The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
-
Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
-
Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
-
Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
-
Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
Jump in the discussion.
No email address required.
Notes -
I suspect that I'm having a depressive relapse after a month or two of genuine euthymia. No surprise that coincides with a return to work and exam grind. My workload is probably 3-10 times what it was on my first rotation. I used to get bored during my shifts. Now I barely have a moment to park my ass, and the other doctors and I have to draw straws to decide who gets to have lunch first. I used to have the time to (at least in theory) revise my notes during working hours or browse the internet. Right now my phone is helpfully noting that I've reduced my screen time by a remarkable margin.
Is this going to get better? Hah. Haha. Hahahaha. This is going to be my life for the next 5 months, no relief from the pain. I am under-medicated for my ADHD. I have worsening migraines. I leave work wanting nothing more than to crawl into bed and stay there.
What clinched the self-diagnosis was sighing. Literal, audible sighing. The last time I was properly depressed, a junior colleague clocked this tell before I did, which surprised me, since I thought I was hiding things well. The literature, predictably, confirms a correlation. (The body keeps the score and occasionally narrates it out loud.) I caught myself doing it yesterday. Then an intern asked me why I was sighing.
@ToaKraka was kind enough to link to the PHQ-9 screening questionnaire lower in the thread. One glance at it made me wince, I didn't have to add up the numbers to know it didn't look good for me.
The good news is that Paper B pressure lifts next week, possibly forever if I pass. I have never failed an exam in my life. That fact is a load-bearing pillar of my self-esteem, and I am aware of how that sentence sounds coming from a psychiatry resident. I'm willing to risk the burnout. The exam has to be cleared eventually, deferring wouldn't buy me study time anyway, and a pass earns me twelve to eighteen months of academic reprieve. The workload stays the same. This is the only consideration keeping me from filing the current monomaniacal focus under "obviously irrational."
Apparently, around 20% of psychiatry residents experience burnout or depression. Lovely. Glad to have good company. I know the pharmacological management of depression like the back of my hand.
Before anyone panics, I'm going to talk to my GP, and warn her that I might need to see a psychiatrist. The last time I did this was slightly awkward, given that I knew precisely what she would suggest before she said it, and she was kind enough to treat me like a fellow professional and go off my self-assessment. I know precisely what to do if it gets too bad to bear.
Let's hope it's just exam stress. Being fully honest, that's not likely to be the case. But it'll help, on the margin. But tripling my stimulant dose?* Proper migraine prophylaxis? More optimism on that front. And I know the NICE referral pathways well enough to demand that I get something more immediate and robust than another course of Standard Antidepressant.
*What a fucking joke. The ADHD assessment and treatment pathway is designed to weed out 90% of people with ADHD before they see an actual psychiatrist. At least if you don't spend a third of a month's wages on a private assessment and consultation. I fell off that wagon because of... depression and ADHD. Getting back on it will be either time consuming or expensive, and I'll take the latter any day of the week.
Oh well. At least I'm not a gynecologist. Gotta look at the bright side of things.
In my experience with ADHD medicine/stimulants (both adderall and lisdexamfetamine) there was a terrifying drop off in efficacy / tolerance level increase after a very short time.
This was around Covid and there was some kind of shortage, so I got prescribed 40s of Elvanse (lisdex) and told to halve them. That was incredible for like 2 weeks. Then I had to take the whole pill. After another 3 weeks, even that stated to fade. That’s around when I quit. From time to time when I need to do long, uninterrupted, boring work I take one, and it works well, but I never do it more than three days in a row for the reason above.
Do they really work for you daily, years on end?
For 90% of my life, I never had to take them daily. Back in India, I'd normally use my methylphenidate SR infrequently, and take a sustained course only before my exams or when I had to study. I'll do anything but open a textbook when not on medication, and even then, it takes a lot of willpower to not end up procrastinating. It's not a coincidence that my Motte-posting goes up drastically around then.
That changed in the UK. I thought I could work unmedicated and save it for my professional exams. No luck. I need something like 20mg of methylphenidate SR just to keep myself going through a 9-5. Then I might need 20-50mg to get studying done on days when I'm not working. I find it borderline impossible to study at all after a full day's work.
When I'm taking methylphenidate at a stretch, over 4-6 months almost daily (as I have done for serious exams in the past)? I think there's an escalation from 20mg a day to 40mg a day over that period, which isn't that significant. And when the exam is over, I get a long drug holiday which resets any tolerance.
I was switched to dextroamphetamine (IR) last year, which is much, much easier to tolerate for me. I was being titrated up, and I was only on my second month and 5mg twice daily when I fell off the train and stopped seeing my psychiatrist. Because I was depressed. Because that's the sensible thing to do when you're getting depressed, of course. Stupidity induced by sickness aside, 10mg a day is a modest dose, and I expect that I'd have gotten up to something much higher by now.
So tolerance hasn't been a serious issue for me, or at least I never seem to get to the point where it's inadvisable to increase doses. The methylphenidate fucking sucked, so I didn't even want to increase the dose.
You probably know the usual advice: drug holidays. If you have a more experimental psych, they might be willing to swap you around between different drugs so that you never become entirely tolerant (I don't remember the degree of cross-tolerance, but methylphenidate and amphetamines have somewhat different mechanisms of action).
There's personal idiosyncracy involved, but in general, most adults on ADHD meds settle down to a steady-state and can keep it that way. It sounds like you're unlucky in having unusually fast tolerance buildup.
More options
Context Copy link
More options
Context Copy link
In retrospect you ever think you’d have chosen a different career path entirely? The front lines of health and medicine always had zero appeal to me. I definitely have my preferred path I would’ve chosen, except for the fact that the industry hadn’t matured and established such that there was a viable and well defined path at the time I’d have come of age to first begin pursuing it in higher education.
Is it possible for you to pivot to a psychiatric modality that’s less straining on you mentally? When I read the DSM-IV several years ago, that alone was enough to give me a mental illness. How do you feel about the people who say psychiatry is a fraudulent, applied science in the first place?
Not really. I entered med school because that was the default expectation, and I couldn't think of better alternatives (I was nudged, not forced into it). I discovered I genuinely like psychiatry as a subject, whereas I genuinely loathe most other branches, particularly internal medicine or surgery. Not for me.
In hindsight, I discovered I do like programming a little. But I found this out too late, and I wouldn't have been brave enough to choose that after high school. It possibly would have been a bad choice for me.
I don't know about mental fortitude on my end dawg. My ADHD diagnosis is not fake. It just didn't exist then, nor did I receive any medication. It's not like I manifested a work-ethic and appreciation for higher education of my own volition, I just found out that the drugs solved problems that nothing else could.
Yes, but you need to remember that I'm a psychiatry resident. I don't get to choose what I do or where I go for the next 2 or 3 years. This placement is unusually awful, and I can't just tell them they need to send me elsewhere. I am optimistic that after 5 months, I'll be somewhere much, much quieter.
I expect that if/when I'm more senior, and as @Throwaway05 suggests, more experienced, it won't be so bad. I have a decent idea of what I'd like to do (General Adult psychiatry, probably). That is a long time away. The British system is retarded.
I've only read the V. And the ICD-10 and 11. Sorry for being a poser. Don't worry, memorizing them gave me mental illnesses too, or at least made my existing ones worse.
I diagnose them with moderate to severe intellectual disability. Or I would, if I could. Instead, I ignore them, and feel glad about the fact that 99% of people don't have such awful takes. There's plenty of room for critique of psychiatry, which I have done myself, but it's not a fraud. I treat sensible criticism with respect.
I could have sworn you said something about The Motte overuse when on ADHD meds, but I can't find it again, so just saying this here. I have found success using LeechBlock NG extension on my PC (especially Lockdown Mode), and the StayFocused app on my phone (which does have a small monthly subscription fee).
Thank you for advice, I do appreciate it. But I will say that my Motte use is a hobby and, in a very real sense, a coping mechanism.
Let's say I've had a really, really bad time before my exams. I've been taking more stimulants than I can tolerate. They're wearing off, and my focus is gone. Or I'm waiting for the next dose to kick back in. This is dead time. I can't study. Instead, I could be using Twitter or Discord. I'd rather be here. I get to talk about interesting things with interesting people. I write about what's going on, which is in part a letter to ny future self. I hope that pain and suffering converts to some degree of amusement for my readers, someone ought to be laughing after all.
And guess what? Half of what I write about is psychiatry. I love psychiatry. I just don't like the way it's taught or trained in the UK. This gives me a small fig leaf. I can pretend that I'm being semi-productive. Maybe some if it is genuinely productive
But without truly draconian steps, being on the Motte is good for me. It's where the people cheering me on live.
More options
Context Copy link
More options
Context Copy link
I know what residency is, I’m just loosely thinking about your career trajectory more broadly. Residency can’t be pretty brutal, sorry to hear what you’re going through.
I haven’t read the ICD-10. My mother was a homemaker all her life but her small library was filled to the brim with a lot of medical literature that she liked to read and study about (for some reason). Occasionally I picked things up here and there.
But don’t be down on yourself to think you didn’t have the bravery to go into programming when you entered fucking medical school. Passion is what allows you to endure and if you’re going through that, you’re a very capable guy. My like of healthcare as a subject matter rests at the floor. I couldn’t do what you’re doing.
Hahahahaha.
There’s actually quite a sizable minority of people in the US that truly believe that. Maybe it’s the case that psychiatrists over-diagnose people(?); don’t know. I’ve never seen one. A lot of people seem to think psychiatrists are just glorified counselors that deal drugs. I don’t know if it’s still a common practice to think you can establish a working hypothesis on someone in 15 minutes. That seems completely absurd to me. But I’d take your word on the matter as a psychiatrist over mine any day of the week.
Really hope you do well.
Thank you. Yeah, it can be an uphill struggle. But when I feel like crying myself to sleep, I remind myself I didn't become an OBGYN resident and the smiles sort themselves out. Psychiatry is probably the least taxing? I don't know, maybe the Public Health or Occupational Medicine people sleep at their cubicle all day.
Very kind of you to say. I will note that being a programmer in India is not a good time. The opposite even. If I'd grown up in the States, maybe I'd have been more open to the idea, but life is what it is. I even seriously considered a career pivot and was grinding MIT OCW and Leetcode (I did one medium successfully!) before I matched into psych, but I desisted when I realized that GPT-4 was better than me and would stay that way. Good call. I'd be so screwed right now.
Goodness. I only read that stuff because I'm paid to. Tell her it's not too late to become a shrink, I've seen junior doctors in their late 40s in the UK. Why do all of that for free?
Psychiatrists both overdiagnose and underdiagnose people. We misdiagnose people too. We're only human. Some of us are better than others (for example, I'm worse). It depends on a lot of considerations, and most importantly, we don't really have blood tests for depression or a brain scan we can do to declare schizophrenia. You have to consider all kinds of nitty-gritty details like the tradeoff between sensitivity and specificity, ROCs, cost-benefit analyses etc, inter-rater validity for diagnoses etc. But there is no obvious rampant abuse where I can see it.
Thank you! So do I :(
It’s an attitude that certainly helps. I won’t say I was ever strongly interested in psychiatry per se, but one thing I always paid attention to in my intellectual development was publishing houses and the topics they often target. I was obsessed several years ago by reading a lot of what came out of Guilford Press and read a concise copy of the DSM-IV that was really popular. I loved it and it caused me to go into a real deep dive into that world for a few weeks before I moved onto other topics.
Any reason why?
Indeed. The tech sector is getting crushed quite badly from what my friends are experiencing right now. And they are ‘not’ fans of the whole AI thing at all. I know how to code here and there but as far as large-scale enterprise projects, yeah; no. I don’t want that on my shoulders. I’m content being a fully middle of the road kind of guy. Mentally I could handle that kind of pressure. I’ve always had the grit to face down stress and pain, but it doesn’t mean I enjoy it. I hate it as much as anyone else does.
I think she just had a passion for that stuff, the same one that I’m lacking to go into a field like that. She’s deceased now but when I was a kid all throughout life she’d be keeping up with that stuff. I only read a fraction of it in broad strokes.
Now this is my shit right here. How do psychiatrists gauge whether they’re more or less on path to following a proper diagnosis? I still imagine there’s a rigorous process in place that’s more than just professional guesswork (although I’m sure sometimes it seems that way, it’s multidimensional).
Do you think it’s possible to have something like blood tests for depression in the future? I’ve read quite a lot on Behavioral Genetics (not trying to get far away from psychiatry) but is it possible there will ever be a cross-disciplinary convergence where psychiatry may be subsumed into some greater branch of genetics? When I read studies about how divorce is heritable (or rather it shares a strong genetic link) or just how strongly our biology determines personality and behavior, it’s startling at times. Especially if parenting really doesn’t matter all that much, then maybe fields like psychiatry and pharmacotherapy or pharmacogenomics may dominate the healthcare of the future. Fascinating to me.
You got this, 😤 ❤️ 👊.
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.
Thanks for showing up. I suppose you can still sympathize with an early-career sod like me, and I'm grateful for that. Now all we need is @reo for the senior psychiatrist take. Don't let the team down dawg!
there are so many replies that i got confused as to where to place this. so i just wrote about the philosophy of medicine, as i understand.
Medicine is the only field where the tool and the patient are the same kind of things - one complex human system meeting another complex human system. That is not a limitation, which needs to be overcome. It is precisely the practice.
Medicine is basically a field where no single model is complete, and the models are always being revised.
By model, i mean it is a simplified picture of how something is or how it works. And it is useful exactly because it leaves things out. Doctors are a special kind of cartographers trying to build up better and better maps to different types of territories.
How do we build those? We started with dissecting the human body, of a cadaver precisely not alive human. Some of us had experience with dissecting a frog or cockroaches (plenty a dime at my place). if you have never seen an open frog, you would be very surprised how much empty it really is. so we cut open a cadaver slowly, methodically, and matched with the photographs in an accompanying manual. we did what it asked us to do, and we continued to match and understand the specific naming systems. the naming systems and particular language are a new language which we learnt so that we can read and talk through that new language with other doctors and nurses and be sure what we are trying to convey is correctly and unambiguously understood by them. and we use it to read books, articles, journals, all life.
Over time, we got comfortable building those new language and mental models of how some particular structure in body is seen and how it is expected to be at a certain place only and not at some other place. Then we shifted to not normal stuff aka pathology. Those normal structures - how can they go wrong. so that knowledge was built upon multiple such cuttings of not-normal structures. We built branches over our normal mental models. eg. the stomach model has this normal model and these abnormal models (which can be of a huge variety).
We also pattern matched these newer not-normal models to find patterns across multiple structures and systems. So, we found Infection Models work reasonably well across the Stomach model, Liver model, Kidney model, etc. This all works pretty well for most of the structures.
Except the brain system. The system is completely different from all other systems. For example, it has a different way of blood supply. Which we named blood-brain-barrier (just a model to say that there is some kind of barrier to normal passage of stuff between the brain tissue and blood).
Over time, more correctly in only last few decades, we have started to see the brain in exquisite detail live and we have been able to have some understanding of which side and which parts of it do what (or get active doing some particular activity).
So for brain things, the models are relatively new and they have to be assessed in terms of what the patient says about his problems, how we are able to see what is happening, what we give (by trial and error) and how it affects the patients. we keep on doing it, write the entire process and revise it more and more. since it is a relatively new field, there are lot of competing what-to-do models, including non-medicinal models and medicine-models. we have done lot of experimental stuff to name all the various little parts of all these models (namely the little chemicals which go to and fro), but they are mostly arbitrary. imo, we are a long way from deep understanding.
The brain has a different problem too. The structure of brain and the function of brain are very disjointed categories. like if you are reading this line, a combination of light pattern goes from this LED to your eyeball, to a functioning wire connecting the back of the eyeball to back of your brain, and then it lights up a particular set of other wires, which are criss-crossed across lot of other brain parts. This is just this little reading line. add the memory of this particular style of light pattern with what it means. now build upon this layer of complexity to what things are normal (the normal model). what things are out of normal (huge number of other not-normal models). and what-to-do models about all those.
When someone thinks of DSM as some sort of fixed written well defined set of maps, i think it is a wrong idea - it is like confusing the map with the territory. IMO, it is a good (at present) way to have a comprehensive set of loose maps. and it will be revised as our understanding gets better, sometimes worse before getting better. sometimes, there will be paradigm shifts.
Same with the genetics parts: yes, those are some newer models, in which we pattern-matched some particular sequences with some disease patterns, because we found few which were absolutely always associated with one particular way of the patient's model of behavior (we call them sure-shot way to label a model). and at other times, it was just found to be more common (we call them more or less probable ways of having a particular set of problem model).
But my base understanding is: Medicine is an interactive playing of what patient shows up, what lenses the doctors have, what models are used to try to change the course of patient's behavior and how it can help in changing the course. At times, it is as simple to sit and listen to the patient and the doctor needs to lend the ear and hold the hand. And at other times, it is a full fledged active working of doctor, a nurse, and 3 attendants to tie the patient and give a sleeping medicine.
So, given how much of this is model-stacking on model-stacking, where does the irreducible human encounter fit? I don't think it as a failure of science, but as the thing which makes medicine medicine and not engineering.
More options
Context Copy link
More options
Context Copy link
Well differential diagnosis is always a struggle to deal with because symptoms may be compatible with a handful of underlying conditions. Common symptoms are also more often than not precursors to more narrowly defined symptoms that can be isolated to a diagnosis. Medicine is a hugely multifactorial discipline and it’s understandable why seemingly simple things involve a complex decision making process. Seems like it’s still messy enough that a lot of it is educated guesswork. How much would you say the average person takes for granted that particular matters are “settled” as far as concepts like “health,” and “disease,” go and that these debates don’t exist behind closed doors between doctors? In other words do these disagreements and debates only belong to relative edge cases or is it pretty widespread across ailments?
Do physicians generally “know” or feel with a high degree of confidence when they’ve correctly zeroed in on what the problem is? I’m just imagining the mental flowchart-like references to chasing a problem down isn’t actually that much different from a mechanic who chases down the chain of failure in a car, or a technician who’s chasing down a motherboard failure on a laptop. By what clinical standard do absurd ideas like Drapetomania, or genetic feeblemindedness, or pathological altruism fail to pass scrutiny? Is it simply because our culture doesn’t legitimize such assumptions?
One book I loved reading years ago was Atul Gawande’s Checklist Manifesto, and it was striking how it effective it’s been proven in medical settings. It’s a great thing to have in a discipline that involves some of the most complex pattern matching capabilities needed that are known to man.
Also, why was it a miracle prions were discovered?
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.
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.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
There are millions of them. The median salary is shit. Hundreds of thousands are desperate to move abroad.
If you think getting out of India as a doctor is hard, oh boy...
I'm really sorry, but a proper answer here would take more time than I can reasonably spare. I really shouldn't be here in the first place :(
TLDR:
We mostly use blood tests to exclude other physical causes for depression, like hypothyroidism, anemia etc.
Technically? You can use low 5-HIAA levels, but nobody does, probably for good reasons I don't have time to Google. Maybe @reo or @Throwaway05 can show up and do the dirty work for me. Help a brother out, ya know.
Neuroimaging isn't entirely useless either, in the sense that there are things in the brain we can observe changing in the depressed. But it's not very reliable. Same with OCD, autism or schizophrenia.
So I hope. So I hope. Thank you.
Is this due to over saturation? Other countries having first mover advantage? Corruption / nepotism? Etc. What are the high paying careers and positions over there, or is more of a problem of economic mobility?
Over saturation? Definitely. Anyone can get a CS degree, and it's not even strictly necessary. Medicine, on the other hand, is strictly regulated and there's a limit on the number of doctors entering the workforce.
The best paid programmers in India usually work for FAANG or adjacent companies, at the Indian branches. Some freelance, earning Western wages while at home. The majority just get by working shitty jobs for long hours with average pay (which means pitiful pay by Western standards). The worst off are TCS code monkeys, who really have nothing going for them.
Keep in mind that this isn't necessarily worse than many other professional careers. Engineers in India aren't enjoying themselves either.
The easiest way to get career or income mobility is to get hired by a foreign company, establish a reputation, and apply for a transfer to a foreign branch. I have a cousin in ML who makes big bucks (by Indian standards, which means close to my UK salary). He's been offered roles in the US, but only on a temporary "put out fires" basis, and not at comparable wages to what someone living and working there would make. I've encouraged him to take it, or simply apply directly at American companies for local full-time roles (H1B route, probably). He entered ML well before it was cool or over saturated, even if he wasn't involved in LLM work. That means he's extremely lucky/forward thinking, probably the latter. I remember him installing weird vision models on my gaming PC when he used to visit, back in 2017. Good for him, I want him to get out while he still can.
And yes, the quota system for H1Bs only worsens things. Everyone is desperate to get one of those.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
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.
Thank you. But I don't think this rotation is likely to get much better, and I say this while fully acknowledging the possibility that depression and fatigue is coloring my judgement.
You have to understand that I'm surrounded by other, competent doctors. Some of them scarily so. They don't get the breaks very often either, barring the "mandatory" lunch break half of them eat at their desk.
I hope I get faster and more efficient. I'm touched by your faith in me. The workload still seems daunting. Oh well, it's 5 months. I've done a full year of about-as-bad, and that only made me so depressed I seriously contemplated quitting medicine. Right now, I'm older, wiser, and better acquainted with antidepressant guidelines. Getting better medicated is my best bet for making this bearable. I am pursuing it like my career depends on it, which it may well do.
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.
Thank you. There is a lot of context I haven't shared, and probably won't share, even in private (with anyone, not you, you'd be more likely to know than most).
That's not the biggest problem I have. I'm happy to write proper psychiatric notes. I write essays on the internet for fun, and that's more intellectually taxing.
You'd be unpleasantly surprised. I definitely was. Psychiatry works very differently here. As a trainee at my level, I do a lot of medical management of physical illness, and I don't like it one bit. This will only change when I become a registrar. I'm not sure what the threshold for "call medicine and ask them to manage this" is in the US, but it's much higher here. That's what's really killed me in the past. [More highly relevant information that I am studiously omitting.]
An early trainee is a glorified ward donkey. All I can do is bray and scratch my ass.
I agree that things will get better later, with time and experience. You know why my last placement sucked. This one sucks for entirely different reasons. Mostly the drastically higher workload. It should get better, once I push through the next 5 months, which I intend to. I worked very hard to get here, I have nowhere better to go, and I do sincerely believe things will get better eventually. I still appreciate the support.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
Wishing you luck brother!
Thanks. Glad to be depressed together, and hoping we can get well together. At least you know my advice comes from a place of unusual professional and personal familiarity.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link