you should make an assumption about whether you will like it, then try it. In order to get to this stage .. you need 4 yrs UG .. MCAT .. 4yrs Med .. the process is annoying and lengthy indeed but there could be a rewarding outcome out of it IF you end up enjoying the speciality Yes well...that's why there are electives and rotations in clerkship. Hopefully that gives the candidate some expectations and hands-on experience in the field - so that their CARMs choice will be one that they enjoy. Whether or not the system works (CARMs) is another debate. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 17, 2011 Report Share Posted August 17, 2011 Actually, I would suggest that you try to research medicine and alternative careers as early as possible. Although it's true that you can't truly appreciate something until you have experienced it yourself, nevertheless there is good information out there to be gained by reading, talking to people, work experience, introspection, etc. that will give you insight as to your suitability for a particular field. In turn, this will either provide you with additional motivation to pursue medicine and strengthen your application, or otherwise alert you to more suitable alternatives early on. It would be rather unfortunate to go through the scenario you suggested based on assumptions only! Link to comment Share on other sites More sharing options...
thehumanmacbook Posted August 17, 2011 Report Share Posted August 17, 2011 Another question I would like to graft onto the thread would be what else would you rather do? I mean, for me, doctors have all of the power... everyone else is duking it out for scraps while docs are basically the king cocks of the medical community... I dunno. I'll probably pose that question, in greater detail, in a fresh thread sometime down the road. They don't. Real hospital finances, pharmaceuticals, and Ministry of Health have more "power" - or specifically, the greater ability to generate and propose new policies and funding allocations than primary care physicians or surgeons. They are not the "king cocks" of anything - their role is essential and focused in terms of service provision rather than that of policy or finance. Of course the feedback from physicians are essential, but their opinion or decisions alone don't ultimately decide anything in terms of policy and politics. Link to comment Share on other sites More sharing options...
xkittens Posted August 17, 2011 Report Share Posted August 17, 2011 With a lot of senior doctors it becomes very clear what their intentions were when they decided to go to med school. There are the impatient jerks that you can tell hate their jobs, I think those are the ones that became doctors for the money, prestige, power and so on. Then there are those that clearly enjoy what they do and made the right decision by going to med school. If someone decides to choose money and power over their own happiness then they're gonna pay for it for the rest of their lives, maybe that's why physician suicide rates are so high. Link to comment Share on other sites More sharing options...
apache Posted August 17, 2011 Report Share Posted August 17, 2011 i'm not trolling and actually agree from my perspective... i could have done clinical psych and been paid 30 g a year to go to school and make similar money to fam docs with about 6 years for the phd and no debt... it just depends on the person Well, i actually wanted to be a doctor up until I actually learned more about the process. Seriously, you have to pretty much give up your life from what i've read. Lets see: 4 years of undergrad - you're 22. (Not to mention, you have to pretty much spend all your free time doing EC's to be competitive) 4 years of medical school - you're 26 or older if you apply late. (Gruelling curriculum where you have to basically study all day unless you're a natural born genius. Ive also read that the last 2 years are killer) and then the medical school acts like its doing YOU a favour(lol) You finally graduate but you still arent even considered a physician. 3-6 years of residency. You're 29-32. ($hit pay with $hittier work hours. From what ive read: upwards of 75 hours/week[WTF?] and a little over $40g-$50gs a year[WTF?!]). Once you do become a full blown physician, you still have killer work hours but at least the pay is decent. (Dont forget all that debt you accumulated.) You also have to pretty much study the rest of your life to stay up to date I just dont see how anyone can go through with this. I mean, you have to REALLY REALLY feel the need to help others. I never expected it to be a walk in the park but i didnt think it was this retarded. Link to comment Share on other sites More sharing options...
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