Off-Topic: Why so little interest in Psychiatry?

[NLengr]

Come on; you can handle the routine work up for "CHEST PAIN" in your sleep. Or "SHORTNESS OF BREATH POST OP."

 

You can't do a psych interview with the same, "EKG, enzymes, CXR, I'll be there in 5 minutes." effectiveness. This is what I meant.

 

BS. That's the same kinda formulaic thinking that misses aortic dissections etc. Plus once you have the chest pain figured out, you have to treat it THAT NIGHT if it's something serious. Nobody is fixing depression or suicide ideation during the middle of the night.

 

By that same logic, I can bang out a really crappy psych consult no problem.

 

Also, as a clerk, it's hard to judge this kinda thing. You don't go and see the medicine or surgical patients who are difficult. You go see the easy stuff that you can handle and is at your level (aka the simple stuff). You aren't being sent to assess and stabilize patients who are hemodynamically unstable due to respiratory failure, or ischemic gut.

[goleafsgochris]

Come on; you can handle the routine work up for "CHEST PAIN" in your sleep. Or "SHORTNESS OF BREATH POST OP."

 

You can't do a psych interview with the same, "EKG, enzymes, CXR, I'll be there in 5 minutes." effectiveness. This is what I meant.

 

This is so dumb lol. You could say the same thing about many psych consults. In fact, I did psych call in med school, and if anything there are MANY psych consults that you can pretty much turn off your brain for. The same as in all specialties. Being inflammatory is not helping your credibility at all.

[leviathan]

This is so dumb lol. You could say the same thing about many psych consults. In fact, I did psych call in med school, and if anything there are MANY psych consults that you can pretty much turn off your brain for. The same as in all specialties. Being inflammatory is not helping your credibility at all.

I think what she was trying to say was psych problems are a lot more nebulous than an objectifiable internal medicine problem. Both specialties are challenging in their own ways.

[Jochi1543]

I think what Renin may have meant is that you have to be very engaged and a very good listener to provide good quality psych care. I know what she means when she says she feels emotionally drained from a routine half-hour psych appt - some of it comes from the sheer things you hear (people sharing their experiences being raped as children, for example) and some comes from having to listen very closely in order to identify certain thought patterns, recognize the reasons behind certain word choices, skillfully manipulate conversation in a productive manner without alienating the patient, etc. So being a GOOD shrink or mental health therapist is certainly very demanding. I know I could never do therapy all day long every day, it's incredibly taxing on you.

[Erk]

Just to weigh in, and having only read pages 1 and 7, I'm kind of intrigued by psych... but in the end, I feel as if the field is, in general, about where medicine was a hundred years ago. A lot of the causes of pathologies are just starting to come to the fore, and there are not very many effective treatments out yet. That may appeal to some, as it makes it a 'brave new world', but for me it means the frustration of finding out the treatment you were using was ineffective based on faulty reasoning and a misunderstanding of the underlying situation. Sure, it may not be your fault, but I don't think I could deal with that very often. Add to that that we don't even have very solid definitions on what constitutes a pathology, and it's a field fraught with moral dilemmas and horrible hindsight in my opinion.

 

I am really looking at jobs where I can use psych in a day to day setting, but not every day. I like the work enough to want to use it, but I'd hate it as a job.

[ploughboy]

Thread bump:

I would feel uncomfortable prescribing antipsychotics to someone that's in a state of delusional euphoria, if it's not a major debilitation in their lives or to their families. It's like taking the happiness out of someone's life

anyone on board?

 

Like everything, it depends. The last bipolar that I put on a Form 1 (a 72 hour detention for psychiatric assessment, for those of you not in Ontario) was a young attractive lady with known BAD who had been seen by my buddy about 12 hours earlier after she'd been brought in to the ED by the police for unusual behaviour. Based on his notes, and from talking to him later, she was hypomanic at the time but did not present an acute danger to herself or anybody else.

 

Flash forward 12 hours, when the cops brought her in again after she'd gotten naked in a busy public area on the edge of a sketchy part of town, while loudly proclaiming that she "loved everybody in the world and wanted to paaaarty!" (that quote went on to my Form 1). She was also clearly manic in other aspects of her presentation.

 

I seriously harshed her mellow by detaining her and having crisis psyche see her, and I'm sure they really took the happiness out of her life, but we quite possibly also saved her from being raped or killed. Would some gentle pharmacological intervention earlier in the day have prevented her extreme decompensation when in retrospect she was pretty clearly on the path to getting worse?? Maybe.

 

Paternalism isn't *always* bad.