Throwaway05
2d ago
Medschool isn't difficult, neither is studying finance. Barely anyone wash out of either and testing with bringing in less talented people show that it doesn't affect graduation rates much at all.
I don't think this is true at all.
With respect to pure academic difficulty Medicine may not be the most difficult, but it does have pretty much the highest volume of content. Keeping up with years of punishing pace (often while doing multiple other things) is incredibly difficult. Once clinical years roll around you are doing things like rotations that could be over 80 hours a week while studying for an academic test, working weekends, pulling 24s and all kinds of other hellacious things.
That bit aside - the selection pressure for Med School is intense. The average MCAT score in an accepted individual corresponds to an 86th percentile. That's a phenomenal amount of filtering out. Once you get to school the drop out rate is pretty low - somewhere in the 3-5 percent range. That is with the intense selection pressures however.
Additionally a dirty secret is that schools will drag you to the finish line (maybe requiring extra years) knowing that doing so will leave you unable to match. Completion without advancement isn't really that, but it is part of the stat juking and realistically residency completion is a much better reflection of "washing out" or not. Advancing through to get your MD and then independent practice is a really different number, if you start with possibly the best reflection: "intention to be a doctor" to "finishing the path" then the completion percentage is probably under 20% or something else obscene.
Throwaway05
2d ago
All granny with a UTI needs is Prozac and Zyprexa!
Throwaway05
2d ago
Oh that would make sense - I just googled and saw born in Germany and the irony/appropriateness took me.
German heritage is a pretty good pick for generic American at this point so it would have made sense.
Throwaway05
3d ago
Apparently he is German. I do not think this invalidates him being American in any way though lol.
Throwaway05
3d ago
I mean lifestyle interventions are always the first recommendation for everything - lose weight and your BP improves. Socialize and exercise more and your depression improves. People don't do these things so we hit the second line interventions of actual medicine that are a band-aid not a solution.
In the case of SSRIs, if one doesn't work....you just switch to the next thing. Psych has more viable first and second line agents than most disciplines. Even if hit rates are lower it isn't a big deal.
Additionally, depression is more of a syndrome than a disease - shit life syndrome, major depression due to a cardiac problems, classic melancholic depression, all of these things manifest slightly differently but more or less the same and zero percent chance we have a full understanding of the underlying pathophysiology. Shit life syndrome likely responds poorly to medication, but how are you going to define that and separate it for the purposes of research?
Throwaway05
3d ago
Do physicians generally “know” or feel with a high degree of confidence when they’ve correctly zeroed in on what the problem is?
It depends on the thing, but it is important to keep in mind that for many problems diagnosis is not important (especially in psychiatry). Fixing a problem is important, but a clear diagnosis? Nah. In psychiatry most problems are fixed by an SSRI or an antipsychotic - who cares if they have schizophrenia, schizoaffective, or bipolar disorder if the solution is the same. Who cares what the cause of the hypertension is? Rule out some important things to rule out, and then move on.
Also because the level of specificity - sick, infection, bacterial infection, anaerobic bacterial infection, a specific organism, the specific genetic profile of the specific strain of that organism, all of these are accurate diagnosis, but you can stop early and often should.
So it's hard to answer some of these questions without being reductive or ponderous.
Prions
Our tools aren't magic - for a long time the start of the art for identifying bacteria was dumping dye on it. Identifying something as weird as your own bits during slightly weird shit is hard as hell.
Throwaway05
3d ago
Now this is my shit right here. How do psychiatrists gauge whether they’re more or less on path to following a proper diagnosis?
Oh boy. This is a long and tough topic. So Medicine is hard. Some people get that some people don't but it needs to be carefully examined.
Some questions are harder than you think, and we don't realize it because we take so much for granted.
So like what is a disease anyway? What is sepsis?
The later is a question still under investigation even though treating sepsis is a core hospital task.
What about a run of the mill bacteria infection? Well turns out usually we are just pattern matching or guessing based off of what died to the antibiotic. An actual culture is useless or impossible most of the time. Spirochetes took forever to identify because splashing shit with these colors we usually use didn't work (yes that's what we do! Random dye!).
A lot of stuff might be an infection and we just don't know yet because who knows what caused it. It's a miracle we figure out prions existed for instance.
So sewing and cutting and surgery is great and all but the noodly thinking bits are an important and interesting part of medicine. Cue nosology.
But you asked about psychiatry though.
That's a further complicated question. The brain is like the most complicated thing in existence, and mental health is the most complicated and multifactorial aspect of medicine.
The specifics become specific, it is why doctors have jobs after all. Some diseases have neuro-chemical markers, brain imaging findings, genetic components and other "hard stuff." This is evolving and of unclear clinical significance.
Sometimes we go off what facilitates communication - depression is hard to define. If everyone including the patients agrees what depression is then you've found it. Sometimes this becomes a cultural negotiation.
Sometimes clinical response is king - if it looks like a duck and quacks like a duck and gets slaughtered by medication like a duck then you got it.
To TLDR it - explaining the specifics of a diagnosis in a thorough way is easy to convey to people in the field who have a shared assumption base, but to people outside of it a lot will be lost in translation and it can look like some stupid questionnaire defines everything.
The rigor isn't what we want but it's more than you fear.
Throwaway05
4d ago
It's impossible to have a good version of this talk in this setting, but I will try - usually (but not always, I'm not there, I don't know what you are struggling with) the problem for early phase trainees is excess cognitive load associated with stuff that should be "free." Writing notes shouldn't usually require thinking, it should only require time. Basic interviews will be effortless. Physical exam (oh wait psych lol)...
Later the difficulty will be true medical decision making in complicated cases, advanced level exam and interview, and leadership and administrative tasks. These have higher ceilings.
For now you are probably finding it painful to do basic things. I mean yeah, that is what training is for. Most of the work is those basic things though, and as you do them more often you will find them easier, they will be automatic. Even sitting at your desk working is less exhausting if dictating or typing your note is automatic and not an onerous process as you remember how to accurately describe such and such thing.
Example - as you start getting more experience you'll notice how remembering everything for the patient encounter gets easier. This is not because you are gaining memory kung-fu, it is because your brain is automatically knowing what is important and pertinent and what is default.
This process will happen as time goes on, but with some mindfulness you can accelerate it - or if that's hard you can just ride the wave and know it will happen.
It's happened before for every trainee and it will happen to you.
One of my favorite processes in medical education is watching textbook driven people go "you aren't teaching me" and then gradually realizing that the work is the teaching and that they learned the textbook without needing to sit down and do that bullshit.
It comes. It's hard and you have to do it, but the knowledge and skills come.
Then things get easier.
*Above advice not valid for procedural skills.
Throwaway05
4d ago
This is going to be my life for the next 5 months, no relief from the pain.
Rotations get better. By the end you'll look back at your level of knowledge and efficiency and be horrified. Remember this part.
Also - I think you said you are on consults, consults in any specialty are highly variable. Some seasons, weeks, months are harder than others. Sometimes jack shit will happen because the hospital is stuffed and another specialty is suffering. The tide goes in an and out, but it does GO.
When I was in residency I had a senior who made the claim that people are fast or slow, and that that never changes. I've learned that's true, but only for some personalities. You do not have that personality.
You can get faster and more efficient if you want to. So want to. And figure out how to do that.
Throwaway05
4d ago
https://thelastpsychiatrist.com/2011/03/bad_at_math.html
Tis a shrink tradition.
Throwaway05
5d ago
psychotics on public transit,
Who said anything about the mentally ill? Threats of murder are how Americans say hello.
Throwaway05
5d ago
If I ever stop posting it is because I relayed this idea to the missus.
Throwaway05
5d ago
I have literally already had a patient threaten to shoot me today!
...and that's not counting the nonsense on my commute.
Throwaway05
5d ago
gym I'm going to for the next week and change is for the mind
Time to plug my favorite cultivation novel!
https://www.royalroad.com/fiction/41330/virtuous-sons-a-greco-roman-xianxia
Throwaway05
6d ago
Is Hantavirus that much of a big deal?
No.
Among other things it has a much smaller window of H2H transmission.
Sure other countries are different, the US is notorious - they should still be doing 24s at least though, no?
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