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This question has quite honestly has been baffling me for many years.

When training in medical school I had no idea what kind of doctor I wanted to be. I toyed with the idea of obstetrics, GP and dermatology. Psychiatry never crossed my mind. Why not? Simply because during medical school, I had only two weeks in my psychiatric placement and did not really understand what psychiatrists do on their shifts. The psychiatrist I shadowed wanted nothing to do with me and so I pottered alone in the oncall room reading about psychiatry instead. I did one home visit in which the patient spent thirty minutes yelling at me and making me feel like I was worth no more than the gum under her shoe. This experience didn’t really put psychiatry in a good light for me so that’s why I never even considered psychiatry as a future profession.

When fully qualified as a doctor, I sampled my possible future aspirations: running around clinics for finding the right steroid cream in dermatology to desperately trying to find some water to drink during a busy night shift in obstetrics. It was only when I had my GP rotation that I really got to interact with psychiatric patients. I found the history, personality and pathology absolutely fascinating, so much so I spent my private time in the psychiatric inpatient department to get further depth of this unique speciality. It was during my time on the psychiatric ward that I really felt immersed in psychiatry and understood what is involved.

Psychiatry has an odd stigma among the public but so much so within the medical fields. I have yet to find a non-psychiatrist speak fondly of this speciality. My friends and colleagues who are surgeons or medics look down upon psychiatrists. I really wonder why? Its simple. Non psychiatrists believe that psychiatrists are the dumbest of the doctors as well as being the laziest. They assume all psychiatrists do all day is have coffee while sitting on a couch thinking they are Freud. I would like to tell all these doctors….I do wish that was true my friend!

In actual fact I have been shown that being a psychiatrist you have be to the most intelligent doctor. You need to know the pathology of obstetrics, surgery, paediatrics, neurology, ophthalmology, dermatology, internal medicine, general practice, sexual health, old age medicine, emergency medicine, liaison medicine, substance and addictions to name a few. The reason is, to fully understand the pathology of psychiatry one has to understand the pathology of organic disease which could in turn be causing the psychiatric presentations. One has to be able to separate the blurry lines of what could be hallucinations from schizophrenia say to that of an organic lesion- surprisingly can be difficult to do for general medics and psychiatrists.

Why do so many doctors not actually become psychiatrists? Is it because they are in fact scared of the profession? The difficulty of not being able to place patients in a box that we so like to do and fix that with antibiotics and get on to the next patient? In psychiatry one cannot do that. One cannot place our patients in an organised box and treat them like a textbook. A psychiatrist has to be flexible and work with the patient and the pathology: something that is incredibly difficult. As doctors we like to have a structured plan and follow the regime. But in psychiatry you simply cannot always do that.

Patients in psychiatry can quite honestly get under your skin- a doctor cannot run away from the emotions evolved from patients with personality disorder as it truly goes deeper to your subconscious. Being non-psychiatrists means we can go to the ward dealing with the disease in front of us, treat it to the best of our ability, then at the end of the day walk away as most likely we will have a different patient the next day. However, in psychiatry we review the same patients, sometimes for years, on a daily basis and we cannot simply ‘fix a problem and walk away’- as personalities, for instance, are for life!

When I talk with my medical and surgical friends, and tell them what I have to face on a daily basis, the respect and awe of psychiatrists certainly heightens.

I think the lack of insight into psychiatric work really is the key as to why there is stigma amongst our own colleagues.

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