Monday, January 21, 2008

Wouldn't Know the First Thing

Rather than post about the continuing discussion regarding my rank list with Wife I will instead post about some other topics until I feel I can discuss the situation with more perspective.

With that being said...

A post from T at Anesthesiobiost (a rather interesting blog about an Anesthesiologist living in, I think, Philly, who is trying to learn the Oboe) illustrated a point that I’ve made to some of my colleagues regarding Psychiatry.*

Unlike Kris Kringle in Miracle on 34th Street who holds a great deal of respect for Psychiatry, I do not. Perhaps my experiences have been dominated with poor understanding or observation of the absolute worst form of practice, but I truly don’t feel Psychiatrists should be held in the same realm as physicians.

For that matter I don’t understand why they need to attend medical school in order to become head shrinkers.

Consider the experiences I’ve seen:

- Patients in an acute Psych ward were treated only by the nurse practitioner for diseases like high blood pressure, diabetes, and headaches. The psych residents and attending were unable to treat these diseases and frequently asked for “med consults” when these “problems” arose. They would then ask the students about the medications and what they did as they didn't know.

- During an ECT day while on an Anesthesia rotation, we were forced to wait for the Psychiatrist to arrive 30 minutes late for the last ECT (consider that we were scheduled in another room after we finished). Once he arrived we were once again appalled to see him spend another 30 minutes talking to the patient about why they were happy having not eaten that morning (as per OR guidelines – NPO after midnight). Then, without alerting the OR team or anesthesia team, this guy allowed the patient’s family to enter the room and observe the procedure. Afterwards he described what they had done and feebly tried to recall the reason for the anesthesia team’s involvement. He fucked up the basic physiology and pharmacology so badly I lost absolute respect for him.

- Whenever a Psych consult was requested at my main teaching hospital additional measures had to be taken in order to get a resident or attending to see the patient within the week. On OB/GYN we had to personally track them down and walk them to the patient floor in order to see mothers before they were discharged. They always acted put out and asked ridiculous questions about the patient’s disease or status (like did they look tired when they delivered – of course they did!).

- An attending stated that psychologists are better talkers than psychiatrists. The job of the psychiatrist had moved from “the couch” to the pharmacy. “Let the psychologists handle the psychoanalytical discussions with the patients, they’re better trained at doing that now than we are anyway. We deliver the drugs that help people”. No, really, he actually said that.

- I spent 2 days being lectured on Freud despite many of his ideas being disproved. They guy was a fucking coke addict with a major sexual compulsion – why are we still being taught about him?

I completely agree with T’s anger over the issue she describes. I don’t understand psychiatrist’s need to attend medical college – because they sure as hell forget about disease processes when they enter residency and apparently are just glorified drug pushers.

* I am not sure what T's opinion of Psychiatry is and am not trying to make any references to the like. Her post only allowed me a moment to reflect on the level of absurdity I feel with Psychiatry.


Old MD Girl said...

Uh oh... I hope nobody interested in psych actually reads your blog.


I haven't done this rotation yet, but my limited interactions with them have been similar to what you have described in many ways.... Though, I will say that I've seen the internists prescribing benadryl as a sleep medication to patients with a possible anticholinergic OD..... so I feel that the ignorance cuts both ways sometimes.

MedStudentGod (MSG) said...

Some of my friends are going into Psych...they know my feelings about the field well.

And yes, there are often mistakes throughout all fields as well - but Pysch was just too much.

social worker said...

An attending stated that psychologists are better talkers than psychiatrists. The job of the psychiatrist had moved from “the couch” to the pharmacy. “Let the psychologists handle the psychoanalytical discussions with the patients, they’re better trained at doing that now than we are anyway. We deliver the drugs that help people”. No, really, he actually said that.

Am I missing something? From my experience, this is generally true. If it's not true, it is what happens in the field.

CanadianPsychRes1 said...

I'm a frequent reader of your blog who happens to be a psych resident who is insulted by your post.It's not fair to paint the entire field with the same brush.

Have you ever worked with a Consultation-Liasion Psychiatry service? These are the psychiatrists who see med-surg patients with delirium, competency issues and chronic psych problems. Arguably they are well versed in medicine and surgical problems (and are often called to sort out "organic" deliriums that haven't been appropriately worked up by the treating team). ie. the patient's been in hospital for 2 weeks and is starting to get confused, we haven't done any blood work but can you come make him less confused for us?

Keep in mind that you don't expect your cardiologist to manage your schizophrenia so why should your psychiatrist manage your CAD?

MSG said...

No, I would not expect a Psych person to take care of CAD...but let's not forget what I was saying - those that I've dealt with didn't know *what* the drugs did anymore or the first thing about treating diseases learned about 1st year of medical school. While I'm sorry for the offense, I am just stating my mind over the matter. My experiences have been extremely poor when dealing with Psychiatry - so therefore my impression is as such.

I had the impression that both fields were involved in psychoanalysis (since we were lectured and tested on various forms during my 3rd year rotation) and I find it interesting that a field dealing with mental illness so readily just gives out drugs and refers to people they feel superior to because of the MD.

social worker said...

MSG: Some Psychiatrists still do therapy...whether it be psychoanalysis or some other form of therapy. However, social workers actually provide upwards of 80% of the mental health care in this country in the form of therapy. And psychologists also provide some percentage (not sure how much). This is not to say MDs are not trained in it. I obviously have not gone to med school or done a residency so I have no clue what is taught there.

My understanding from talking to psychiatrists I work with is that there's a lot more money in med management than in psychotherapy...which is one reason psychiatrists have given up the couch so to speak.

I am interested to hear what you think about the new law in some states and the proposed law in others about psychologists prescribing medications. I believe if they take a certain amount of credit hours in New Mexico, they can then prescribe psych meds for their patients. If you do end up posting on it, I'll voice my thoughts there :)

oh, and thanks for the clarification.

Canadianpsychres said...

thanks for replying. A post that generates discussion is a good thing.

But I caution you to not make swooping generalizations about specialties because you can easily offend. Try to use non-emotional language. It'll help you make a better argument. This applies in all areas of disagreement.

Oh and I'll keep reading your blog :)