Psychiatry as a Med Student

My psychiatry experience was well rounded and very different from any of my other clinical rotations. I experienced inpatient, outpatient, early child, and geriatric psychiatry.

In psychiatry, there is no physical exam. I did not need my stethescope. I found this weird.

Since there is no physical exam, history becomes even more important than it usually is. Thus, the history in an average psychiatry note was at least 2 or 3 times longer than an average internal note and 4.6 million times longer than the longest surgery note.

Outpatient psychiatry is the worst. Outpatient psychiatry is basically psychiatric clinics for patients who are sick enough to still need help, but healthy enough to be in their homes doing their day to day activities. Our government does not currently provide funding for patients to see psychologists or counsellors. This means that if a patient cannot afford to see a psychologist/counsellor, but needs someone to talk to and work through problems with, they will go to a psychiatrist, which is covered under our province's health plan. This is a problem because we already have a psychiatrist shortage in this province and their time could be better used managing more acutely ill psychiatric patients rather than providing counselling which can be provided by other mental health providers.

Inpatient psychiatric patients blow my mind. I found patients in acute psychosis to be fascinating. For those of us who are lucky enough to be free of psychosis, our minds are who we are. If we develop cancer, lose an arm, or have a heart attack, we understand that our bodies are failing us, but our mind is still ours. I think that the sense of self which stems from our mind is the basis upon which philosophers created the concept of a soul. When you meet a schizophrenic patient, who was previous healthy like anyone else...and their mind has failed them, it is terrifying. I still do not understand how a once rational person can honestly believe that a microchip has been implanted into his tongue so UFO's can eavesdrop on his conversations. If our minds can become this sick too...then what are we? What is our consciousness? A random set of electrochemical reactions? That doesn't make sense...does it? WTF.

Anyways...

So my thoughts on psychiatry as a med student:

Positives
1. Great lifestyle
2. Interesting potential for research
3. Deal with a unique set of illnesses

Negatives
1. Very little medicine
2. Looked down upon by many other doctors
3. Long, long patient interviews

Psychiatry was interesting and I think I will be better able to deal with psychiatric comorbidities in the future, but I definitely will not become a psychiatrist.