What to Be (or Not to Be)?

As a medical student I was asked this question repeatedly by residents and attending physicians as I rotated through the various third-year clerkships. I learned early on that they were really asking what specialties I was considering. My peers advised me to answer this question as vaguely as possible by saying something like "at this point, I'm keeping my options open." Unfortunately, I did not always heed this advice; most of the time I answered quickly and confidently "a psychiatrist!"

One response to my enthusiastic endorsement still resonates in my ears today: "Well, that's good, but psychiatrists don't get to do anything." Reflecting back on my clinical experience as a psychiatrist, I strongly disagree with this judgment - and likely would even if I had chosen a different specialty.

I started thinking about choosing a specialty at the very beginning of medical school. I began by acknowledging "what I didn't want to do." I was able to say definitively that surgery and obstetrics were "off the list." I realized that the lifestyles associated with these specialties would not suit my personal goals. After making that determination, I figured that everything else would be fair game.

Once I got into the thick of first-year classes, my brain was like a sponge, soaking up as much information as it could. I found neuroscience coursework rather interesting, but not quite enough to put neurology at the "top of my list." Surprisingly, the experience that sparked my interest in psychiatry came during a time when I was not involved directly in classes or clinical work.

During my first summer break, I was selected to be a teaching assistant in a summer program for aspiring medical students. The program was designed to give participants a glimpse of the first-year medical school curriculum and help them acquire other skills in preparation for medical school. I was told that the students would likely view the teaching assistants as valuable resources, not merely to help them learn the coursework, but at times, to provide counseling and emotional support. I found this to be very much the case.

On several occasions, participants in the program wanted to talk with me about things not directly related to the program itself; including issues such as family problems, romantic relationship conflicts, and a perceived inability to handle the pressures of medical school. I was somewhat taken aback by the frequency with which this was happening to me, especially considering that I was a stranger to most of the students. There were some who became increasingly comfortable talking with me about nonacademic matters as the summer progressed, as if they were receiving therapy sessions. At the same time, I became more comfortable holding such sessions.
Finally, one of my classmates pointed out "you are very easy to talk to." This came as somewhat of a surprise to me because I had always considered myself a "talker," and so did others who knew me well. Even with the limited knowledge I had then, I understood that psychiatry involved more than just listening to people's problems. However, I also believed that it lent itself more to listening than did other specialties.

After that summer, I was eager to begin my second year of classes and get more hands-on clinical experience. While I found each course interesting in its own way, absolutely none of them captivated my attention more than the psychiatry course. This was quite significant, considering I had gained the reputation of being a sleepy head in class, especially after lunch. Somehow I managed never to fall asleep in psychiatry class, regardless of how much sleep I missed the night before.

Later, I remember speaking with a resident who said that he considered the "interest factor" when selecting his field. He suggested that I seriously consider a specialty whose material I could read for extended periods of time without becoming bored. Using himself as an example while holding up a rather large surgical textbook, he said, "I could read this book for hours without putting it down." This was valuable advice, and I found it to be the case with psychiatric literature.

Finally I reached the much anticipated third year. Students were allowed to submit their preferences for the order in which they rotated through the required clerkships. There were varied opinions among my classmates about how best to do this. I opted to have my psychiatry clerkship in the first half of the year but not as my first "block." However, my request was overridden, and I was scheduled to have psychiatry as my very last rotation of the year. I felt initially that this was a horrible thing, but in the end, it worked to my advantage. In their attempts to comfort me, some of my classmates who knew I was very much interested in psychiatry said, "Who knows, you may find something else you like." As it turned out, this did not happen. Everything else I saw made me want to do psychiatry even more.

While going through the other clerkships, I began to hear horror stories from other classmates who did the clerkship of their primary interest and hated it. While apprehensive that this could happen to me, I remained hopeful. And then it came, the long-awaited psychiatry clerkship. After only a few days into it, I thought to myself "I could not have ended the year on a better note!" I absolutely loved every aspect of it; the residents, the attendings, the ancillary staff, the lectures, and the patients. What many other classmates considered boring was thrilling to me - not to mention that I scored higher on the psychiatry subtest than any other clerkship exam.

All things considered, psychiatry was the obvious choice for me. It was where skill and genuine interest converged. Fortunately, I did not seem as comfortable in other areas, so there were no distractions. Contrary to the opinion of the anonymous surgeon mentioned earlier, I do quite a bit, most of the time without even having to touch my patients. The fact that I can facilitate healing in patients by listening and speaking is one of the things I like most about my profession.

Marion E. Wright, Jr., MD, completed his residency at East Carolina University Brody School of Medicine, and joined a small-group practice in Wilson, N.C. He is happily married and the proud father of a 3-year-old son and 14-month-old daughter.

This article originally appeared online, September 2011, on PhysiciansPractice.com.