As many of you likely know, for those like me who are in their last year of medical school this month contains Match Day, when we will be notified of where we will spend our residencies and potentially our fellowships and beyond. While those familiar with my posts know that I applied into and will almost certainly match into pathology, as I was fortunate enough to have a busy interview season, this seemed like a good moment to reflect on the only other specialty where I exhibited similar capability and consequentially could have considered a career.
From an academic standpoint, psychiatry has always been a strength of mine. Looking back to even before the MCAT, considerations of the impacts of chronic stress on health disparities were a key element of my academic work. On the MCAT itself, the then-new psychiatry section proved a vital element in my ultimate success. The interpersonal element was slower to come, as some of you may know. Early in medical school, I was occasionally critiqued as a “robot” but fortunately, this improved with the passage of time. By my clinical years, my ability to engage with patients had become a key asset allowing me to standout in early rotations while my knowledge was still building. By the time I engaged in my psychiatry rotation almost exactly 1 year ago, I proved myself more than up to the task of performing at a high level. You will notice, however, the significance of March 2020 as roughly the time when many medical students, including myself, were pulled back from clinical work, which both bisected my rotation and rendered it pass/fail despite honors performance both clinically and on the shelf exam. Months down the road I selected psychiatry as one of my required AI’s and did finally achieve my honors officially, however, I was already fully committed to the path at the time.
Having briefly described my experiences it is clear that one of the reasons I did not apply to psychiatry was the lack of an officially recognized high-level performance at the outset of the application season. The chief reason I selected an alternative path, and why I am writing this piece, however, is because of an awareness of unique personal features which would make me a passionate and capable but vulnerable psychiatrist. Long before medical training, I have found myself as an unofficial caregiver and counselor for close friends dealing with physical and mental scars from childhood chronic disease, depression, and suicidal ideation secondary to abusive home environments and the impacts of alienation due to immutable aspects of their identity. While this breeds enormous engagement with a broad range of psychiatric patients and has led to extremely positive interactions with some of my patients in psychiatry, it also leaves me extremely vulnerable to transference. It can also make me slightly more malleable in the face of splitting in an attempt to divide the medical team. The chief form this takes is brief moments in which professional distance in colleagues can be made to look like a lack of caring to me. While I am aware of these foibles and have improved vastly in safeguarding against them, what is a consistent asset in terms of empathy in fields like IM or family medicine would, I think, potentially harm me across a career in psychiatry, where even rare moments of overly strong doctor-patient bonding could be disastrous.