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    Hello all,

    So I'm a med student in 1st year but I'm wanting more information from people who've had experience in psychiatry, naturally if a consultant wonders by that'd be spectacular.... however on the off chance that don't I'd like to hear from anyone! Including fellow med students or whatever really, even if you've not spent long in that environment.

    I'm more after a typical day or even week if you fancy sharing, I've read the few that are available on NHS careers and some other similar websites and find them quite useful, however I feel as if they might amplify the positive. Essentially some contrary views may be useful to me, not that I'm expecting or hoping for that..

    Thanks.
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    Not a consultant but have had a lot of experiences in psychiatry as I'm hoping to go down that career route. Have you looked at the RCPsych website? They have some descriptions of Core training and Higher training which may help some questions on training.

    From my experience the lifestyle and working life looks pretty good compared to some other specialties although that may change given how the mental health care system develops/worsens. The hours are pretty good and flexible, and I think overall the clinical case-work isn't demanding in terms of pure hours but most psychiatrists would say their workload can be pretty varied week by week. (Even if paradoxically they have longer exposure to the same patients.) On top of the ward-rounds, admitting of new patients, a lot of psychiatrists will spend their time in MDT meetings or in community teams, as well as outpatient or community clinics. I also know a lot of psychiatrists who are involved in research, special interest, professional development, teaching of students and trainees or else work in some other capacity (e.g. legal mental health, policy etc.) You also get some psychiatry-specific things such as mental health tribunals for example. Part-time is possible and the training is overall very flexible. There seems to be a good deal of support throughout training.

    The best way to see what a psychiatrist does is go shadow one! Are you wondering about anything in particular? Or any particular contrarian viewpoint you're hoping to hear (or disprove)?
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    Thanks. Yeah I should have been more clear, I've been through those links before as well, just couldn't remember which were what.

    Shadowing is naturally the best idea and I will most likely do so, but I thought making such a topic might be a good idea too.

    Nothing in particular no, I can just imagine official sources as being perhaps over positive. If anything I'm looking for negatives I suppose, but anything would do. Even just the general mood in the profession slot the future but I hardly expect them to be realistic or happen.
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    (Original post by PoolR)
    Thanks. Yeah I should have been more clear, I've been through those links before as well, just couldn't remember which were what.

    Shadowing is naturally the best idea and I will most likely do so, but I thought making such a topic might be a good idea too.

    Nothing in particular no, I can just imagine official sources as being perhaps over positive. If anything I'm looking for negatives I suppose, but anything would do. Even just the general mood in the profession slot the future but I hardly expect them to be realistic or happen.
    So again I'm no psychiatrist but I think people who work in mental health would say one of the hardest things to get over is working with the fact that so much of a patient's problems seems to be out-with your control. People with mental health problems are often the most vulnerable and stigmatised in our society and a lot of the times their problems stems from social problems, economic problems, problems with justice, with equity, with relationships. These are difficult things to 'fix' as a doctor, and in a lot of cases it's really the system that is broken and you may feel it's beyond your own power to actually make a difference. Not to mention a lot of the times our healthcare system is just not in a good enough place to be dealing with this kind of supra-medical problems (see CAMHS for example, or prisons, or even some liaison services in A&E (although the latter is I hope getting better in some hospital emergency departments)). Although the broken 'system' is by no means a problem just in psychiatry.

    Psychiatry can also be incredibly emotionally draining and invasive. It's not a specialty you can just go throughout your day on auto-pilot. Your patients will often demand a lot of emotional resources from you. (Not to mention that psychiatry patients, out of all specialties, are perhaps a patient group who are most resistant to you as a doctor so already there is that antagonism there.) Psychiatry is pretty much all about talking and communicating so it can be very taxing. I've had experience in trauma therapy centres where day-in, day-out I heard the most horrible, traumatic stories of torture, child abuse and neglect which really takes its toll. Difficult or complex cases may completely take over your life if you aren't prepared to invest energy in thinking about mechanisms to cope, transference/co-transference etc. A lot of psychiatry is not pleasant: PICU; suicides in young people; involuntary detention; forensic hospitals (generally); inpatient eating disorders wards. And all of this is overlain with a sense of ambiguity over nosology, over diagnosis (DSM etc.), over choice of treatment, over whether X or Y will work.

    Then you have all the institutional problems, which aren't all psychiatry specific but definitely a problem: increasing amount of paper-work and bureaucracy; lack of enough community resources; waiting lists for psychotherapy omfg IAPT ffs; the lack of prevention; lack of translatable research into practice.

    On the other side of the story, I think actually psychiatry's future is looking relatively bright (even if you take into account the supposed mental health crisis looming). Recruitment is up. Funding is up (or at least promised to go up). People are becoming more mental health literate and aware. I hope in the near future a lot of the sub-specialties will make massive changes (such as CAMHS for example). Equally I think psychiatry is about due a few big research breakthroughs which might really make an impact in practice, especially in the interface with neuroscience. I think younger generation of psychiatrists are bringing a dynamic new energy to what has been a relatively stuffy discipline, especially in terms of some areas such as research into personality disorders and psychedelics.

    I could talk about mental health for days but I'll stop here for tonight. Happy to continue on the dialogue! (I'm not sure if there are any other psychiatrist wannabes lurking in the medical student forum or if I'm representing a one-man army here.)
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    That's been really useful. In a sense I do find mental health very interesting and would read any amount of conversation about it, however I'm not entirely sure I'd that would translate into psych as an actual career.
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    (Original post by PoolR)
    however I'm not entirely sure I'd that would translate into psych as an actual career.
    Of course it's far too early for you to set yourself on one career as a first year but how so? What's putting you off it?
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    Well it's early and I do have other interests, but basically it boils down to my interest in the theory not translating into clinical practice.
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    (Original post by PoolR)
    Well it's early and I do have other interests, but basically it boils down to my interest in the theory not translating into clinical practice.
    Not to sound like I'm grilling you but I'm curious what kind of theory is your interest, and why you don't think it would be translatable clinically?
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    (Original post by spacepirate-James)
    Not to sound like I'm grilling you but I'm curious what kind of theory is your interest, and why you don't think it would be translatable clinically?
    That's fine, talking things through is how I deal with things anyway.

    I have done some shadowing but it was with drug addiction psychiatrist, for one.

    I believe that although I find the symptoms interesting and perhaps get a (slightly ghoulish) 'thrill' of sorts when reading about aspects of psychiatry that the work itself isn't as appealing.

    I'm not saying it doesn't appeal at all but just not as much as the subject in abstract, the negatives you listed I did see and experience somewhat, and they didn't seem too bad at the time however over years I imagine they could grate.

    Also what I saw made me think things were too rushed for the Dr to truly get to know the patient all that well, or the appointments were few and far between.
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    My background: completed psych placements at med school (Adult and Adolescent) and worked as an old age psych FY1 for 4 months.

    My comments based on my experience:

    Workload: The day job is easy. Super easy. You have time to chat to colleagues, to take lunch, to actually do your eportfolio/elearning within hours. I was once talking to a psych reg about her daughter for an hour, then someone tried to phone her and she answered saying she was too busy and would do it later, then we kept talking. Yeah.
    Psych on calls sounded like they could be a lot more work.
    However, the work a psychiatrist is doing can be very stressful. Massive oversimplification, but you are pretty much there to make two main decisions: whether to change medication or not, and whether to let the person go home or not (be it from clinic or ward). If your patient is not improving, any remaining family can find that very stressful. Mental health is inherently a lot more stressful than physical, i find. But the opposite is sometimes even worse: if they're on the ward but getting better you need to decide to let them home. But, particularly in those with schizophrenia or a history of serious suicide attempt... its often just impossible to tell who is going do something serious to themselves/others and who isn't. You risk assess of course but definitives are not a feature of psychiatry yet. And unlike, say, choosing whether to give more fluids to a septic patient or not, if a psychiatrist gets this decision wrong everyone knows you got it wrong and if the worst happens they can end up with their photo in a national newspaper. On the adolescent ward some patients had realised this and would threaten the psychiatrist into letting them stay as their home life was worse. "Doctor, if you send me home I'm going to buy 100 paracetamol and take them all then go to the Daily Mail". Then proceed to display completely normal mood and behaviour otherwise. Pretty frustrating. In my experience psychiatrists often practice very defensively, which leads me onto the next point:

    Legal aspects: It seems like about 80% of what my consultant did was purely legal stuff to cover their backs, not actual care. The documentation you have to do in psychiatry (which was my main role as the FY1!) is super super detailed. Way more detailed than anyone other than a lawyer (+ team) could ever read. Then there's a seemingly endless stream of legal forms, tribunals, relatives appealing that their relative needs to leave (or stay in). I found that aspect very... boring. Bit unpleasant but mainly just boring.
    My understanding is that psychiatrists are sued a lot, second only to Obstetricians.
    Incidentally, the nurses had to document what they did so meticulously that they had literally half their shift set aside for doing so (it took so long because none of them could type - i could have done it in about 20 minutes - but still, the fact that they were willing to do that shows a) how little work they did and b) how much emphasis on legal aspects there was among the team).

    The medicine: Everything in psych takes a long time and that makes the benefit you are doing much more difficult to see than, say, cutting out someone's appendix. You can definitely stop a suicidal patient from killing themselves, get their mood sorted and send them home to live a fulfilling life, but that process takes months, not hours/days. And then a lot of your patients will have relapses or never reach good function.
    Its important to point out that a lot of medical/surgical jobs are also like this though - neuro has few curable diseases, renal is full of people on hemodialysis, oncology puts people through chemo, etc etc. Instant gratification is not a feature of many careers. This criticism of psychiatry is sometimes a little disproportionate, albeit true. Its just that the lack of physical evidence of improvement (scan results, bloods, etc) is lacking and I think that impacts on the satisfaction a lot of doctors (including me, I admit) get from the job.

    There is also the personal danger aspect. I've never seen something serious happen, but its always a worry. Especially for home visits.

    Psych was definitely not for me (as you can probably tell). But it did have some good aspects. I agree the science is interesting, and that can form a bigger part of your day to day life if you get involved in research and/or teaching. Not very PC, but some of the patients can be quite entertaining (the manic ones or the ones very detached from reality) and the psych team always seemed to have lots of funny/interesting stories about their previous patients. One of my housemates is going into psych and he absolutely loves it - loves telling people about his crazy days. The guys who work on the forensic wards... their stories were next level disturbing. Which made for about the best lecture of med school.

    TL.DR - Obviously you should get your own experience but to sum up mine: if you can embrace the legal aspects and accept that things move slowly in psych, there are the potential rewards of potentially interesting patients, having lots of good stories to tell and generally speaking a good work-life balance and good selection of jobs (+/- research/teaching) if you make an even slightly competitive application.
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    (Original post by nexttime)
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    That was an interesting and rather in depth read - thanks for sharing your experience.

    My personal (very brief) experience of the legal aspect within Forensic Psychiatry, including the assessments written up for court, the tribunals etc was that it was all rather interesting. I do think it takes a certain sort of person to enjoy this sort of thing, and I appreciate that as a student I had a very different perspective of the work compared to someone who has done the job for the past ten years, but I enjoyed watching the work that went into these types of documentations. They went into so much detail into the patients lives, from childhood to school work, occupations to relationships, that I have not seen in any other speciality.
    The work was integrated with not only the Mental Health Act but with Law on a much bigger scale i.e. giving evidence in court, how to answer questions put to you by a lawyer, your duty as a doctor within the court etc. I find Law quite an interesting topic, so for me it was a fantastic experience.

    I fully appreciate that this isn't for everyone - one of the General Adult Psychiatrists told me that he could never become a Forensic Psychiatrist because you spent most of your time staring at a wall in your office writing up one document after another.

    I just have a quick question for you:

    I will be picking jobs for F1 in March this year, and am interested in a career in Psychiatry. Would you recommend that I do a psychiatry rotation in F1 or F2? What was the difference in limitations and experiences between yourself and the F2 on your team?

    I appreciate this would be different in different hospitals etc, but I have been told by some people that I should leave my psychiatry rotation for F2 - just interested to hear your opinion as someone who did an F1 job in the speciality.

    Thanks for your help.


    Sorry to hijack the thread OP - in response to your original question, I am interested in a career in Forensic Psychiatry/Psychotherapy, and it's great to find others with a similar interest. I would definitely recommend getting as much experience in the area as possible.

    I had some 'average' experiences in some places, but my Forensic Psychiatry placement, which I organised myself over the summer holidays, was one of the best placements I have ever had. It was not only my interest in the area (although that certainly helped), but the enthusiasm of the team, and the eagerness of my consultant to show me as much of the career as possible - from the office work to court to initial assessments of patients to tribunals. You just need to find that one person who has a passion for their speciality, and for me that was the catalyst that made me realise: I want to do this.
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    (Original post by Angury)
    ... rather in depth read...
    Haha yes.

    And no I didn't even mention how assessing a psych patient works - so much more detail. Psych clinics with their 2 hour appointments and a 40% or so DNA rate are something else.

    Re: FY1/2 - the difference where i was (which is a common theme i think) is that FY2s do on calls whilst FY1s just do the ward work. Being on call involves getting phoned by A&E and other medical facilities to come and do assessments, then running everything past a senior. You needed a car. If you are interested in psych that is probably a good experience to have and if you have the choice, I'd probably agree with the person who said try to get it in FY2.

    We had regular psych teaching, grand rounds (which lasted a whole half day per week and you could actually reliably attend!) and opportunities to do... essentially anything we wanted. They even gave me informal study leave to allow me to sit an exam (and FY1s don't get study leave so they were under no obligation to do so). A psych job should be a great opportunity for you, if its anything like where i was.
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    My eight week psychiatry placement as a medical student was with a crisis team. Every day I was out seeing acutely psychotic patients in their homes, talking down suicidal patients from bridges, watching armed police break into properties, etc. I then spent a single day on a psych "ward" where all the patients' symptoms were reasonably well controlled and I was bored out of my mind. I suppose the lesson here is that, like most specialties, being a psychiatrist can mean a number of different things depending on the setting in which you choose to work.
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    Hi, OP here. I managed to forget everything surrounding my account so I'm back here.

    It's a shame because I do feel as if I enjoy psychiatry and discussions surrounding it a lot, I followed some of the stuff in the other thread about medical anthropology and as mentioned psychiatry does bump up against humanities a fair amount which is a huge plus.

    However all the other aspects of the job, as in the day to day things, just seem a little too much for me! Or indeed the opposite where I'm essentially morphed into a quasi lawyer. I imagine the solution would be to do both and mix things up within the profession but I'm not entirely sure. All in all I am fairly sure I'll always be slightly envious of people who do go down that career path despite knowing it's probably not for me.
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    (Original post by RPool)
    Hi, OP here. I managed to forget everything surrounding my account so I'm back here.

    It's a shame because I do feel as if I enjoy psychiatry and discussions surrounding it a lot, I followed some of the stuff in the other thread about medical anthropology and as mentioned psychiatry does bump up against humanities a fair amount which is a huge plus.

    However all the other aspects of the job, as in the day to day things, just seem a little too much for me! Or indeed the opposite where I'm essentially morphed into a quasi lawyer. I imagine the solution would be to do both and mix things up within the profession but I'm not entirely sure. All in all I am fairly sure I'll always be slightly envious of people who do go down that career path despite knowing it's probably not for me.
    Whilst I do (unfortunately) stand by everything i said, what's being posted here is just individual experience mostly from people who didn't have a high baseline interest in psychiatry. I do encourage you to seek your own exposure as much as possible - you may have a different take.
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    (Original post by nexttime)
    Whilst I do (unfortunately) stand by everything i said, what's being posted here is just individual experience mostly from people who didn't have a high baseline interest in psychiatry. I do encourage you to seek your own exposure as much as possible - you may have a different take.
    Most definitely will, I like harvesting opinions from others too though, it helps me. Besides it can't hurt to hear what others think or have experienced.
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    (Original post by PoolR)
    That's fine, talking things through is how I deal with things anyway.

    I have done some shadowing but it was with drug addiction psychiatrist, for one.

    I believe that although I find the symptoms interesting and perhaps get a (slightly ghoulish) 'thrill' of sorts when reading about aspects of psychiatry that the work itself isn't as appealing.

    I'm not saying it doesn't appeal at all but just not as much as the subject in abstract, the negatives you listed I did see and experience somewhat, and they didn't seem too bad at the time however over years I imagine they could grate.

    Also what I saw made me think things were too rushed for the Dr to truly get to know the patient all that well, or the appointments were few and far between.
    What is it about the work that you think you wouldn't find appealing? (I know you mentioned some of the legal aspects above).

    I too find the theories around mental health fascinating, particularly the more sociological and public health side of things. But when shadowing psychiatrists, I've found that I have been able to translate this interest into clinical practice. I think a lot of it does come down to the type of experience you gain as a student on placement, and I certainly came across clinicians who didn't seem to have much interest in their speciality and that just led to a very dull placement - it's difficult to be enthusiastic for a speciality, even if you do have a genuine interest, if the people around you aren't keen to teach you.

    While I found certain aspects of my psychiatry placement dull, my Forensic Psychiatry placement was one of the best placements I ever had. As another example, I also find the conversation around mental health in the public sphere quite interesting, and again, it was not something that I was able to convey during my General Adult Psychiatry placement which was mostly within an inpatient unit, but I was able to see manifest itself in other areas.

    I guess it depends on what interests you about mental health, and how you can translate that into a career. Is it having the opportunity to take an in depth history, gain a unique perspective into a persons life? The psychopharmacology behind the medications? The underlying social issues? The integration between health and law, sociology and literature? What is it that you want from a career?

    I also think there are a lot of areas within Psychiatry that you can go into, and some areas may be more appealing than others depending on your personality. Over all, I would say it is helpful to gain as much experience as possible, and find clinicians who are enthusiastic about their speciality.

    I also think an interest in mental health can be useful in other areas, depending on what it is that specifically interests you; I'm currently on a GP placement which is filled with mental health.
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    Hi.

    I think it's more that when I read about the actual day to day work that a psychiatrist does it comes off as not too exciting. Also during my own shadowing it was very much the same from person to person, given that one of the things I see so often is that 'every person has a different experience etc.' I genuinely didn't see that so much - and I don't mean to be callous about it, naturally I know there are differences between people, but generally it'd be quite easy to predict what a new patient would be like/background etc.

    In essence I imagine I could talk to a psychiatrist for a very long time and have them tell me about some interesting things they've seen, the mix with humanities is also good (but I'm unsure if it's something I could sustain an interest in for very long if I'm realistic about it, by which I mean decades). Basically I've to work out whether I'd be happy just reading the odd pop psychology book or if it's something I really want to be in the mix of.

    By the by the psychiatrists I shadowed were enthusiastic and pretty amazing, the consultants were at least, whereas the more junior ones seemed a little less enthused - seems to be the colossal amount of paperwork which had them irritated though, not the actual job. Oh, and occasional frustration with how their patients didn't tend to get 'better', as it were.

    As mentioned though I'll work on more shadowing - any other places for me to go poke around whilst I'm at it?
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    (Original post by RPool)
    As mentioned though I'll work on more shadowing - any other places for me to go poke around whilst I'm at it?
    Don't forget that you can make any specialty more colourful with some teaching (students and junior doctors), outpatient work (e.g. in your subspecialty), emergency work (e.g. the general psychiatry element), research, medico-legal work, writing, etc.

    Do you have access to the forum at Doctors.Net.UK? If so, it might be worth asking in the psychiatry forum for a perspective from people who are working in that field. The posters there will often give a very honest perspective on their specialties.
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    (Original post by RPool)
    x
    Some thoughts about things you could see other than addictions (which I think as you said can be a bit samey):

    General adult - Make sure you get some solid experience in general adult psychiatry inpatient. It gives a great experience to see a mix of patients and broad range of psychiatric conditions and issues. Fairly fundamental and standard psychiatry.

    Liaison - Good liaison psychiatry is incredibly fun and engaging. Its integration with emergency department and medical services gives it that sort of 'fast(er)' pace. Following a liaison team is exciting and you realise how important liaison is. I've found that generally medical doctors are quite appreciative of liaison psychiatrists! NB: If you have the chance see if you can follow/talk to the psychiatrist who deals with transplants/oncology if there is one in the service.

    Old age - Surprisingly rewarding! Slower pace but don't write it off entirely. You see a lot of dementia, Alzheimer's. Treatment is mostly nonexistent but a lot of the cognitive/assessment stuff is quite interesting from a research side. If you follow a junior doctor in old age you will also get to see a lot of medical stuff.

    Psychotherapy - Worth repeating the obvious: a lot of talking. You kind of have to already like psychology/psychotherapy to like this. I think it's really useful to get to grips with what psychotherapy entails and the intervention is conceptually really interesting - especially psychodynamic therapy. You will be sitting on a low cushioned seat for most of the day. NB: If you have the chance I'd recommend seeing psychotherapy (especially CBT, CAT, EMDR) practiced in a specialised psychological trauma service. You get some unforgettable patients and experiences but can be emotionally draining.

    CAMHS - I really liked the few outpatient clinics in CAMHS I had sat in on but not everyone does. The specialty invites a lot debate, controversy, skepticism. A lot of emphasis on social and family.

    Forensics - Hard to get experience in forensics but worth it I think even for a day or two. Gives plenty of dinner party fodder talk; terrorism and extremism is the new psych vogue thing right now. Secure units and prisons are interesting environments. Some people genuinely find forensics too intense/scary however.

    Other - Don't have a lot of experience in these personally but you could get some community-based experience in early intervention services, crisis services, eating disorders, rehabilitation, young persons service or homelessness service (if you have a local one). Or some other subspecialties like learning disabilities or neuropsychiatry or perinatal.
 
 
 
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