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10 REASONS WHY I DO NOT WANT TO BE A PSYCHIATRIST
I
do not like to be associated with mental illness
Mental illness is perhaps among the most misunderstood diseases in medicine,
both by the layman as well as doctors. The stigma in psychiatry is often
heightened by movies which make every psychiatric illness a violent and
dangerous one, and every psychiatrist strange and often unethical. The
most prominent is perhaps the mad psychiatrist, Dr Hannibal Lector. Even
serious movies paint a bleak picture of psychiatry such as “One Flew over
the Cuckoo’s Nest”. The truth of the matter is mental illness and the
mentally ill need to be understood better. In my practice, 90% of the
patients I see are not violent or aggressive but they may have behavioural
and emotional difficulties which need care, concern and professional help.
I
do not like to practice holistic medicine
As medical students, we study progressively the basic sciences, to the
study of the lower forms of life, finally ending in studying the human
body and the diseases that afflict it. This is a material approach that
makes it easy in physical illness to ignore the person and concentrate
on the pathology. Holistic medicine emphasises that such scientific study
must be combined with a genuine concern of the patient as a fellow human
being. Psychiatry is the medical specialty that deals with diseases of
the mind. As such, there is often a need to consider all aspects of the
person. For example in schizophrenia, we have not only to treat the neurotransmitter
abnormalities, but we have to understand the impact this illness has on
the social and psychological functioning of the person.
I
do not like to deal with my patients in depth or develop a good therapeutic
alliance
In dealing with a patient with a mental disorder, psychiatrists have
to understand the patient’s background in great detail. Psychiatric history
taking may take well beyond 30 minutes, delving into aspects of the patient’s
early life, his relationships, his hobbies and interests, his responses
to numerous crises and stress as well as his feelings and attitudes. The
psychiatrist has to deal in depth with the patient’s life story. The basis
of the practice of psychiatry is the development of a good doctor-patient
relationship and the understanding that improvement in the patient’s problems
lie not in the doctor’s skill alone but also in the patient’s own self
belief. Psychiatry emphasises the need for doctor and patient to work
hand in hand.
I
do not believe that disease may have non medical causes
Psychiatry considers the medical model only as one of several models of
illness. How illness is also determined by the other factors such as psychosocial
situations, the personality and make up of the patient is always a consideration.
A patient with depression may need some correction in his brain Serotonin
but this may also be the result of the loss of the loved one whom he has
had no opportunity to grief over, just as he missed seeing his father
pass away from cancer when he was 12 years old.
I
do not like to work with other healthcare professionals
Psychiatrists work in a multidisciplinary environment in which he is the
leader of a team that may consist of the nurse, the psychologist, the
social worker as well as the occupational therapist. The multidisciplinary
concept is even stronger in child psychiatry where the team may also include
teacher and educational psychologists. Besides working in a mental health
setting, psychiatrists often liaise with their medical colleagues from
other disciplines in a general hospital setting.
I
do not like to listen to my patients
Psychiatrists spend inordinate amount of time listening to their patients
and their life story. As a result, their patients may develop a relationship
with their psychiatrist which can form the basis for helping their patients
understand themselves better.
I
do not like to work with my patients and their families
Part of the problems that patients have is their place in the family.
The psychiatrist realises that the family is a complex system that needs
to maintain an equilibrium but in doing so may cause pain and suffering
to some members in the family. For example, a child refuses to go to school
because his parents quarrel often and the mother is depressed. His school
refusal was due to his fear and concern for his mother. Dealing with the
child alone would not treat the main problem which was the marital conflict.
I
do not like to treat my patients with non medical means
Psychiatrists do give medications and electroconvulsive treatments. These
are but some of the tools that the psychiatrist is armed with. Psychotherapy
is a form of talking cure that helps patients understand themselves and
find ways to deal with their own difficulties. Psychiatry requires the
doctor to explore the life story of his patient and to develop competencies
in a number of related disciplines like neurology or medicine and to think
across disciplines.
I
do not believe that the practice of medicine is an art as well as a science
Psychiatrists are scientific in their approach to mental illness but also
learn interpersonal skills to handle their patients. The psychiatrist
also spends time learning about the basis of human behaviour and how these
behaviours can be changed. The training of psychiatrists in Singapore
involves 3 years of basic training culminating the Master of Medicine
examinations. Three further years of advance training in the form of an
apprenticeship under a senior supervisor will complete the training process.
Trainees will be rotated through all aspects of psychiatric including
child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry
as well as liaison psychiatry. Psychiatry is as much a science as it is
an art.
I
do not want to understand myself better
Psychiatrists need to understand themselves better in order to be effective
in helping others. Thus the psychiatrist has to consider his or her own
personality problems, foibles and ways of coping with stress in order
to gain a fruitful insight into himself or herself. Most psychiatrists
gain this through working with their patients and discussing their work
with senior doctors. A readiness to work through his or her own hang ups
is an essential part of the training.
If any of the above reasons fit you, psychiatry is not the specialty you would want to consider.
DR DANIEL FUNG