The fake doctors

February 25, 2008 at 8:49 pm (Clinical rotations)

Recently I wrote about my disdain for psychiatrists who wear white coats. In no other field of medicine will you see such a shiny, immaculate white coat as those worn by psychiatrists. Many of the residents I know have coats with creases in them that are as sharp as the day they bought them. To this day, I’ve only seen one psychiatrist with the stain at any time on his white coat. He openly admits that the discoloration is to due some coffee spilled during break.

Psychiatrists run in fear from any medical issue that patients may present with. Slightly elevated blood pressure? Call an internist. Slightly elevated blood sugar? Call the internist. Slightly elevated cholesterol? You get the idea. The residents and attendings use a shotgun approach to ordering labs and when anything comes back abnormal, they run and hide behind other doctors like a terrified small child does when he hides behind his parents’ legs. Now I know they had to learn medicine during medical school. I know they had to pass STEP III to get licensed as physicians. But the overwhelming response from psychiatrists—when presented with medical issues—is, “Why concern ourselves with kidney function and other nonsense when there are other pressing issues at hand?” On two separate occasions I have witnessed residents state that metformin leads to hypoglycemia. Any first-year medical student knows that metformin, a drug used to manage diabetes, is employed as a first-line treatment precisely because it does not cause hypoglycemia. Yet here they are, these disgraces to the title M.D., making untrue statements about the side effects of a very popular medication.

Psychiatrists act as if they should not concern themselves with medical issues, yet then get offended when people say that they aren’t real doctors. In this rotation we employ a device known as the mental status exam (MSE) to check our patients’ functional abilities. I have heard more than one practitioner state that the MSE is the psychiatrist’s physical exam. To this day I have yet to see a note that links the MSE to the body in a similar fashion that a neurology note can link physical exam findings to lesions in the brain. They claim to be medical experts of the mind, yet are neither talented as physicians nor as therapists. I cannot think of a greater waste of education than that of psychiatry.

For every psychiatrist there is, one seat in medical school is given up so that a person can join the pseudoscience realm of Freud. Their expertise requires eight years of training (four years of medical school + four years of residency) that do not translate into meaningful results. At best, they are misunderstood practitioners of the id and super ego. At worst, they are directly leading to the current shortage of medical doctors.

Therapists, on the other hand, make a unique contribution to the world by promoting insight and new behaviors that can lead to a decline in depression, anxiety, substance abuse, and maladaptive work and social behaviors. Therapists require many years of training and experience to provide an unparalleled level of service to people who need them. I have no problem with therapists. Psychiatrists, however, are a drain to our society because they can neither serve as medical physicians nor are they skilled practitioners of psychotherapy. Our only hope is that Medicare and insurance companies continue to cut reimbursement rates for psychiatrists to the point that the field is abandoned altogether. Only then will be free of their tyranny.

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27 Comments

  1. none said,

    harsh…ouch.

  2. Michael Rack, MD said,

    “Our only hope is that Medicare and insurance companies continue to cut reimbursement rates for psychiatrists to the point that the field is abandoned altogether.”
    I am a psychiatrist, but I am also a real doctor too (board certified by the American Board of Internal Medicine in internal medicine and sleep medicine).
    Medicare/insurance cuts won’t have too much of an effect. Most psychiatrists in private practice don’t take medicare. Many run cash practices (they collect cash up front and then assist their patients in filing for out-of network benefits).

  3. Dr. Alice said,

    Nice to see another medical person who’s recognize the fraudulent nature of psychiatry. I hated my third year rotation, and even then I didn’t manage to produce such scathing denunciations. Keep it up. I hope you enjoy seeing, on medicine and every other rotation, the number of elderly patients drugged up with ativan, prozac, lexapro, restoril, just because it makes it easier for other people to deal with them.

  4. Y. S. said,

    Though a good read, it is a bit harsh.

  5. Woah said,

    Haha, I really hope my colleagues aren’t actually this dumb! Wouldn’t be too big of a surprise though.

  6. John said,

    I beg to disagree. It really sounds as though your exposure to “real” psychiatrist is limited. I am a third year and I just spent the most awesome month with an incredible doctor. I used to think there was little one could do for the criminally insane, but this guy is unbelievable and gets results. His knowledgebase is wide too. Since he sees those with extreme pathology, the efficacy of his various therapies are very obvious. And if he has someone with basic health issues, he takes care of these as well. He is the first shrink who I have seen that uses his stethoscope on every meeting. He is above all, first a doctor, then a shrink. He told me all docs must be good PCPs first, then know their specialty.

    I think the guy should be an inspiration to all docs who get too into their specialty and forgot the patient is not a collection of artificially separate systems. I think you may have forgot this in your analysis of above.

  7. John said,

    Oh, yeah, the above was not meant to flame you, my friend, only to perhaps ask you to reconsider your thoughts based on your exposure to a limited number of physicians who chose psychiatry as their specialty.

  8. Danielle said,

    I can’t believe any “medical expert” would EVER say anything that IGNORANT about psychiatrists! A psychiatrist is certainly a healer more so than most MD’s (Mis Diagnosers).
    Neurosurgens are prob. the most respected Dr’s in the medical field. Fair enough! You respect therapists, so why is a professional who treats the brain AND the mind so lowly regarded?

    If you ever took a medical ethics class, you would know that mental illness is the WORST type of illness, because “when one ceases to THINK like a human, they are NOT considered human” Isn’t it our complex brains/minds that which give us our advantage over other species?
    So why does someone who bestows “humanity”, anything short of a miracle worker?
    “A mind is a terrible thing to waste” What happens if it’s lost?

    Doc, take a look at the Merck Medical Guide. Look up Scizophrenia. Listed by the WHO as 1 of the 10 “Worst afflictions unleashed on humankind”. Not only do these people suffer HORRENDOUS pain, but they are failed by the nurturers (family), protectors (police), healers (you), and abusers (the ignorant). Do the physically ill get this bonus? Do you get the luxury of position to decide if a person who threatens suicide if committed again, or society at large if their not? Do your patients even know somethings wrong, and able to express it to you? Does radiology the “Mecca” of healthcare back-up/corfirm/pretty much dictate your diagnosis? (I presume radiologists are not real Dr’s either).

    -Even if my argument falls on deaf ears, HEAR this! You and your fellow God-complex suffers are NOT the heroes of medicine.
    Scientists, Researchers, and Chemists are! You are merely messangers of vicarious, memorized, rote knowledge, passed on down by the “Real” warriors fighting the backlashes of Mother Nature by inovation, experimentation, and dedication.

    I am NOT a Dr. I am an ex-ultrasound tech, applying for a psych PH.d, and a MANIC-DEPRESSIVE sufferer, Whom corrently is pieceing back a horribly shattered life, thanks to a psychiatrist and all those involved with psych. rehab.
    Thank you for taking the time to read this,
    Danielle

  9. Jay said,

    I don’t understand the personal slant of the original posting, do you mean psychiatrists are bad people? Sure, psychiatry is ages behind other specialties in continuity of care, proper and consistent diagnosis, effective treatment and long term research outcome based treatment systems. Considering mental illness/substance abuse is also leagues more challenging than most physical disorders, this seems fairly with current human innovation and funding priorities. Unless your advocating for the abolishment of pharmacotherapy for psychiatric patients, why not work to improve the practice of psychiatric medicine before talking down about it’s practitioners?

  10. Joshua Gaines said,

    You sound like a Scientologist.

  11. QuarterMD said,

    Geezus…that girl Danielle seems pretty crazy.

    Well I came across your blog by accident. I was actually just looking up information on the military match because I was curious to see if certain military residencies for really competitive specialties like Derm are easier to get into compared to civilian residencies (was trying to see if there was a back door way to get in). I was looking for ave USMLE scores by specialty, number applied:number accepted ratios..that kind of stuff, but I guess it doesn’t exist since they don’t even offer derm out medical school according to one of your earlier posts I read. Anyways definitely not going to do the military scholarship. I decided I wasn’t back in undergrad but was flirting with the idea again after having to take out 66K just for my first year. Anyway your blogs really funny and has kept me entertained the last couple hours. Can’t wait for 4th year…

    Half M.D.: Air Force medical students cannot enter derm, but Army students can. Joining the military in the copes of getting into residency on the off chance that it might be less competitive is a very bad idea.

  12. Jim said,

    There are other areas of science which don’t claim to fully understand the brain, if psychiatry is putting drugs into it then either it has the edge and isn’t sharing the knowledge or its making it up.

  13. Jim said,

    Paxil study 329 disagrees with Danielle

  14. Jim said,

    Sorry for all the posting but I noticed this from Danielle also:

    “Doc, take a look at the Merck Medical Guide. Look up Scizophrenia. Listed by the WHO as 1 of the 10 “Worst afflictions unleashed on humankind”. Not only do these people suffer HORRENDOUS pain, but they are failed by the nurturers (family), protectors (police), healers (you), and abusers (the ignorant)”

    The WHO also looked at the prognosis for schizophrenia in 3rd world countries, where they hardly have psych drugs and mental health is very low on their list of priorities. I would suggest you look it up.

  15. Jim said,

    Horrendous pain inflicted by people like you Danielle.

  16. BMD said,

    I am a newly graduating medical student about to start my residency in Psychiatry. I must say that the author of this article is categorically incorrect and offensive in his description of my field. First, off I am and always will be a “real doctor.” I kicked butt on step 1,2, and 3, and I have been continually complimented by attendings on my clinical skills during rotations such as internal medicine, family medicine, and emergency medicine. I have absolutely zero fear of dealing with patients with general medical complaints – abdominal pain or chest pain or otherwise – I know how to do a belly exam, I know how to read an EKG, I know differential diagnosis for a variety of chief complaints one should know as a new MD. Now, I ask you, what is the definition of “medical” or “doctor?” You may have encountered a psychiatrist who doesn’t know (or remember) the indications for tPA, the ottowa ankle rules, the mechanism of penicillin, or how to manage coagulopathy caused by hepatitis C-induced hepatic carcinoma, but how many obsetricians or orthopedic surgeons know the neurobiology of depression, the differential diagnosis of psychosis or depressed mood or anxiety? Furthermore, the author of this article is incorrect to say that psychiatrsts are inadequetley trained in psychotherapy. They most certainly are. My residency program has extensive training in psychotherapy. I plan to work my tail off on my internal medicine rotations during intern year, and continue a lifelong tradition of reading both internal medicine/family medicine and psychiatry articles, as these fields are all interrelated.

    As new physician, I will treat my mental health patients pharmocologically, psychodynamically, and culturally. If my schizophrenia patient is tachy to 101 or develops essential hypertension (diagnosed after secondary causes have been ruled out [conn's syndrome, pheo, renal disease, etc.] ), I will not consult internal medicine quickly as this author suggests.

    Just who do you think you are buddy? If you care to challenge me, medical doctor=physician=psychiatrist, on medical knowledge – both general non-psychiatric medicine and psychiatric medicine, I will take you on. I know my shit, I will always know my shit, and to be frank, you don’t know shit about the type of medical students that psychiatry attracts. We are very intelligent, and we have great medical knowledge. Our attending psychiatrists are the same way. You sir, are a quack.

  17. Rahul said,

    I would prefer to do the 5-year joint psychiatry/internal medicine residency and would love to see a broader range of patients. By the way, what do you think of nurse practitioners with white coats?

    Half M.D.: Ideally I would prefer that no one wear white coats due to infection control. However, if they’re here to stay, then ARNP’s should wear short coats to reflect their years of training.

  18. Anonymous, MD said,

    You are certainly entitled to your opinion; however, I, being a psychiatrist almost eight years out of residency, must vouch for those diametrically opposed parties like myself. I could go on all day pointing out all of the fallacies in your statement, but I only see that as being a futile effort. The only thing that I’d like to dispel, however, is this recurrent notion that psychiatrists aren’t familiar with general medical knowledge, because, for any psychiatrist seeking board certification, it is imperative to know everything that your average GP or internist would know.The board certification test for psychiatry is laden with idiosyncrasies, and is actually far more stringent than those in other specialties of medicine.

    As for your encounters with the two psychiatric residents; I find this to be very disconcerting. During my stint as an attending, I actually found all of the residents to knowledgeable.

    -Anonymous, MD

  19. Anonymous, MD said,

    -EDIT-: I must note one error in my previous post; in the last sentence, I meant to say “to be very knowledgeable.”

  20. Cedric said,

    I am currently doing my undergrad and I do want to be a psychiatrist but I hope to change the game by studying hard in medical school and always treat the general medical issues first before the psychiatric conditions. I think if Im ever going to become a great doctor that when I attain that hard earned status that I need to change the pace by always doing physical exams myself, actually utilizing my stethoscope, and treat medical illness that presents in front of me like coghs,pneumonia, diabetes hypertension or any other medical problem. I do not believe in passing a patient around or back to a primary physician just because im a psychiatrist. If im not going to establish myself as a very knowledgable, objective, outside the box doctor then i am wasting my time. Any advice for a doctor in training? Id love to hear it.

  21. anonymous MD said,

    Why are small support groups sprouting up across the nation for 3rd and 4th year medical students who are scared to disclose to their families they are pursuing psychiatry? There are anecdotal cases of students being disowned, or cut off financially by their parents. Fiancees have called off weddings when they find out their partner-to-be is going into psych. And the students themselves suffer the anxiety, pain, and anguish of disappointing their loved ones. Why all the fuss?

    Well, it’s unfortunate that people have to seek out these support groups and such, but it is very revealing how deep the public disdain is for the field of psych. When I was a med student, a psychiatrist I rounded with had a patient complaining of abd pain, and he just brushed it aside, later telling me that in principle, he should never lay a finger on a patient, even if it is for a physical exam of a complaint. That situation forever tarnished my view of psych. Now, I understand the lines he didn’t want to cross, but if you want to shell out $200K, and 8+ years of your life so that you can become an “MD” who is “not allowed” to touch his patient, then go ahead. But don’t get defensive when people who ARE allowed to touch or cut open their patients think you are a lazy doofus or just an unfortunate waste of a medical education. Psychologists get the job done (more or less) and God knows we need more family medicine/primary care docs. The most defensive people I have ever encountered in my life are psychiatrists, and it certainly doesn’t take a shrink to figure out their insecurity is just beneath the surface, ready to spill out with the slightest remark or inkling that their medical skills are anything less than magnificant. If psychiatry was done away with completely, the world would keep on spinning. NPs/Psychologists would take over, and GPs would keep doling out the prozac. And the rest of us wouldn’t have to deal with this big bunch of crazy hypersensitive crybabies who tried to take the easy way out by securing low six figure salaries without having to ever get their hands dirty. Give me a freakin break! Maybe the rest of us need a support group to deal with these clowns and the giant chips on their crisp white coat shoulders.

  22. Dr Francia said,

    Be careful to judge another specialty as mere placebo.
    I worked many years very closely with psychiatrists, neurosurgeons, ER docs,
    internists and other specialists. They have a place in the medical arena.

    Surgeons look down on psychiatrist but that is a clear sign of pure ignorance.
    Psychiatry is very important specially if you know what you are doing.
    In geriatric medicine it is crucial for you to understand how to manage the abnl behavior
    of patients with serious neurodegenerative disorders including dementias.

    unfortunately, most internists and surgeons would be useless in this case
    they will be clueless. I even heard neurosurgeons say oh hyperglycemia call that
    internal medicine resident for consult….

    So before opening your mouth think very carefully about what you are going to say.

  23. Dr Francia said,

    psychiatry is a very important specialty
    specially if you get down into the neurochemistry and neurobehavioral aspects of many psychiatric conditions,

    It can be fascinating…indeed…
    The greatest achievement is when your patient is responding to treatment the way you have envisioned then you know you are making a difference.

    Don’t let anyone put you down because you are pursuing psychiatry….I would pursue psychiatry in a heart beat!

  24. Dr. Naris said,

    The poster is not a psychiatrist, he/she is pretending just to sell their point.

  25. Perfectly Healthy said,

    You realize that you’re a sick puppy, right? I think you have a hairball in your 1st chakra.

  26. LenoCok said,

    Jealous of the salary of private practice psychiatrists? Loser.

  27. JayZ said,

    The author of this post needs to see a psychiatrist, I think he is depressed and needs help.

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