Every Rose Has Its Thorns

Ah, psych...a pretty intriguing and plush rotation when compared with the others I've done so far. For human interest and humane hours, it can't be beat. The residents and attendings I've interacted with thus far are smart and decent. Refugees from other specialties come every week to check out the program and consider switching over to the psych-side.

So of course, one is tempted to consider this as a chosen specialty. And yet...

For every positive outcome I've seen take place, there are six or seven or fifty patients hanging around the day room without a seeming hope of improvement. Some get worse and not better under our care. Not even the positive changes can be wholly attributed to the profession.

Then again, are positive changes in any specialty ever wholly under control of the medical staff? Isn't there always an element of spirit, fate, luck, or whatever you prefer to call it, to healing? And don't psychiatric patients, possessing of a positive prognosis or not, deserve our best attempt at care?

As far as I can tell, to be both a good and a fulfilled psychiatrist, you would have to be not only tolerant of ambiguity but be able to thrive in a sea of it. One online test I have taken designed to match future specialty to med student personalities told me that I might be such a person (http://www.med-ed.virginia.edu/specialties/TestStructure.cfm , I would recommend this whatever specialty you think you're destined for...)

Then again, after nearly a month of this, an argument against choosing psych has emerged, and it goes like this: Why not head toward something like family med, where you interact mainly with highly functional patients, problems like hypercholesterolemia can more or less be brought under control by the numbers, and the vast majority of patients get better?

We shall see...