Choose Psychiatry 2022: Have I got what it takes to be a psychiatrist?

When I’m teaching medical students one of the common questions they bring up in discussion is whether they have what it takes to become a psychiatrist. They often worry about whether they have the right type of personality and how they might deal with stress and the emotional impact on themselves of looking after people who are often distressed.

In fact, the largest study to date on the career choices of recently qualified doctors found that self-appraisal of own skills was the second most common reason for people rejecting psychiatry as a career¹.

So, I asked some colleagues what they felt the most important attributes were for people contemplating a career in psychiatry but were worried about how they might cope.

Professor Vivienne Curtis, Head of School of Psychiatry for London at Health Education England stresses the importance of academic curiosity:

“A key requirement for young psychiatrists is curiosity about all aspects of the person’s life; Curiosity about the causes of their symptoms including the role of biological, psychological and social factors and an ability to understand the risk and benefits of treatments that might be available. It then takes a unique skillset to synthesise this information in a way that can make an importance difference to people’s lives.”

Analytical ability is something that Professor Nandini Chakraborty, lead for national recruitment for psychiatry, also endorses:

“Whilst never forgetting the importance of hard numerical data in research, the ability to fuse multiple perspectives to form a logical conclusion, is a key skill for every psychiatrist.”

It has previously been postulated that Psychiatric trainees may be more naturally suited to thinking about problems using a divergent style of learning where they consider situations using a variety of models in a highly reflective way².

Simon Rose, Patient Representative on Council at the Royal College of Psychiatrists, describes why this approach is important:

“An ability to understand that science exists against the backdrop of our lives often with exposure to stigma, discrimination, and poverty. The two threads are intertwined. Although medicine and science are important, they are not exclusively so. Arts and social sciences are really important too.”

But we need to be cautious in thinking there is only one ‘type’ of learner suited to psychiatry. The best teams incorporate diverse thinkers who can collaborate to find solutions to complex problems, and in psychiatry that will always involve the patient.

Gary Hodge, mental health nurse and research fellow at the University of Plymouth described that for him:

“The greatest quality of psychiatrists I have worked with is their ability to recognise and utilize the knowledge and skills of those around them.”

And of course, the way we learn and think changes over time based on our experiences. Aspects of our characters can help as well as hinder us in our jobs but can also be modified. For example, whilst attention to detail can make someone a fantastic psychiatrist it can also get in the way when it comes to managing time. Finding a balance is key. And that comes with experience.

Working closely with people who are suffering will invariably bring up issues for ourselves. It’s part of the human condition and no part of medicine is exempt. Vicarious loss and tragedy are inherent in the job of being a doctor whatever specialty you choose. Where psychiatry differs from the rest of medicine though, is by having a sophisticated understanding of the unique psychological factors underlying interactions between doctors and patients and how these may make us feel and behave.

UK Psychiatric training programmes support trainees to understand what is going on in individual therapeutic relationships though weekly Balint groups and one to one supervision. These activities are enshrined in the curriculum and seen as vital ways of learning understanding, compassion, and reflecting on our own vulnerability and resilience. Understanding basic psychodynamic principles such as projection and projective identification can go a long way to understanding people and our emotions in a clinical setting.

Dawn Hy is a Mum who has extensive experience of mental illness within her close family and who has worked tirelessly to make sure others coming after her have less bewildering experiences. She says: “showing you are human too” is one of the most important qualities of a psychiatrist.

Professor Nicolas Procter, Chair of Mental Health Nursing at the University of South Australia gives this advice:

“Be curious, open to, deeply interested in storytelling. ‘Lean-in and listen-in’ respectfully, compassionately entering into a person’s conceptualisation of their story, distress, how they see their troubles and ideal scenario for support. Be aware of your own self experience.”

Being clear about our values i.e., the standards we set for our own behaviour and judgement about what is important is key. These drive our motivation throughout our careers. Every individual will have their own. For me, helping the most vulnerable and marginalised to belong within our communities is a firmly held value alongside values of excellence and doing your very best. Most of us will be able to identify our values and track them back to childhood. For me, being naturally curious about others, combined with a love of communicating in challenging circumstances, has meant that psychiatry has been a very good fit for my personality, skills and values.

But psychiatry is a broad church as Dr Brent Elliott, a neuropsychiatrist and liaison psychiatrist in East London points out. “I would say we need lots of different psychiatrists; people who are good at neuroscience, analysis, computational modelling, pragmatists, those who are politically driven, people who are community oriented, researchers, psychopharmacologists, philosophers and critical psychiatrists to keep us on our toes.”

When a Professor of Psychiatry asked me at the end of my final undergraduate viva in psychiatry “Have you considered a career in psychiatry?” my reply at the time was “I’m not sure I’m cut out to be one.” On reflection, I don’t know why I hesitated. In many respects, it was probably because psychiatry was so different from other parts of medicine that I had spent much more time in as a student.

However, I am confident my younger self would be incredulous to see how much I have learnt, grown, and developed over time. We don’t do that in a vacuum, and I am eternally grateful to my patients and colleagues who have been the very best of teachers over 30 years.

When I look back, I myself had doubts about whether I could emotionally cope with a career in psychiatry.

And I’ve spoken to many colleagues who wondered the same. Being a doctor of any sort means you will face challenges, but I, and other colleagues working in psychiatry, found getting to know our patients, and helping them get better over the long term, made the job enormously emotionally rewarding.

I found I did have the emotional resilience to deal with the challenges which came my way and I think more than likely, if you’re considering a career in psychiatry, you would too.

I am also very happy that I followed the seed of possibility sown in that conversation and ultimately decided to #ChoosePsychiatry.

References

1. Goldacre, M.J, Fazel, S, Smith, F and Lambert, T (2013) Choice and rejection of psychiatry as a career: surveys of UK medical graduates from 1974 to 2009. The British Journal of Psychiatry, 202, 228–234.
2. Airey, N., Marriott, J., & Rodd, J. (2001). Learning styles of psychiatrists and other specialists. Psychiatric Bulletin, 25(8), 306-309. doi:10.1192/pb.25.8.306.