What Exams?!

It's the weekend before another round of exams. And for the life of me, I just can't get motivated to study. So I do what I do best under these circumstances - procrastinate, something I have skillfully mastered after spending most of my life as a student. Cleaning, doing laundry, fixing up my bike, day-dreaming, reading about photography, going to the marina for coffee, making dinner, and blogging about procrastination - it's been a success! I have avoided looking at anything that has anything to do with psychiatry for a whole day.

Perhaps this is the manifestation of my ambivalence towards psychiatry. I'm ready for the rotation to end, not that I have any ill feelings about the specialty. To the contrary, I think it's a very important field without which medicine wouldn't be complete. From what I've seen, it's the only field in conventional Western medicine that treats its patients with a holistic approach, the whole biopsychosocial model med schools are so desperate to teach to the next generation of doctors. During this rotation, I have seen plenty of patients whose debilitating mental illnesses have been treated and managed well enough to allow them to initiate steps toward getting their lives back on track. So I don't think psychiatry is not "real" medicine, it's just that I don't think I can hack it.

Many people say, and I also believe, it takes someone with a certain personality to do psychiatry. By "certain personality," I don't mean crazy. Talking is of paramount importance in the field. Because there is no lab tests for most psychiatric illnesses, results from history-taking, or interviews, are the only information available to diagnose them. Conversational and interpersonal skills are essential for a successful interview. The ability to make people relaxed, to accurately read people's body language and their tone of voice, to ask questions in a way to solicit useful answers are all qualities in this "certain personality." A psychiatrist would have to be, in a way, manipulative to get the information he needs for an accurate diagnosis. I'm the first to admit that I'm not a great conversationalist. Sure, that's what the years of post-grad training program is for. But why train a monkey to walk on two legs when he's really good at swinging from branch to branch?

Another reason for psychiatry to be not my cup of tea is that I find its inadequacies frustrating. The mental health inpatient unit works in a somewhat revolving-door fashion. Patients present acutely, they are treated until they are well enough, then they are discharged, only to present again soon after with another acute episode that requires admission. Part of it is that psychiatric illnesses are chronic conditions, and part of it is a reflection of our social problems. Most of the patients reflect a cross section of society that is in many ways confounding their treatment: homelessness, neglect, abuse, self-harm, social isolation... Often times, psychiatry warps into social work, balancing the safety of the patient and the community against the need for an empty bed that will be filled by the next admission waiting in ED, knowing the patient will probably re-present acutely before his next outpatient appointment. In this regard I am impatient, I want instant gratification, I want tangible results now. I prefer surgery where the patient presents with a problem, a diagnosis is made, followed by surgery, the patient makes a recovery and is discharged; case closed. The idea of presentations that end with definite results, whether good or bad, appeals to me. That's something psychiatry tends to lack.

This rotation not only gave me new-found respect for psychiatrists, but also helped me put psychiatry lower on the list of possible future careers. Like they all say, it's not you, psychiatry, it's me.

And with that, I have killed the remainder of today. Good job.

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While ruminating on the topic of psychiatry, I cooked up tonight's dinner: vegetarian fettuccini topped with grilled haloumi and avocado.