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.