Anna Mead Robson: Psychiatry – a specialty for failures?

Anna Mead RobsonI once met a medical student who had failed his first year exams. “It’s ok,” he said, as I tried to console him. “I know I’m not very bright, but I can always be a psychiatrist after medical school.”

Two years later, after I had professed an interest in psychiatry, a doctor told me: “You know you’re intelligent, right? You don’t have to do that – you could be a real doctor if you wanted to.”

Until I started medical school I had no idea that psychiatry was regarded by some as a “non-medical” specialty for failures. I was disappointed to find that a career that sounded intellectually thrilling could have developed such a reputation. I am not stupid, and I do not want to be regarded as such if I go into psychiatry. Furthermore, it seems insulting to mental health patients that students who fail exams might be encouraged to enter psychiatry as a last resort. Psychiatrists have the privilege of caring for some of the most vulnerable members of society, and the profession should be attracting the very brightest and most humane medical students, not the drop-outs.

I now know that my experiences are not unique. A survey presented at the International Congress of the Royal College of Psychiatrists last week showed that most doctors identify psychiatry as the least respected medical specialty. Furthermore, many psychiatrists claim to feel stigmatised within their profession; 41% of the psychiatrists surveyed felt their advice was not valued by non-psychiatric colleagues. Most of us, at some level, crave respect. Like most medical students I have worked my academic socks off for most of my life. Do I really want to go into a career that will leave me feeling misunderstood and under-valued?

The college now holds an annual one-day student conference designed to lure the next generation into psychiatry, which I attended this week. This year’s speakers were genuinely inspirational, but I fear they may have been preaching to the converted. “How many people here want to be a psychiatrist?” asked the college’s president, Professor Dinesh Bhugra at the start of the day. We all raised our hands confidently. One student enthusiastically shouted out: “Psychiatry’s the best!”

Later in the day, Professor Nick Craddock’s talk on “Myths about psychiatry” was well-received, but I doubt any of us would-be shrinks believed the myths he cited in the first place. If you believe statements like “mental illness isn’t as important as physical illness” and “psychiatric treatments don’t work”, are you really going to give up precious time and money to travel to a psychiatry conference? The challenge lies in getting the message across to would-be surgeons.

The conference strengthened my belief that psychiatry is a fascinating and academically challenging specialty, but back at medical school I know I am still in a minority. Now I’m not saying that all medical students should become psychiatrists, because the specialty clearly isn’t for everyone. But can we not do more to stop the corrosive anti-psychiatry attitudes that still seem prevalent in the medical profession? One of the challenges is learning how to respond when a colleague makes an ill-informed comment. Most psychiatrists I know are very nice, thoughtful people. But it is hard sometimes to be nice and assertive. On neither occasion when it was put to me that psychiatry was for less academic students did I fight back. I simply smiled, tilted my head empathetically, and through a series of gentle questions tried to gain a better understanding of these poor people’s delusion. Was it a traumatic experience at medical school that turned them that way? Were they genetically pre-determined to look down on psychiatry? Perhaps innovative neuro-imaging techniques will help us understand more in future… Yes. I was made for the specialty.

Anna Mead-Robson is a fifth year medical student at St George’s, University of London and a Student Associate of the Royal College of Psychiatrists. She is a Clegg Scholar at the BMJ.