Why psychiatry?

The specialty is facing a crisis in recruitment in many countries, but a career in psychiatry is appealing and rewarding. So "why not?" asks Sabina Dosani

There's never a dull moment in psychiatry. Psychiatry is, after all, the branch of medicine that offers everything: people and stories as well as symptoms and signs; a chance to use medical skills but also develop expertise in therapeutic communication; continuity of care; emergency work; flexible working; and rapid promotion. That's why it's so difficult to understand why psychiatry is facing a "fundamental recruitment crisis" in the United Kingdom and many other countries.¹ The question medical students ought to be asking is not so much "why go into psychiatry?" as "why not?"

Psychiatry is progressive. Long gone are the days of the men in white coats carting off someone to the local asylum, never to return. Few other specialties today offer a comparable degree of variety and rapid career progression.

A handful of psychiatric conditions have a routine diagnostic test. Most depend on a detailed history, careful examination of mental state, and thorough physical examination. The interpersonal contact offered by this diagnostic process is unrivalled. Assessing patients is intellectually stimulating and emotionally engaging in equal measures-something that cannot be said of most disciplines.

Working in multidisciplinary teams seems to be less hierarchical in psychiatry than in most other specialties.

AJ PHOTOS/SPL
Never a dull moment for you, that is

Sharing ideas and perspectives with colleagues from different professional backgrounds is especially helpful when faced with complex diagnostic cases that are difficult to formulate and manage.

Diagnosis draws on almost every aspect of medical training.² This is particularly true in liaison psychiatry, the subspecialty concerned with the psychiatric needs of patients in general hospital beds or outpatient clinics. Liaison psychiatrists have particular expertise in the interface between psychological and physical health, managing medically unexplained symptoms as well as treating acutely disturbed patients, presenting often complex comorbidities as well as challenging legal dilemmas.

If you enjoy medicolegal work then forensic psychiatry, the discipline responsible for caring for mentally disordered offenders, may be for you. Forensic psychiatrists may be based in prisons, secure units, special hospitals, or general psychiatric hospitals. They work closely with the judiciary providing expertise on issues like fitness to plead, criminal responsibility, and risk.

The past decade has seen rapid advances in understanding the cause of a number of neuropsychiatric conditions and developing management protocols-for example, the treatment of Alzheimer's dementia. Old age psychiatry has emerged as the ball going Cinderella subspecialty. It offersunique opportunities for psychiatrists who enjoy adult psychiatry but also appreciate applying general medical training. Psychiatrists working with elderly people predominantly assess and manage patients with cognitive impairment, together with a team typically comprising community psychiatric nurses, occupational therapists, social workers, and psychologists.

Child and adolescent psychiatrists are also predominantly based in the community and work in multidisciplinary teams. They see children and young people with emotional, behavioural, and intellectual problems. Here, I must confess a conflict of interest: my clinical passion is child psychiatry. I find it endlessly exciting, thought provoking and rewarding. A positive treatment outcome can literally change the course of a young person's life. Child and adolescent psychiatrists develop close relationships with multiple generations and often play a key role in breaking disruptive patterns of behaviour that have repeated themselves over decades, if not centuries. We work using a combination of pharmacology, cognitive behaviour therapy, psychotherapy, and family therapy. Forget the cliche of people playing with dolls in darkened rooms. Most work is short term, goal focussed, and there is a growing evidence base for drug and talking treatments.

Psychiatry has always tended to appeal to medical students with an interest in the arts and humanities.³ However, if you prefer developing hypotheses, testing research ideas, developing new ideas and innovatory approaches, academic psychiatry ought to be high on your list of career options.

Psychiatry: an intellectually gratifying, emotionally rewarding job that's compatible with a life outside medicine, offers rapid career progression, and at the moment has a shortage of consultants. So, why not?

Competing interests: None declared.

See Careers pp 335-6 for an article on forensic psychiatry.

Sabina Dosani, consultant child and adolescent psychiatrist, Maudsley Hospital, London
Email: sabina.dosani@slam.nhs.uk


studentBMJ 2006;14:309-352 September ISSN 0966-6494

1. El-Sayeh HG, Budd S, Waller R, Holmes J. How to win the hearts and minds of students in psychiatry. Advan Psychiatr Treat 2006;12:182 92.
2. Feifel D, Moutier CY, Swerdlow NR. Attitudes toward psychiatry as a prospective career among students entering medical school. Am J Psychiatry 1999;156:1397-402.
3. Cutler JL, Alspector SL, Harding KJ, Wright LL, Graham MJ. Medical students' perceptions of psychiatry as a career choice. Acad Psychiatry 2006;30:144-9.

   

           

	EDITORIALS Why psychiatry?       Sabina Dosani (September 2006)
	Kimberley M Kendall ( August 30th, 2006)       Medical Student Intercalating in Medical Genetics, Cardiff University kimkendall007@hotmail.com
	The question 'why not psychiatry?' is one that has occurred to me on a number of occasions. The number of students in my year at medical school who have expressed an interest in psychiatry as a career is relatively low. It is for this reason that I took enjoyment in reading Sabina Dosani's article on the merits of psychiatry as a choice of specialty. I believe that one of the main reasons medical students tend not to express an interest in psychiatry is stereotypes. The stereotypical image of the 'mad' patient and the psychiatrist who is almost as bad as them has not helped the popularity of the specialty. Unfortunately, the experience we get to rectify these stereotypes often comes later in the medical curriculum. By then, we have formed opinions about the specialty without really experiencing it. Child and adolescent psychiatry is often particularly neglected with regards to clinical attachments. Many see psychiatry as a depressing specialty. Of course, some of the things you hear in psychiatry are extremely sad. However, students often fail to realise that there are many ups as well as the downs. As Sabina Dosani commented, 'there's never a dull moment in psychiatry'. I have a particular interest in child and adolescent psychiatry and have been lucky enough to work as a research assistant at a child and adolescent psychiatric clinic over the summer. There is indeed less of a hierarchy in psychiatry compared to other specialties. I regularly witnessed members of staff (both junior and senior) from different disciplines engaging in discussions and asking each other for advice. As the staff in child and adolescent psychiatric clinics do not get to see students very often, I found that I received a lot of attention while there. There was always someone willing to explain more about a condition I was interested in. An increased awareness of specialties outside the traditional medicine, surgery etc would go a long way to easing the recruitment problems for psychiatry and dispelling the myths surrounding it. This is something that would need to be addressed in the medical curriculum e.g. by delivering earlier careers advice.