Friday, May 27, 2011

To Shrink or Not To Shrink?

Here at Shrink Rap, we often talk about the stigma of having a psychiatric disorder. It's funny, but society has it almost ranked, so that certain illnesses are very stigmatized--schizophrenia and schizoaffective disorder, and borderline personality disorder, to name a few, and others are pretty much socially acceptable: Attention Deficit Disorder, for example, especially among the high school/college crowd where the patient often gets identified (or self-identifies) as the source for those late-night stimulants that so many kids cop.

It's not just the patients. Psychiatrists are also stigmatized, and that doesn't help much when our society talks about the shrink shortage.

Exalya writes:

I'm a first (almost second) year medical student with a strong passion for psychiatry. I love listening to your podcasts; you give me hope for my future when the drudgery of first year classes is getting me down, and I feel like I always learn something useful.

That aside, I am writing to you seeking some advice. At my school, we are required to follow doctors in family practice clinics periodically during years 1 and 2. Frequently I am asked, "What field are you interested in?" to which I reply, of course, "Psychiatry." It seems like every time an attending finds out that I'm into psych, I get eye rolls and flippant remarks. The most common ones are "Psychiatrists just push drugs," "Talk therapy is garbage," and "You'll talk to patients more in family practice." Do you have any advice on how to deal with attendings who do this? Is this the kind of attitude I'll be facing during 3rd year rotations outside psych?

Appreciate anything you have to offer!

From Dinah:

Dear Exalya,

I am so glad you enjoy our podcast! I also got the same nonsense, one of my preceptors told me that I would be more use to society as a plastic surgeon. Great.

The three of us wrote a post sometime back called Who Wants to be a Shrink?...please check it out.

Psychiatry has a lot of options: it is what you make it. You can have a low volume practice and focus on psychotherapy, you can have a high volume practice and madly write prescriptions, or you can mix it up. You can teach, do basic research and never see a patient, be a chairperson or administrator, focus on public health or private health. I do promise you, if you want to, you will talk so much more to your patients than in family practice. I also promise you won't make the money that you would in a surgical subspecialty. There is always the advise the financial aid adviser gave me when I graduated from medical school heavily in debt and insisting I was going in to psychiatry: "Marry rich."

What should you do? Ignore these turkeys. Do what you love and have a career where you enjoy your days. We took a survey recently: 90% of the shrinks in our state said they would do it again (at least of those who answered the survey).

From Roy:
I agree with Dinah. You will have lots of flexibility in what you can do. And you do not need to marry Rich or any other guy. As for the flip remarks, you Will get them. Shrug them off as uninformed comments, or as just trash talk to get you to go to their specialty. Just smile and tell them that you hear all the smart people go into psychiatry ;-)


From Clink:
Yes, I heard comments like that when I was a medical student too: if you become a psychiatrist you'll lose your medical skills, why bother being a doctor if you're just going into psychiatry, psychiatric disorders mean there's nothing "really" wrong with the patient, etc. Twenty years later, I still occasionally hear comments like that---even from friends and family. It's a hazard of the biz. You'll eventually have the last laugh though, the first time you get called to consult on a delirious patient and you can lecture the "real" doctors about forgetting their basic psychiatry skills. You'll also see how the karma plays out during residency: all the surgery and internal medicine docs will be miserable while the psych residents love their work and their patients. And really, psychiatry IS a lot more fun than any other specialty. Don't be too hard on the docs making ignorant comments. They're jealous.