Shirah Vollmer MD

The Musings of Dr. Vollmer

Why Be A Psychiatrist?

Posted by Dr. Vollmer on September 17, 2013

Who becomes a psychiatrist? Many would say those that can’t stand the site of blood. I always took issue with that half-joke, half-truth comment, because for me, I really really like blood. I like organs. I liked my surgery rotations. I liked drawing blood. I became a psychiatrist because I never wanted to get bored. At the time, all other specialties were following algorithms, meaning that once these were mastered, there seemed to be little challenge. With psychiatry, talking to people, is always new and different. I like that. I wonder if that same principle applies to my younger colleagues. Were they drawn to listen to stories, or were they drawn to the fun of psychopharmacology? Psychopharmacology is fun, in that people get better from medication and this, of course, is very satisfying. Still, I wonder how young people decide their specialty these days. A psychiatry rotation in medical school deals with chronic mental illness. It would be hard to extrapolate from that, my daily life as a private practice psychiatrist. I am sure there are the practical considerations of paying back loans, controlling one’s hours, and the amount of overnight call. I think I should ask my students. Stay tuned.

4 Responses to “Why Be A Psychiatrist?”

  1. Jon said

    OK, I’ll bit. What did they say?

  2. Shelly said

    My intern friend hated her psychiatry rotation because she said that nobody ever gets better. With meds, diseases can be controlled but not cured. The schizophrenic can control the voices, for a time; the bipolar can learn techniques to moderate between the highs and lows. The anxious can meditate or take yoga or pop Ativan. And really, don’t the stories from your long-term patients get repetitive and boring? Don’t you get frustrated and upset when you see your patients falling into their routines even though you’ve spent years discussing with them the pitfalls in their lives? Don’t you ever want to “divorce” patients? How is psychoparmacology in psychiatry any different than psychopharmacology in neurology or cardiology or internal medicine?

    • The issue with psychiatry is that it is a long game. A rotation cannot possibly clue one in to the rewards of long-term work. I think of psychiatry as I think of parenting. One hopes that the ideas and the relationship, over time, will give rise to a beautiful flower. Another way of thinking about it is that it is fertilizing soil, with the hopes of better growth. People are not schizophrenic or bipolar, but they are Tom, Sally and Carolyn, and within each person are struggles which can get better. It is this personal relationship which makes my work fulfilling, and of course, through this blog, is how I express my deep concern that these relationships are fading into a distant past. In terms of boredom or frustration, this comes with every relationship, and so it is a bump in the road, that hopefully can eventually lead to a deeper and more stimulating relationship. Again, as with this blog, sometimes I repeat my ideas, knowing that I am repetitive, but trying to push through to a deeper truth. Relationships go through struggles, and so the same is true for psychotherapy. A divorce is a really sad event, but again, like all relationships, both parties take away a piece of the other, even when there is a divorce. Pharmacology is very different in psychiatry, because the patient is the main arbiter of the response. In cardiology, there are objective measures, like blood pressure and cholesterol levels. We, as psychiatrists, must rely on tone, affect, posture, eye contact, general intuition, and sometimes collateral information, to determine the success or failure of our intervention. Thanks.

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