Aspects of psychiatry this doctor appreciates

Working as a psychiatrist is very rewarding. It’s stressful in a unique way, and some people may look at me strangely for having an unusual job. But overall I really enjoy it. Here are some of the aspects of psychiatry that I really appreciate.

1. Being trusted. Psychiatrists meet people when they are at their most vulnerable points, and we are entrusted with extremely personal information, often before we even have the chance to get to know our patients very well. We often hear intimate details of patients’ lives that they’ve not previously shared with their primary care doctors, spouses, or best friends.

2. Meeting a variety of people. Mental illness does not discriminate based on age, sex, race, religious preference, sexual orientation, or income. It can affect anyone from any walk of life. There are not many professions where one has the opportunity to work with such a variety of people as do psychiatrists. I’ve also found that when I’m not in my professional role, I’m comfortable approaching people that some other professionals might not feel comfortable approaching–simply because of my experiences as a psychiatrist. I’ve learned that even though each of us is unique in some respects, humans truly are more alike inside than we are different.

3. Learning about life. My patients have taught me much about how the world works. I’ve learned about failure, loss, heartache, poverty, losing one’s self-respect, and even suicide. But I’ve also learned about perseverance, resilience, faith, forgiveness, love, and hope. I’ve treated wealthy professionals whose lives appeared enviable and perfect to the world but who were profoundly depressed and looking for reasons to continue living. Likewise, I’ve treated destitute people who had lost what little they’d had in life who were able to smile and find hope. However, a very important lesson I’ve learned is that the world, as much as we try to paint it into neat little black and white categories, is really just a bunch of shades of gray. We humans try to make it manageable and understandable by oversimplifying it. Paradoxically, in some ways, the more I learn about the world, the less I feel I know.

4. Having flexible options. Psychiatrists have a greater variety of work arrangements available to them than do most other physicians. We can work full-time, part-time, or participate in shared work arrangements. We can go into private practice, join a single or multispecialty group, or work for an HMO. We can work in the military, in corrections, or for the V.A. We can do work as independent contractors for various social service agencies. We can do clinical work or research. Or, we can piece together some combination of the above. Such variety can help to keep one’s career interesting and may reduce the likelihood of developing burnout. Of course, having so many options also doesn’t hurt job security.

5. Being intellectually stimulated. The field of medicine is always evolving. But when it comes to the mind and the brain–I wouldn’t say the study of it is in its infancy, but there is so much that we still don’t know. There are always new things to learn in psychiatry, and that helps to keep it interesting.

6. Being a physician. Psychiatrists are the only mental health experts who have gone to medical school. I regularly look for and find medical issues in my patients that probably would have been missed had I not known what to investigate.

 

Jeffrey Knuppel is a psychiatrist who blogs at The Positive Medical Blog, where this post was originally published.

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  • Jackie

    Psychiatrists are smart people. Everytime I was having ‘communication’ problems with my family doctor, I would be offered a referral to a psychiatrist. I was proven ‘sane’ by the latest one I went to – the only time I agreed to such referral. Before that I just switched to another family doctor whenever I was ‘threatened’ with a psychiatric referral. Then pretty soon my ‘real’, life-threatening disease would be found and I would be ‘vindicated’.

    Doctors, do not be afraid of referring your patient to a psychiatrist!

  • Anon

    Nice post. Especially #6. It seems that doctors (those who are not psychiatrists) so often feel threatened or overwhelmed by mental health issues in their patients. In my experience, a good psychiatrist can see past the social awkwardness and notice, for example, that the patient really looks unwell. Or that their symptoms have a pattern which suggests a hormonal abnormality, neurological problem, or something else.

    They also understand it’s normal for some degree of depression to be part of a chronic illness, and it’s really the underlying problem that needs to be focused on for diagnosis and treatment. So much better than another approach I’ve seen from medical doctors that goes something like “Let’s treat the anxiety because that’s what’s annoying to me, and hopefully your physical symptoms will just go away”.

    For patients who have medically unexplained symptoms, a psych referral from one’s doctor may seem like a medical dead end, but a good psychiatrist can be a patient’s best ally in getting the answers they need.

  • Greg

    Sometimes I think that psychiatrists have become the new Marcus Welbys of medicine – they get more time to see patients than us primary doctors, and so can get to know patients better. They are also encouraged to talk about aspects of a patient’s life such as relationships, family life, education, work, what it was like growing up, etc. Stuff that we primary doctors used to have the time to talk about, but now won’t be able to do in the 5 minutes before the next patient. No doubt psychiatry is a difficult specialty but sometimes I envy them, or perhaps nostalgically see what used to be all of us in them…

  • Campykid

    Your post is a nice contrast to the 3/5/11 NYTimes article about psychiatrists moving from talk to drug therapy (http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?_r=1&src=me&ref=health)

    • horseshrink

      Been there, done that, bought the shirt. The NY Times article reflects mainstream reality for psychiatric practice now. I gave Mr. Gardiner a heads up about this dynamic a couple of years ago (though he might have already been aware of this.) It was good to see him write about it now.

      I currently work in an institutional setting with the severely, persistently mentally ill … with people who had to commit crimes to receive adequate services due to the inadequacies of the community mental health system. (true story … across the nation now. Google “criminalization of mental illness”)

      • horseshrink

        Error … should have been Mr. Harris.

  • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

    Great post Jeffrey ~ My mom’s a psychiatrist and I worked in her office before med school. Now I’m a family doc who has set up a practice that is actually more like a psychiatrist’s office with a couch where patients can lay down and talk. Schedule 30-60 minute visits. I love it! Best of all worlds. . .

    ~ Pamela

    Pamela Wible MD

    • horseshrink

      Sounds nice … but also sounds like a significant income hit, unless those are cash visits. Would be surprised if commercial third party payers would reimburse a FP for 90805′s or 90807′s.

  • http://obesefromtheheart.com Sara Stein MD

    Wonderful description of what we do in psychiatry. For those med students who are reading, being a psychiatrist does not mean stopping being a “real” doctor – it means enhancing being a “real” doctor with additional knowledge and insight. Psychiatry teaches us the art of listening to the patient with a keen ear that can discern psych versus medical. We have the luxury of time to hear the whole story, something PCP’s are sadly without.

    In the last year, I’ve found 2 cases of thyroid cancer, numerous cases of undiagnosed rheum diseases and diabetes and thyroid illness, a few gall bladder patients, and one case of acute mono! Even though I am not treating those diseases, it is gratifying to have worked up the patient and referred to appropriate care.

    The secret to success is to avoid being seduced by the shortcuts offered by the pharmaceutical companies, and to use everything you learn in medical school and residency.

    Thanks again for a great post!
    Sara Stein MD

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