October 28, 2008

Pondering on: Psychiatry

"Psych is a good break, so schedule it in between two hard rotations like OB/GYN and Surgery."

That's the advice that sage MS-3s will give the wide-eyed MS-2s as they plan out their schedules for third year. I wondered why this was so and whether or not Psych deserved the "bad rap" that they got for being easygoing slackers.

The wonder vanished when I entered Psychiatry. As a disclaimer, I am not saying that Psychiatry residents are trying to avoid hard work or do as little as possible for their patients. After all, they are still doctors and ALL doctors are caring and they all work hard (at least all of the ones I've met so far have upheld this archetype.)

I noticed that there is a certain aura that Psychiatrists try to cultivate. It is a very crafty and carefully created sense of ... relaxation. Low stress. The level of care for our med-student well-being went far beyond what was necessary and it was almost laughable at times. Here's a true story of something that happened to one of my friends:
"You rounded on your patients instead of having lunch?!? WHAT?!? Go eat! Go to the dining hall. We don't really need you here for our afternoon psych rounds anyway."

I would almost feel bad about hanging out with the residents in my attempts to soak up psychiatry when they were sitting around idly. I think the record earliest time I ever got out was by noon. Granted, this was after rounds with three separate attendings/groups and we rounded on a lot of patients, but that is really early. And I wasn't done for the day; I still went to school to read about psychiatry.

In my opinion, the reason why the psych residents were so aggressive about being so relaxed has a lot to do with their patient base. I was on the consult-liaison service at a large hospital in my state. There are a lot of patients who were admitted to the hospital and had psych issues come up tangential to their main diagnoses. We were called in to see them for the psych issues. It wasn't necessarily because the medicine or surgical teams couldn't handle alcohol withdrawal syndrome or depression or schizophrenia. They didn't have time to take care of these problems.

THAT is the crux of the psychiatrist. Their niche comes from having this precious TIME to sit down and talk with patient for as long as it takes to make a connection and help them feel better.

Even if they have a ever-growing list of patients on the service, the no-stress attitude keeps them from glancing at their watch or the clock (and undoing a lot of patient rapport when the patient feels pressured to "wrap things up" or what have you.)


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