clinical medicine skills as a psychiatrist

[quixote1974]

Hi,
I want to share with you one reservation I have about going into psychiatry. I feel like I would be giving up the clinical medical skills (i.e. physical diagnosis, interpreting labs, diagnosing and treating infections), as a psychiatrist. Of course, I would be giving this up to specialize in taking care and help fixing up people who really suffer greatly, arguably, more so than people with just strictly organic disease. But I'd still like to know fromyou all whether my year of internship provide me with the clinical skills to deal effectively with non-psychiatric organic disease? This would be an issue for me if I went into pathology or radiology or other specialities removed from the bedside, but this is the one thing that makes me think twice about my desire to be a psychiatrist. Please no flames--an honest reply would be appreciated.

Thanks, Rich

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[Iron Horse]

If you don't need those specific skills to practice psych, and you want to practice psych, why are you worried about losing those skills? If the answer is that you enjoy those aspects of medicine, perhaps you should consider other specialties or double board.

Even if you get trained in certain areas/skills during residency, if you never use them you will lose proficiency anyway. I would suggest figuring out what/how you want to practice and then determine what type of training you need in order to get there.

 

[md_student10021]

yes, you will lose clinical skills. that's just the way things work. after all, do you think an ortho can remember all the details he might have learned during his ob/gyn rotation in med school? or does the ophthalmologist have the faintest recollection of cardiac electrophysiology?

the point is that you will lose skills that you don't use on an ongoing basis, but you will develop far more as a specialist in whatever field you choose.

best of luck.

 

[Big Lebowski]

If you really desire to keep in touch with clinical skills...it's possible in psychiatry. Though not really a mainstay in mental health...there are some areas where stong knowledge of clinical medical skills will help you greatly.

For example, the geriatric population require special attention to their multitude of medical problems adding a twist to their managment. Other fields like dual diagnosis and consult/liason will require that you have a strong knowledge of organic disease. Other illnesses play a role in mental health such as cancer and hypothyroid. Some psychiatrists specialize in psycho-oncology. As utility of brain imaging continues to expand, the fields of neurology and psychiatry are going to be sharing much more in common.

Other opportunities include combined residency training. There are med/psych, FP/psych, neuro/psych, and peds/child psych/adult psych programs out there. There are also some good biological fellowships at some programs. In addition, some larger facilities have med/psych wards.

So you can see that the opportunities are available and the benefits of "clinical medical skills" could serve you well.

 

[PublicHealth]

It is amazing how many people are hospitalized because of a behavioral problem or predisposition. In fact, many patients can be restored to health with proper preventive care and behavioral modification. Unfortunately, many patients don't find themselves in a psychiatrist's office when first admitted. If only psychiatry, preventive medicine, and public health became more interdependent, many patients would be saved the agony of dealing with our current medical and mental health system, which may best be characterized by the following adage:

"Health is the state of incomplete diagnosis."

 

[medcat3]

Yes, in all likelihood, your clinical skills will decline as a Psychiatrist (but as you mentioned, same with Pathologists, Radiologists, etc.). However, they don't totally go away...at the VA Psychiatrists still do physical exams on the new patients if they are direct admits (i.e. didn't get admitted through the ER). Also, you have to be a good clinician to interpret lab results, EKGs, etc of your Psych ward patients and know when they should be transferred to the Medicine ward. People on the Psych wards have heart attacks, get broken noses, and have seizures and you have to know how to stabilize these patients until they can be transferred.
When I decided that I wanted to become a Psychiatrist, I had to come to grips with the fact that I may not be using my expensive stethoscope as much as I thought when I first entered medical school. I later came to realize that many other physicians don't use their stethoscopes (i.e. surgeons...just joking ) and it doesn't make them any less of a physician. As a psychiatrist, you will use your clinical skills more than you think, but less than an Internist or FP.

 

[ckent]

I have a classmate who was doing his psychiatry rotation with a psych intern that wanted him to get consults on every patient she had. He finally got fed up when she asked him to page the medicine consult because their patient had a nose bleed. He was like "even if you never went to med school, haven't you ever gotten a nose bleed?! Did you need to go see the doctor for it?"
Some people forget their clinical skills very quickly.

 

[psydoc]

I've thought a good deal about this issue in thinking about residency training. I came up with the conclusion that medical training for psychiatrists is a somewhat a "grey" area. Your basic medical skills are mostly taken for granted for the reasons that medcat3 and big lebowski have outlined, but the fact is that few psychiatrists are able to live up to these expectations; the point is that time is short, the experience needed for building good clinical skills is huge, and most of the things which you do to learn to be a good psych won't help you with internal medicine and vice versa.
In a nutshell you're expected to know what you cannot learn, and the shortcomings of psychiatrists as well as of a lot of other specialists in clinical medical skills are de facto tolerated because this is the price that has to be paid for the expanding of knowledge and expertise in specialized fields. This is a little frustrating for students, even the ones in medical school who have been faced for years with challenging learning demands: I think a lot of students feel somewhat "defective" when they chose a path that leads them far from clinical medicine.
Furthermore, the student perceives that doctors tend to deny the inevitability of this process: I suspect that this attitude is due to the need to preserve the cohesion of physicians as a professional category.
This is just my impression, but I think that the same fact that we're talking about this issue, which I have debated a lot of times with my fellow students, seems to point to that direction. I'm open to other opinions and look forward to read more of yours, though.
P.S. However, at the end I chose to pursue residency training in psychiatry

 

[rxg16]

What's the problem? Just do med-psych.