In which it becomes hard to tell who, exactly, is the crazy one

So. Psych. It's been an interesting month, but I'm kind of ready for it to be over with at this point. I am finding myself incredibly lucky to have been assigned to child psych, because the attendings and residents are lovely and fun and laid-back and somewhat less weird than most of the psychiatrists I've come into contact with (not to mention the awesome hours--left at noon today). The patients, however, can range anywhere from incredibly sad (the four year old who wanted to die rather than see his biological father) to the incredibly weird (a teenager who believes her parents have been replaced by body doubles), to the incredibly frustrating (my patient, who has been depressed for an inordinate amount of time and literally refuses to accept the fact that he's getting better...in fact, continues to claim that he's worse despite the fact that he smiles all the time now).

There are things that I like about psych, but they are, in general, the things I like about most general practice specialties--talking to patients, hearing their stories, and figuring out what is wrong with them by putting the puzzle pieces together (and then of course coming up with the treatment plan). The things I definitely don't like, however, are far stronger. I do not think I could do a specialty day in and day out for the rest of my life wherein people don't, as a rule, get better. Yes, there are many patients for whom we make a big difference, and those are wonderful moments. But for many, we simply listen to their sadness, give them some medication to help balance out their brain chemistry, and send them home to a terrible family and terrible situation that will probably only perpetuate the problem as long as they continue to be sent there. We can't keep the patients forever, and only rarely is there enough of a problem to involve CPS and find a better living arrangement. Instead, we diagnose a lot of patients (especially the younger kids, so often admitted to our service for aggression or other behavioral problems) with "Parental Disorder NOS"* and do what we can for as long as we get to keep them in our care.

Perhaps this is why many people express frustration with internal medicine and family practice--dealing with patients who refuse to get better, refuse to take their meds, wind up back in your office months later for exacerbations of the same problem over and over. Except in this case, it's even more depressing because at least as a family doctor you can place some of the blame on the patient for bailing on their end of the bargain. On the child psych floor, it's almost never the kids' fault that they have a crappy home that has taught them crappy coping skills.

I am incredibly glad that there are people who feel called to be child psychiatrists (or any kind of psychiatrists, for that matter), but I think you might have to be a little bit crazy to be one of them.