Why I Chose Psychiatry As My Specialty

{Rancho Cucamonga, California}

I am often asked why I chose psychiatry as my specialty, yet as one of my readers pointed out, I’ve never described my reasoning in a blogpost!  So here goes my short story of why I chose the path to become a psychiatrist…

The time to solidify your choice in medical specialty and apply for residency training programs occurs during the Fall of the 4th (and final) year of medical school.  Students have various reasons for choosing a specific specialty, some knowing which specialty they wanted to go into since childhood, others typically contemplative until right before application season.  Some people even change their minds in the midst of residency training and decide to switch specialties.

As a medical student, I attended most class lectures, yet spent majority of the time passively writing notes while chatting on instant messenger.  However, when it came to psychiatry, I woke up every morning with excitement to attend each lecture (quite unheard of since I practically dragged myself to every other lecture series), paid attention (and even turned off my instant messenger), thoroughly read the textbook, diligently took notes, and excelled at every exam.

During third year of medical school, students start clerkships, which consists of rotating through various primary care specialties (typically family medicine, internal medicine, Ob/Gyn, pediatrics, psychiatry, and surgery).  When interacting with patients during each rotation, regardless of the specialty I was assigned, I ALWAYS spent more time with my patients asking about their psychological and social backgrounds.  As a result, I eventually became identified by my senior resident and Attending physicians as the student who would generally be assigned the patients with a history of mental illness or medically-related psychiatric issue.  Also, if a patient was admitted to the hospital for physical symptoms, yet the extensive medical workup failed to determine any causative explanation for the symptoms, I was told to assess if there were any emotional issues that might be contributing to a patient’s intractable symptoms (such as cyclical vomiting syndrome, intractable pain, etc).

I specifically remember one patient — a young woman with intractable nausea/vomiting, who was unable to keep down food and fluids.  Her medical workup was normal and the medical team could not identify a cause.  While the medical team spent only a few minutes to check in on her (to do a quick medical exam and see if she had eaten), I went to visit her after rounds to chat.  My intuition told me that there was more to her issue than solely a physical complaint.  She was quite shy and spoke only a few words, yet after a few minutes of engaging in conversation, I believe she saw that I wholeheartedly cared about her wellbeing.  As it turned out, she experienced ongoing stressors at home due to a recent move with her boyfriend and often felt isolated since she was often home alone with no friends in her new area of residence.  I promised to check in on her after daily rounds and she thanked me for taking the time to speak with her.

On the third day, I saw her untouched food tray, and after a few minutes of talking, I asked if she liked ice cream.  I brought her vanilla ice cream from the supply in the nurses’ station.  We talked about how she missed her family back home.  After several minutes into the conversation, I watched her open up the ice cream cup and slowly start nibbling on small scoops.  After eating 25% of the cup’s contents, she politely asked for a cup of water.  I quickly got up to pour ice water and asked about her little brother as she took a few sips from a straw.  Before I left the room, I closely watched her for a few minutes to observe if she’d vomit the contents.  She appeared comfortable with no sign of nausea.

The following morning, I viewed the nurses’ report, which noted that she had no episodes of vomiting overnight and even ate a jello snack.  I said ‘goodbye’ to her that morning since our medical team informed her that she’d likely be discharged home after lunch.  I couldn’t help but wonder if she’d be okay returning home to the same environment that triggered her symptoms.  However, the empty plate on her breakfast tray was an indicator that she ate that morning, which reassured me.

Others docs may feel this way about their own specialty, but in my view (currently and as a medical student at the time), there is an art to psychiatry.  There are no labs to rely on and although psychopharmacology is of importance, I immediately noticed the value of a therapeutic connection and communication necessary to fully understand an individual’s situation and the context of their symptoms.  Despite such a strong emphasis on pharmacology during medical school, I recognized early on how much certain symptoms (even physical) could not be improved solely by medications and standard treatment alone.  I recalled reading The Diving Bell and the Butterfly as a medical student, which inspired me to try various different creative ways to communicate with other patients who struggled to verbalize their needs, and had a bit of success with many.

I have several other reasons that contributed to my decision to pursue psychiatry, but wanted to emphasize how much the nature of my connections with patients empowered me as a medical student.  The psychological components of a person’s history are often not prioritized when it comes to a patient’s medical care.  Throughout medical school, I often felt inferior particularly because I didn’t achieve the highest grades compared to my classmates.  However, I knew one thing for certain when the time came to apply for residency: as a psychiatrist, I could play a vital role in emphasizing the importance of an individual’s psychological and social background in order to fully address health and wellness.  And I felt confident that I’d do whatever I needed to be damn good at my profession.

Photo by Marlon Santos