A few thoughts about psychiatry, the last of my third year rotations.
I don’t think there is a specialty with more opportunity to do good than psychiatry. The amount of suffering and mental confusion and anguish in the world is too large to put numbers to it. I don’t think there would be any limit to how much good an effective, caring psychiatrist could bring about in the world.
On the other hand, a lot of efforts in psychiatry seem to be futile. A lot of these issues of abuse, violence, and maladaptive behavior run so deep and are so ingrained that it seems patients will never get better. That is a little overwhelming.
I worked at Children’s on the inpatient unit. Most of the patients seemed to be pretty average, but they just had a rough go of it with the family and home environment. I feel like 75% of children psychiatric issues (at least the ones requiring an inpatient admission) would resolve with loving, dedicated, responsible guardians. It was hard to see kids enduring those situations.
Lifestyle is the bomb. There is hardly a psychiatrist that works over 40 hours per week. I witnessed my fellows and attendings taking afternoons and mornings off at will to attend their children’s events or to take care of personal matters. Or there is the option of working three night shifts per week at the Parkland Psych ED and making upwards of $250,000 a year for 36 hours per week. Those are numbers I could get used to.
Alas, the work is a little too boring and much too draining. Inpatient intakes, or first time consult interviews, would take as long as two hours a piece. I could maybe pull off one of those a day, but there were days on the consult service with up to 5-8 consults. That is way too much. Plus there is very little medicine to think about, just drug interactions usually.
Psychiatry is actually an important component of every specialty. I think the most effective clinicians understand this and make it a priority to serve the emotional needs of their patients. It’s not easy, but that is the extant to which I want to practice psychiatry in the future. It also wouldn’t be too bad to manage some depression medications or stimulants on an outpatient basis. They say the majority of psychiatric illnesses are actually treated by primary care physicians anyway.
All in all I enjoyed the psychiatry experience I had, and I especially enjoyed the "psychation" I had. It was good for me to take care of myself for a while.
When we notice injustices and cruelties in a system — speak up. Speaking up is necessary not only to call attention to the wrongs of the system — whether it be medicine or America or the planet — speaking up is essential for your survival as a human being. If we see something and say nothing, it will gradually tear us apart.
Stephen Bergman, known by the pen name Samuel Shem, author of The House of God