meus intuitus

why psych?

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I’m taking a mental health break (double entendre intended) tonight to write this post about my impression of primary care medicine and my thoughts on my career path so far.

I’m beginning to develop a particular sentiment—a feeling that may progress into a genuine and personal philosophy on medicine.  After working in a fast-paced 20-patients-a-day primary care clinic for a week and a half, I am finding myself somewhat uninspired.  Medicine is just so…  Algorithmic.  Reflexive.  Rote.  Patient complains of X, Y, Z?  Test him with A, treat him with B, failing that try C.  These are what the data tell us to do.  Unlike what I was promised, there is no art here.  The art is lost to the minutia.  It’s not that it should be any other way—evidenced-based medicine is a wonderful thing.  It just may not be right for me.  If there is anything I have learned in the last two years of medical school, it’s how extremely right-brained I am.  The regiments of medicine easily slip through the sieves of my creativity, inspiration, and intuition.  Ambition got me into medical school, but ambition is not enough to build a career, a life on.

Thankfully, medicine provides its own exit:  Psychiatry.  For all the reasons that my colleagues hate psychiatry, I love it.  No obvious right answers, intricacy of personalities, no measurable chemicals.  This is the realm of the intuitive.  Certainly, plenty of measurement and empiricism is present (otherwise it would be quackery), but the cores of the analyses are amorphous.  The mind is complex in a way that we, as complex as our minds are, can not even fathom.  The mind is like the weather—billions of inputs, effects, and endless results; you can make small predictions about it, but bet on what it will do next year and you will lose your wagers.  Indeed, like the weather, but more complex.  It takes a technician (albeit an admirable, dedicated, and high-functioning one) to be a master of medicine, but it takes an intuitive to be a proper psychiatrist.  Internal medicine is checklists, criteria, and algorithms.  Psychiatry is understanding.  The psychiatric patient may fulfill the checklists for depression, but if you understand her well enough, you may yet come to the conclusion that her trials are more chiefly situational and that all she needs is some extensive support and guidance; you must then determine the nature of the support and guidance you will provide—something that, again, requires understanding.  This, at least, is my fledgling impression of psychiatry from the four weeks I spent on it.

More practically, I am just more interested in minds than I am bodies.  As noble and important as it is, I seriously don’t give a damn about managing a 50-year-old’s LDL cholesterol levels so that he can get a little more mileage out of his wretched body.  Life, for me, is not about longevity.  Life is about experience, revelation, and enlightenment.  Life is about growth.  Longevity is merely a conveniently large canvas upon which to paint the progression of our minds.  I want to help people grow—out of their demons, out of their prisons, and into better versions of their former selves.

This past year, there was a psychiatrist who got locked in a cell with a homicidal psychiatric patient.  The patient laughed and advanced towards the psychiatrist.  The psychiatrist, in spite of his horror, analyzed the situation and stated, “you can not hurt me!  It’s snowing outside.”  The patient’s thoughts blocked and his movements ceased with them “…what?”  The psychiatrist repeated, “that’s right!  You can’t hurt me because… it’s snowing outside!”   The patient clutched his head with both hands and began pacing the room, “…what?!”  The orderlies had just enough time to get the keys to the cell and the doctor was freed.  That’s understanding.  ~True story

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Written by meusintuitus

August 22, 2012 at 6:14 pm

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