Thursday, February 15, 2007
Who Wants to be a Psychiatrist?
[begun by dinah]
There are lots of wonderful things about being a psychiatrist.
Is this a good way to start a post? Seriously, there are. The med school stereotype includes real downers, and not that many docs go into psychiatry: All psychiatrists are crazy (I would say Most psychiatrists are perhaps a little odd, present company excepted, but what's the thrill of being "normal"?). Psychiatric patients don't get better. This is just wrong: they do get better and many are effusive with their appreciation. Psychiatrists don't get paid well. Umm, compared to the neurosurgeon who gets thousands for an operation, that's true. Okay, shrinks are at the bottom of the doctor pay-pole, but money isn't everything.
So this is what's great about psychiatry: the field is huge. One can become a psychoanalyst, never touch a patient, never prescribe a medication (still? not sure, I'm not a psychoanlyst and only know a handful), see patients 4 or 5 times a week (rich ones) to get to the bottom of their defended conflicts: this is all Art and No Science. One can see patients in a multitude of settings ranging from prison to public clinics to private offices, inpatient, outpatient, partially hospitalized, college health clinics, emergency rooms, psych hospitals, general hospitals, or everyone's favorite: hospitals for the criminally insane-- okay, okay, ClinkShrink says I have to call it a secure forensic facility. One can become an an administrator and never deal with a live patient. Or an academic researcher and write grants, run clinical trials on patients, or study neurotransmitters and receptors and also have little to do with whole people--this is all Science and a little Art. There's room as a psychiatrist for a second life: parent, novelist, fine artist, even blogger. I suppose that's true of other medical specialties as well, but psychiatry tends to attract (some) folks who are interested in the introspective, the artistic side of life and its creative outlets. Am I right? No clue.
I write a lot about doing psychotherapy. It's not all I do, I write a fair number of scripts and I've always identified myself as a community psychiatrist--a shrink who works in publically-funded clinics with chronically mentally ill patients. I was even an administrator for a while there-- But I like to write about psychotherapy, I think because it's illusive, it's hard to pinpoint why it's helpful to talk to someone, how it effects cure or change or even what value we place on comfort in the absence of cure or change.
And why do I like doing psychotherapy? In a word, intimacy. Nowhere do people touch so close, let you in with such trust, then change and get better not because of a drug, or just because of a drug, but because of what you do with your being: listen, reflect, and sometimes just care.
I was destined to be a forensic psychiatrist. I didn't know it at the time, but growing up on a steady diet of Agatha Christie, Ellery Queen and Arthur Conan Doyle (not to mention Ed Gein jokes) pretty much determined my professional future.
When I was in medical school I never planned to be a shrink. I was considering almost everything else---emergency medicine or oncology being the foremost---until I took my psych rotation. It was the high point of my medical school experience. I had some pretty amazing and unusual cases (even compared to what I've seen since then), including one famous case involving a patient who is still discussed in forensic training programs. Our civil commitment hearings were held in an actual courtroom so as a medical student I also got to see my first expert testimony in front of a real judge. One of my progress notes was even quoted at the hearing. Pretty darn cool.
Meanwhile I saw residents in other specialties dragging their butts around the hospital exhausted and demoralized. While they intellectually liked their specialties they just didn't seem happy. Psych residents, on the other hand, loved what they were doing and smiled a lot. They also tended to have delightfully twisted senses of humor. I fit in there.
I've never regretted my decision. I still like my patients and my colleagues. I still like the predictable chaos of institutional work and the knowledge that I'm doing the right thing. It's fun to see people gradually get better and to know you had something to do with it. When I hear an interesting delusion I wonder why anyone would want to do anything else. And I particularly liked it today when my patient told me, "Thanks, doc. You're a blessing. You really are."
Pretty darn cool.
[finished by Roy]
Fine, I'm being forced to talk about why I like being a psychiatrist, by threat of emasculation. I'm not going to talk about why I became a psychiatrist, but why I love it. Keep in mind I'm a Consultation-Liaison psychiatrist (also called psychosomatic medicine), which is essentially psychiatry in the general hospital. I see all sorts of people with all sorts of problems, from the mundane to the fascinomas. You get to help solve problems by thinking of things in ways others haven't. It's a bit of Sherlock Holmes plus Marcus Welby, with some Dr Huxstable and a bit of House thrown in.
I can do any kind of psychiatry I choose (inpatient, outpatient, administrative, research), in any type of practice (solo private practice, group practice, clinic, hospital-based, large single specialty practice), part-time or full-time, and pretty much always be able to get a job that pays well while being independent enough to be able to vote with my feet if I disagree with how an employer treats patients. I have, in fact, done all of the above at various times (as Dinah can attest), sometimes many of them at once.
At one point I thought of being a psychologist, but found it too theoretical, and it didn't answer all my questions about how the brain works, how the body works, etc. The best part is being a physician and having the confidence of knowing the difference between, say, a seizure and a pseudoseizure, because I learned about both these things, learned how to examine for these things, and know the importance of getting it right or wrong.
At another point I thought of becoming a neuroscientist, but found that I missed the people contact. I really like working with folks whose brain is on the fritz, and helping them get their picture back so they can enjoy life more. That is satisfying.
(I hope Dinah's happy now :-)
And now that you've heard why we all love our jobs
And now that you want to be a shrink, too,
I thought I'd post
This poem for you.