As an MS4 going into psych, this thread is kind of bumming me out. Do most of you attendings feel this way? Does working with patients in psych eventually burn you out?
And sunlioness, I'll PM you sometime soon about a possible option I recently came across.
Edit: and to add to that, are you more frustrated with the system or the patients/practice of psychiatry itself?
well i think this forum tends to be very misleading because of all the cheerleading for psychiatry as if it were the most amazing specialty ever and was endlessly fascinating. the reality is most people who go into psychiatry aren't really all that passionate about it. we also have a higher number of defectors from other specialties who come to psychiatry because its as far away from medicine as they can see themselves getting, rather than because they have any real passion or drive for working with the mentally ill. even if you do have this passion (and i fall into this camp) it can be draining. obviously any medical specialty can be draining but i do think there are things that can be particularly tiresome in psychiatry.
1. Dealing with patients who are often iatrogenically stuck on benzos is painful.
2. It is even worse dealing with patients who are more explicitly drug seeking and can make you feel like a glorified drug dealer.
3. It can be draining working with people who don't want your help, they want fun drugs like stimulants and benzos (maybe throw in some suboxone), or for you to support their dependency on the state by helping them get or maintain disability.
4. often toxic family members can become your biggest problem and interfere with treatment or enable patients
5. there is no doubt, no matter how respected psychiatry is in the system you work, psychiatry is always shat upon because that is the purpose of a consultation liaison service, to contain the projected anger and other poisonous emotions that other services have to patients, and because psychiatry tends to be undervalued. as a consultant other providers may not listen to any of the recommendations you make and you have to be okay with that.
6. In the emergency room, it can be soul destroying seeing all these criminals become psychiatrized by a system that criminalizes the mentally ill and medicalizes criminality.
7. Some environments can be dangerous and involve working with deeply unpleasant people who are not only uninterested in your help but are beyond it.
8. Psychotherapy can also be extremely draining after a while. it takes a lot of energy and patience to sit with patients, listen carefully to them, and contain powerful emotions.
9. The nature of psychiatry is so personal that we tend to take it very personally when patients attempt/commit suicide and see this as failure on our part in a way that runs deeper than deaths that occur in other fields on medicine.
10. Despite all the claims that we have parity we do not. As a result there is a lot more hoop-jumping to get patients the care they need and ridiculous prior authorizations for things that can be very frustrating.
11. We live in a society where there is supposed to be a pill for every ill, and patients may come in demanding some quick fix solution where there is none. this can leave everyone feeling disappointed and frustrated.
good psychiatric training actually helps you to deal with these types of situations by giving you the skills to set limits, be reflective, understand your own feelings, deal with toxic systems, roll with resistance, and maintain your safety. But even still, if you work in the wrong kind of system with the wrong kinds of patients is can be demoralizing and soul destroying. it is really easy to provide poor psychiatric care without thinking about these things, it's the good psychiatrists that find themselves burning out and becoming discouraged. Also psychiatry can be a deeply nourishing and intellectual specialty raising all sorts of fascinating questions and you learn so much about different ways of formulating patients and psychopharm etc but much of this is not stuff you may end up using in your day to day work.
Personally, I think doing full time clinical care is too much and I plan to diversify things by being involved in teaching and training, writing, policy/advocacy, consultation, service development, administration, forensic work. Its a good idea to shake things up a bit and also to continue to reflect on what kind of work you want to be doing. There is a lot diversity within psychiatry to explore but for some people psychiatry (or any medical specialty) is not what they want to be doing and they will have to figure out where they make get more personal satisfaction.
