watch this video before you apply psychiatry

[@elizabethschuler8890]

Preston, as someone who is much longer down this journey of life, I adore listening to you…the kids, the kids are alright.

[@gillablecam]

Your point about the stigma against psychiatry manifesting as people "missing real medicine" is so true. As a junior doctor, I swore up and down that I wouldn't be "one of those psychiatrists" who can't even chart insulin anymore. It's only as I'm approaching the end of my psych training that I'm realising how much of that was based in a denigration of the knowledge and skill of psychiatry underneath general medicine.

[@rusinoe8364]

But can you manage general medical issues?

[@thebeatles9]

for me the interest is both in the somatic and psychologic. so yes, I definitely want to still be able to manage their insulin while also having them lay on the couch and talking about the childhood. We already have a MD degree, there isn't anymore validation tot he outside world needed than that.

[@gillablecam]

@@rusinoe8364 depends on the issue, just as if you asked a general physician "can you manage general psychiatric issues?" they would have a complex answer. They're both important skill- and knowledge-sets.

[@casinoroyale0013]

@@thebeatles9 or DO degree

[@bettievw]

This is such a weird thing to me. Because other specialties will readily state that they shouldn't be trusted with general care outside their specialized area, and yet it seems like only *some* areas get stigmatized. I wouldn't want an orthopedic surgeon to help me with my cough, or for an ear nose and throat doctor to reset a dislocated thumb, or for a radiologist to deliver my baby. People specialize for a reason. General medicine is hard, that's why people specialize in being able to do that really really well, and others specialize in more specific disciplines.

[@2AZSUN]

Preston, you totally nailed it on this one. The only thing I'm left wondering is what wisdom got edited out. It feels like you hit record and said a whole bunch of great stuff, then went back and edited out what I'm guessing was more great stuff. It would be great to see the full unedited version of this. This one is also particularly good because my spouse has been a psychiatrist for 34 years and your take as a current resident has a unique feel to it. Medicine has changed so radically over the last few decades, it's really interesting and fascinating to hear your current take on it. Thanks for sharing your insights.

[@arqamhusain9357]

Thank you for making this video. As an EM resident who sees too many psychiatric patients in the ED, I really enjoyed watching this video and hearing your thoughts and perspective on psych and it was a breath of fresh air. I honestly never viewed psych in this light and will hopefully have a new, more philosophical perspective when I see my psych patients in the ER now. Thanks!

[@MuhammadRifai-kw5bb]

As a 3rd year med student who is heavily considering psych, thank you for this

[@airlion1205]

Actually, thank you for making this. I was actually highly considering on applying to psych this cycle!

[@Voguewow]

Actually, thank you for making this. I was actually highly considering on not applying to psych this cycle!

[@fulltimeslackerii8229]

Psychiatry is arguably the most depressing discharge planning I’ve ever had to see as a med student. A lot of homeless people, abandoned by their family and all we can do for them is a shelter brochure or a bus pass back to their tents. It’s AWFUL and it’s why I can’t see myself in the field regardless of how interesting I find psych and its pharmacology to be

[@orangeblossom1712]

Haha welcome to hospital social work🙃

[@fulltimeslackerii8229]

@@orangeblossom1712case managers have the toughest souls in the hospital

[@YanpingSoongNora]

I used to be said homeless young person estranged from my family (for being trans/queer) lol, but now am an M2. Is that how all y’all really just feel about us?

[@AntonGlasberg]

Murica

[@rachellllhines]

welcome to reality

[@marytheresadavis7071]

I’m a second year really starting to think about how to approach finalizing what specialty I want to do as I move through rotations, and this has given me great food for thought. Thank you!

[@pathurd9595]

I really appreciate everything you do on your platform Preston. I’m just a pre-med in my third year and after two years of ignoring what makes me human and tying my self worth to external factors I got really depressed. I’m in therapy and on an SSRI and finally starting to take care of myself again. Your content is a reminder that mental illness is unfortunately for some people just part of being a human, but it’s not a defining feature or moral failure and it CAN be treated. You set an incredible example for the kind of physician I hope to be.

[@zingoid2710]

I've always wanted Psych but was in a weird way ''closeted'' about it. I went to a really competitive med school and Psych was generally looked down on, like an easy way out, not scientific/evidence-based and generally seen as purely soft skills with bad outcomes. I even see it now as a doctor, whenever I say to colleagues I'm applying to Psych, I usually get a frown and indirect disappointment/disengagement from them for going into a field that is ''basically 3-4 drug classes'' and a lot of ''faffing about for nothing''. Same with family, who see it as kind of a waste as ''I could be doing something harder''. Its difficult to come to terms with to be honest, we all enjoy the pleasure of being perceived as ''smart'' or doing something hard, especially coming from colleagues, but at the end of the day it boils down to one thing for me: What do I find interesting. What will I find interesting 30 years down the line, and that answer is easily Psych, to the point where I don't see how people are interested in things like Medicine/Surgery. Its also very obvious once you work in general medicine that a lot of it has bad outcomes and ''bandaid fixes'' with no actual resolution of the root cause.

[@DerfVader12]

Started STEP1 dedicated this week and this video was the inspiration I needed. I’ve learned so much about psych from you Preston and I can’t wait for my rotation!

[@dillonnoltensmeyer4471]

I really like the format of this. Perhaps you could start a podcast?

[@itspresro]

@@dillonnoltensmeyer4471 I am! Trailer is coming out 2025

[@marinmazer]

You will also experience ego as colleagues and people pushing on your skillset and framing it as "not real medicine", while being so oblivious to the limits of their own practices that are also only based on anecdotal evidence or just pretty limited research data. There is selection bias to look at psychiatry studies as inherently vague and "fuzzy", which many other docs find "uncomfortable" while ignoring this vagueness and limitations are present in way more aspects and subspecialties of medicine we don't typically find "vague".

[@EstherDwomoh]

Thank you for this video, Preston! I’m a recent college grad and I’ve always been interested in psychiatry. Your emphasis on presenting your narrative and story is *really important* I’m a first gen immigrant and that’s always been fundamental to how I navigate my experiences in the U.S.. My focus is on providing accessible care to low-income, first gen immigrants and their children (emphasis on adolescent psychiatry) - I know from personal experience what it’s like to navigate your mental health as an immigrant. You’ve given me something to ponder over. Thank you again! Happy holidays.

[@Sandy-of6gq]

Wow I'm surprised to hear psych has enough time to have philosophical/ existential conversations with patients. I'm intrigued!

[@Arachisage]

"if you don't order yourself, how are you supposed to guide someone else to a meaningful life" This is something that has troubled because my own mental health isn't terrific. And I was so afraid I did not take up my med school offer. Because I didn't want to do more harm than good. And yes I was interested in psychiatry because I think conversations about life are so interesting and important. And now I'm afraid of trying again for med school because I'm getting older I don't think psychiatry is beneath medicine or what. If anything I 100% agree and love it that it is treating the person as holistically as possible, rather than just treating a bunch of statements. Medicine is both an art and science, and it's also life.

[@angieyk3930]

I want to do clinical genetics where I live and I'm surprised how similar my reasons are. It's definitely great work-life balance and emotional intelligence is a big part of the job as you're often breaking bad news, and having to understand how it will impact your patient's life and planning ahead for their reaction is important to deliver the news correctly and coordinate the resources to support your patient. Will be using your video for inspiration.

[@Diego-ce4bs]

I just got accepted to med school! I have no frame of reference for any of this but will keep your insights and humor in mind on my journey!

[@65215612]

Currently going through psych residency interviews and this will definitely help me!

[@misteratoz]

I found this to be wildly interesting and I'm a hospitalist who also wonders if I'm really helping people sometimes

[@mooshiemars6867]

Could you also make a video on how you balanced fitness, hobbies, working, etc. during med school?

[@JaysAnatomy101]

Heya Preston, honored to be so early to this video. I'm currently trying to decide my own rank list; I'm curious what factors would you recommend considering most in terms of ranking programs? (if we were to ignore location of course, which I think is important to consider but very unique to the individuals situation)

[@john8890]

Do you think it’s worth a person’s time and energy to transition from a PMHNP to an MD trained psychiatrist?

[@Banchik_danchik]

Tolerating abstraction and ambivalence is a sign of emotional intelligence which is most definitely required for psychiatry. Stigma can come from fear of not knowing what we don’t know, that’s scary for a lot of people. Anyway here’s some lithium (bring lithium back)

[@onoderarintaro5179]

omg presro i love you dude and you encourage me more to do psych

[@SaSpursFan]

Working at UH will make you feel shitty and like you’re not a “real enough doctor” so know that you’re not alone and it’s not like that outside of this bubble.

[@daydin3535]

my psych rotation is coming up! thanks Preston

[@user-bv7jc]

amazing video. thank you SO much for sharing.

[@pega7us]

Some of most important contributors to analysis were physicians, like Donald Winnicott. I also think pure therapy often overlooks biology. Do you think it would be an overkill to become a psychiatrist in order to do mostly therapy?

[@leightonolsson4846]

Really enlightening.

[@williamdavis9630]

I think the stigma regarding psych is somewhat justified to a degree. Psych rotation was ironically depressing experience for me. These patients were legitimately sick but more often than not it felt like our interventions were doing little to nothing. The level of non-evidence based decision making and anecdotal justifications for decision making was quite disturbing. Stack that on top of the treatment failures and relapse rates and it wasnt a pleasant experience for me. Idk, felt sad, these patients were clearly in need of help but felt the interventions werent helping and sometimes, were doing more harm than good

[@fulltimeslackerii8229]

This is how I felt. At the end of the day, a vast majority of my psych rotation felt like bandaid fixing so that they can handle their subjective experiences. It wasn’t as satisfying or “concrete” as say, treating an infection or taking out an appendix. Things I know were permanently healed.

[@Sandy-of6gq]

I felt this on a lot of "somatic" rotations as well. Yes some specialties like cardio have "harder" body of evidence but still the majority of the cardio patients were very sick and in a sort of a vicious spiral or at the very best oscilations in the intensity of their illness. Plus suffering from the side effects of meds and/or procedures complications. I guess a quick and complete resolution of an illness is quite rare, except maybe sometimes in infectious diseases and minor trauma surgery.

[@CheeseLoversUnited]

I'm not casting aside the legitimacy of your critiques but ime the stigma is not frequently rooted in some noble loyalty to evidence based practice, it's stigma towards mental illness. One of my mentors in psychiatry once said that it's a palliative profession: it's about managing symptoms, sometimes ones that will always be prominent or progressive over time. What counts as a 'successful intervention' and an improvement in quality of life in that context can seem depressing to those on the outside who feel uncomfortable even just knowing the stories of our patients.

[@mediokritet]

Is it possible to ever completely get "rid" of ego? Is it enough to get as aware as possible of where your ego is fragile and work on not letting it rule you? I'm horribly uneducated on all of these terms so I'm probably butchering it, I apologize. I'm just really curious.

[@pega7us]

If you completely get rid of the ego, you will likely become one of his patients. The ego is a normal part of the psyche. You don’t need to get rid of it, but rather need to keep it from becoming inflated or deflated.

[@zachjones6944]

Become a Buddhist monk.

[@compositeur8455]

You manage it

[@jobis34]

Psychedelics

[@sadieheald1125]

This is sad but as a social worker and a peer it really blows my mind that you went into psychiatry. I have met so few smart, capable, affable psychiatrists. Thank you thank you thank you for doing and sharing about this specialty.

[@medicalchalupa9928]

I’m wondering if peds emergency is best for me. It’ll allow me to care for the kid and help treat parents anxiety around their child’s acute illness without me having to follow them long term. No clue though, haven’t even reach rotations yet

[@zachsalisbury9771]

Awesome video!

[@PinkNinjaKick]

“Spiritual depression is different from clinical depression.” Do you understand and/or agree with this sentiment?

[@rachellllhines]

I match (hopefully) into psych in March! this is so real, I have peers applying to psych only because of the work-life balance and it is frustrating to see them get more interviews than me just bc they have a higher step score??? idk the whole process is wack at best

[@jobis34]

How much did step score matter when applying?

[@rachellllhines]

@ its definitely not everything but for some programs they wont even look at u if you’re below a certain range! (this is all under the radar they would never say this explicitly on their websites but its true)

[@Dragonmoon1598]

Question: What is the key difference between psychiatrists and therapists: the ability to prescribe medication? Or is it more than that?

[@A432Hz]

Psychiatrists are Medical Doctors, MD/DO licensed. Therapists/psychologists are not medical doctors and can have a variety of academic credentials, whether it be PsyD, PhD, LMFT, etc. Thus their approaches to treatment are different. While psychologists specifically focus on the mind through various means whether it be psychoanalysis, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, etc., psychiatrists use their medical degree to also understand how physiological stressors and pathologies can also affect the mind in addition to understanding psychology. Yes, the most obvious difference is *the ability to prescribe medications*, but people often overlook how the psychiatrist understands the body as a whole, not just to start a medication, but also exercising judgement on not starting one. Being able to write a prescription implies one is capable to understand the human body enough to give a medication while weighing benefits and risks.

[@mathew9851]

@@A432Hz Thanks captain obvious

[@orangeblossom1712]

Psych does evaluations for diagnosis and medication management

[@DennisBolanos]

It’s like asking, “What's the difference between a neurologist and a professional?” 🤦🏻‍♂

[@mathew9851]

Hi Preston, I'm not entirely sure that the neurosurgery gunner needs to unpack that. They might have found their place in the world and know what requires to get where they need to be. In addition, perhaps, you wanting to unpack that may be you wanting to project your worldview onto that person, unconsciously. I could be totally wrong, but just some thoughts I had.

[@lauren1225]

I don't think that unpacking it necessitates it being wrong. The end result could be packing it back up the same way.

[@Sandy-of6gq]

But how sustainable is it to live like that? What if they get injured and can't operate anymore? What happens after they retire? I feel like it deserves at least a little reflection before letting most other non-neurosurg facets of life and their identity wither away. But if everyone did this maybe we wouldn't have many neurosurgeons left 🤔😆

[@momentstorture6399]

"start to miss real medicine"... brother even you have internalized this The line between psychiatry, immunology, and neurology is becoming increasingly blurred I think if you take ownership, engage other specialties and don't let your general medicine knowledge rust it is very easy to avoid this "not real medicine" trap Manage your own diabetes, UTIs, metabolic syndrome, headaches, etc. Its not hard, we were all taught this just have to insist on continuing to do it.

[@twoscoops4181]

Your hair looks great!

[@JamilaJibril-e8h]

Why they all shaving alike 😦

[@compositeur8455]

@JamilaJibril-e8h he's in the army

[@JamilaJibril-e8h]

@compositeur8455 oh okay now I get it.. thanks

[@ArloKnudsenFit]

(1) I love your haircut, Preston!!

[@thebeatles9]

Imagine having a background (degree) in psychology. And a decade of work as a crisis counselor and psych tech. That will be infinitely better than a step 2 score.

[@Fusion4Dayz]

First