Psychiatry vs Neurology

Nick Medford nick at hermit0.demon.co.uk
Wed Feb 7 14:05:20 EST 2001


In article <95nhhs$tes$1 at nnrp1.deja.com>, Astomi <astomi at my-deja.com>
writes
>If a neuroscientist was thinking of becoming a clinician, which of these
>two would be a more attractive clinical arena, and why? Which of them
>would let you more constructively incorporate a clinical training to
>your neuroscientific background in a synergistic fashion? One
>non-so-trivial hurdle is the transition between two different cultures
>(the hours, the conception of authority, the discussion pace, depth of
>analysis, etc): in which specialty is this transition easier?. I would
>like to read about your personal experiences.

You don't say where you're posting from, and that may have a large bearing
on the decision.

Anyway- I was a trainee neurologist but switched to psychiatry, I'm also
involved in neuroscientific research (this is all in the UK). For various
reasons I prefer psychiatry:

1. Suits me better to spend my clinical time learning about people's
psychological make-up.  I always felt clinicians in other specialities tended
to lack the time and/or inclination to explore this in the depth it merits.

2. You can usually do something for your patients: you may not cure many,
but you can help most. In neurology you are often doing little more than
documenting their problems and then hoping the physio will help them a
bit.

3. In research terms, the questions in psychiatry are bigger and more
interesting, to me anyway. The neurobiology of higher thought processes and
emotions, for example, is rather more compelling than questions about
motor control or peripheral nerve conduction. Not everyone thinks so of
course. This is not to say that there isn't excellent work on higher mental
function done by neurologists.

4. Better quality of life: fewer on-calls, and not quite so overloaded
clinically. Of course this depends on the particular circumstances that obtain
wherever you are.

Downside of psychiatry is that to a greater and greater extent the problems
of life in general are being 'medicalised', and you end up acting as a
repository for the problems that might have been dealt with by village elders
or priests in days gone by. E.g. 'I'm depressed because my husband beats me
up, can I have Prozac'. Of course such people may in fact have become
clinically depressed, but more often they have unhappy lives for social/family
reasons and being asked to see this as 'illness' and do something miraculous
about it can be very difficult. Nevertheless it forces one to think long and
hard about the role of medicine, and that in itself can be very instructive. 

Another point to consider is that neurologists en masse tend to have more
knowledge of basic neuroscience than psychiatrists en masse, although I
think this is changing as psychiatry becomes more scientific. Psychiatry is
however, by its very nature, less scientific on a day-to-day basis than other
branches of medicine. But if you're doing a mix of clinical and research
work, this can make for a refreshing contrast between the two arms of your
work. 

Hope this helps

-- 
Nick Medford






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