You like the idea of being a shrink, doing talk therapy, and having people all figured

你喜歡當心理醫生，做談話治療，讓人們都知道你的想法

out.

出。

Let's debunk the public perception myths of what it means to be a psychiatrist, and

讓我們來揭穿公眾對精神科醫生的認識誤區，以及。

give it to you straight.

直接給你。

This is the reality of psychiatry.

這就是精神病學的現實。

Dr. Jubbal, MedSchoolInsiders.com.

朱波醫生，醫派內參網。

Welcome to our next installment in So You Want to Be.

歡迎來到我們下一期的《所以你想成為》。

In this series, we highlight a specific specialty within medicine, such as psychiatry, and help

在這個系列中，我們強調了醫學中的一個特定的專業，如精神病學，並幫助

you decide if it's a good fit for you.

你決定它是否適合你。

You can find the other specialties on our So You Want to Be playlist.

你可以在我們的 "所以你想成為的人 "播放列表中找到其他特產。

If you want to vote in upcoming polls to decide what future specialties we cover, make sure

如果您想在即將到來的民意調查中投票決定我們未來的專業內容，請確保

you're subscribed.

你已經訂閱了。

If you'd like to see what being a psychiatrist looks like, check out my second channel, Kevin

如果你想知道當一個心理醫生是什麼樣的，請看我的第二個頻道，凱文。

Jubbal, M.D., where we featured Dr. Petey Kass in a Day in the Life of a Psychiatrist.

Jubbal，醫學博士，我們在那裡介紹了Petey Kass醫生在精神科醫生生活中的一天。

Link in the description.

說明中的鏈接。

Psychiatry is the field of medicine focused on understanding and treating mental health

精神病學是專注於瞭解和治療心理健康的醫學領域。

disorders and psychological distress.

障礙和心理困擾。

Psychiatrists use the Diagnosable and Statistics Manual, currently in it's fifth iteration,

精神病學家使用《可診斷和統計手冊》，目前已是第五次迭代。

hence the name DSM-V, in assessing a patient's constellation of symptoms and determining

是以被稱為DSM-V，在評估一個病人的症狀群和確定。

if they exhibit a diagnosable disorder.

如果他們表現出可診斷的疾病；

But psychiatrists can help patients with other conditions, even if they aren't classified

但精神科醫師可以幫助有其他病症的病人，即使他們沒有被分類為

DSM illnesses – including psychological distress from pain, trauma, difficult relationships,

DSM疾病--包括痛苦、創傷、困難的人際關係造成的心理困擾。

or other high stress situations.

或其他高壓力的情況下。

If you've ever confused psychiatrists with psychologists, you're not alone.

如果你曾經把精神科醫生和心理學家搞混了，你並不孤單。

Psychiatrists are medical doctors, meaning they have their MD or DO, and they've completed

精神病學家是醫生，也就是他們有醫學博士或博士學位，而且他們已完成了

4 years of medical school, followed by residency, and sometimes also fellowship.

4年的醫學院，然後是住院醫師，有時也是研究員。

They can diagnose and treat mental conditions using either medication or non-medication

他們可以使用藥物或非藥物來診斷和治療精神疾病。

treatments, such as psychotherapy.

治療，如心理治療。

While psychiatrists can use medications to treat patients' more severe symptoms, they

雖然精神科醫師可以使用藥物來治療患者較嚴重的症狀，但他們

rely on talk therapy training to help people with more mild symptoms, or, with problems

依靠談話治療訓練來幫助症狀較輕的人，或者，有問題的人。

that wouldn't necessarily respond to medications.

不一定會對藥物有反應。

Psychologists, on the other hand, have either Master's or PhD level training, and while

而心理學家則有碩士或博士級別的培訓，雖然。

they're able to diagnose and treat mental illness, they can only use non-medication

他們能夠診斷和治療精神疾病，但他們只能使用非藥物治療。

treatments.

治療；

Sometimes you'll see psychiatrists and psychologists working together, with psychologists focusing

有時你會看到精神科醫生和心理醫生一起工作，心理醫生專注於

on therapy, and psychiatrists usually focusing their expertise on medication, although they

治療，而精神科醫生通常把他們的專業知識集中在藥物治療上，儘管他們的專業知識和技術都很高。

can do either.

都能做到。

While some think that psychiatrists go into the field because they subconsciously want

雖然有些人認為精神科醫生進入這個領域是因為他們潛意識裡想要

to fix their own problems, or that they're highly eclectic and strange, this isn't

來解決他們自己的問題，或者說他們是高度折衷和奇怪的，這不是

quite true.

很對

As a psychiatrist, you'll have to be adept at relating to a wide range of individuals,

作為一名精神科醫生，你要善於與各種各樣的人交往。

and that also requires well developed interpersonal skills.

而這也需要良好的人際交往能力。

And while it has a useful handbook, psychiatry is much more than just memorizing DSM criteria

雖然它有一本有用的手冊，但精神病學不僅僅是記住DSM標準那麼簡單。

and slapping on diagnoses to patients.

並給病人貼上診斷書。

Psychiatrists use the DSM as a guide, but they formulate patients more holistically

精神病學家以DSM為指導，但他們為病人制定的方案更加全面。

than that – they're looking at the psychological, socioeconomic, and physiologic causes of their

比這更重要的是--他們正在研究他們的心理、社會經濟和生理原因。

symptoms as well, not just the symptoms themselves.

症狀，而不僅僅是症狀本身。

There are a few ways to categorize psychiatry.

精神病學有幾種分類方法。

As a clinical psychiatrist, you'll be seeing patients, doing therapy, and generating treatment

作為一名臨床精神科醫生，你要為病人看病，做治療，並制定治療方案。

plans.

計劃。

If practicing inpatient, you'll see patients admitted to the psychiatric ward or consult

如果您是住院病人，您將為精神科病房收治的病人看病，或為您的病人提供諮詢。

service, meaning those treated primarily in other areas of the hospital, but requiring

服務，指那些主要在醫院其他區域治療，但需

secondary psychiatric care.

二級精神病護理；

As a consultant, you'll educate primary teams on various psychiatric and psychological

作為一名顧問，您將對初級團隊進行各種精神科和心理學方面的教育。

conditions affecting their patients and provide them with your psychiatric treatment recommendations.

影響患者的病情，並向他們提供你的精神科治療建議。

With inpatient, you're dealing with more severe cases that often require more critical

對於住院病人，你要處理的是更嚴重的病例，往往需要更多的危急情況。

treatment.

治療。

These patients often have multiple psychiatric conditions and are generally more complicated

這些患者往往有多種精神疾病，一般比較複雜。

than those you would see in an outpatient clinic.

比你在門診看到的那些。

There's also a great deal of medicine involved as these patients often have multiple medical

由於這些患者往往有多種病症，所以還涉及到大量的醫。

issues that either worsen or mimic psychiatric symptoms.

惡化或模擬精神症狀的問題；

For example, certain medical issues like cancer, brain injuries, or COVID can result in delirium

例如，某些醫療問題，如癌症、腦損傷或COVID，可導致譫妄。

or agitation, which can both look like psychosis or depression.

或焦躁不安，看起來都像精神病或抑鬱症。

With outpatient, you'll be primarily combining psychotherapy with medication management for

對於門診，你主要是將心理治療與藥物管理結合起來，以達到

patients with whom you'll have more longitudinal relationships, as they'll come to the office

你將與他們有更多的縱向關係，因為他們會來辦公室。

multiple times over months to years.

數月至數年內多次。

With outpatient, you also have more flexibility in managing things beyond traditional psychiatric

有了門診，你還可以更靈活地處理傳統精神科以外的事情。

diagnoses, like sleep, pain, or distress from various stressors.

診斷，如睡眠、疼痛或各種壓力源的困擾。

If you focus on research, you can choose from bench or clinical work.

如果你專注於研究，你可以選擇工作臺或臨床工作。

With bench research, you often work in a lab and do research at the cellular or molecular

在工作臺研究中，您經常在實驗室工作，在細胞或分子上進行研究。

level to explore foundational neurobiology that may help explain the brain function of

層次，探索可能有助於解釋大腦功能的基礎神經生物學。

people with psychiatric conditions.

有精神疾病的人；

With clinical research, you could explore the efficacy of different medications and

通過臨床研究，你可以探索不同藥物的療效和

treatment options in treating specific patient populations or psychiatric conditions.

在治療特定的病人群體或精神狀況方面的治療方案；

Interventional psychiatry is an exciting new area exploring brain stimulation through trans

介入性精神病學是一個令人興奮的新領域，探索通過經絡刺激大腦。

cranial magnetic stimulation, or TMS for short, ketamine, and deep brain stimulation.

顱磁刺激，簡稱TMS，氯胺酮和深部腦刺激。

In an academic setting, you can work either primarily inpatient or outpatient, but associated

在學術環境中，你可以主要在住院或門診工作，但相關的。

with an academic teaching hospital.

與一家學術教學醫院。

This offers less flexibility in your practice, but will allow you the opportunity to do research,

這為你的實踐提供了較少的靈活性，但會讓你有機會進行研究。

work with medical students and residents, and pursue academic leadership.

與醫學生和住院醫師一起工作，追求學術上的領先地位。

You'll be working at a medical center that is likely pushing to advance the field, but

你將在一家醫療中心工作，該中心可能會推動該領域的發展，但你將在該中心工作。

will be at the whim of the bureaucracy of the hospital, and your appointment types,

將由醫院的官僚主義，和你的預約類型。

meaning appointment length and therapy vs. medication management ratios, will have a

意味著預約時間和治療與藥物管理的比例，將有一個。

limit set by the institution.

機構規定的限額。

In a community setting, you'll work with hospitals or outpatient clinics run by the

在社區環境中，您將與醫院或由政府管理的門診部合作。

county or city public health departments.

縣或市公共衛生部門；

Patients will primarily be Medicaid or uninsured, meaning you'll have the opportunity to work

病人主要是醫療補助或無保險的人，這意味著您將有機會在這裡工作。

with underserved patients and a greater proportion who are severely mentally ill.

服務不足的病人和比例較大的嚴重精神病患者。

Dual diagnoses amongst this patient population is not uncommon, meaning a substance use disorder

在這些病人中，雙重診斷並不罕見，這意味著藥物使用障礙。

plus a separate mental health diagnosis.

加上單獨的心理健康診斷。

For these reasons, this work can be highly rewarding, as this is a population with less

由於這些原因，這項工作可能會有很大的收穫，因為這是一個人口較少的。

access, but it can also be highly frustrating working with a socioeconomically disadvantaged

但與處於社會經濟弱勢地位的人合作也會非常令人沮喪。

population, as medication and appointment adherence may be problematic, as is access

因為堅持服藥和預約可能會有問題，獲取藥物的機會也會有問題。

to other resources.

到其他資源。

Private practice entails one or more physicians setting up their own shop outside of a larger

私家診所是指一個或多個醫生在大醫院之外建立自己的店鋪。

medical center.

醫療中心。

They have complete control and autonomy, seeing patients as they choose.

他們擁有完全的控制權和自主權，根據自己的選擇給病人看病。

This has the greatest amount of flexibility in most domains, including how much they charge,

這在大多數領域具有最大的靈活性，包括他們的收費方式。

which insurances they take, the balance of therapy versus medication, and visit durations.

他們參加哪些保險，治療與藥物的平衡，以及訪問時間。

However, this is running a business, and there are of course risks associated with that.

不過，這是在經營企業，當然也有風險。

At the beginning, you'll have to do more work to build a patient population, which

剛開始的時候，你要做更多的工作來建立病人群，這是

may mean making less money at first than you would with an established group or medical

可能意味著一開始賺的錢比你在一個成熟的集團或醫療機構賺的錢要少。

center.

中心。

With psychiatry, you don't have to choose a single type of practice.

對於精神科，你不必選擇單一的執業類型。

You could do academia a few days per week, and some private practice on other days with

你可以每週做幾天學術研究，其他時間做一些私人練習，與

a smaller psychiatry group.

規模較小的精神病學小組。

After 4 years of medical school, psychiatry residency is 4 years, unless you go into a

醫學院畢業後，精神病學住院醫師是4年，除非你進了

child psychiatry fellowship, in which case you can skip the final year, making it a 3

兒童精神病學獎學金，在這種情況下，你可以跳過最後一年，使其成為一個3的

year residency.

一年的居住期。

More on fellowships shortly.

更多關於研究金的內容很快就會出現。

As a PGY1, meaning your first year out from medical school, you'll do primarily general

作為PGY1，也就是你從醫學院出來的第一年，你將主要做一般的... ...

medicine rotations, like inpatient and outpatient medicine, emergency medicine, neurology, and

醫學輪轉，如住院和門診醫學、急診醫學、神經病學，以及。

the like.

諸如此類。

You'll spend some time on psychiatry, usually inpatient, from a few months up to half a

你會花一些時間在精神病學上，通常是住院治療，從幾個月到半個月。

year, depending on your program.

年，這取決於你的計劃。

As a PGY2, you're now completely immersed in your psychiatric training, primarily on

作為PGY2，你現在完全沉浸在你的精神病學訓練中，主要是關於

inpatient and consult psychiatry services, though some programs will offer a small amount

住院和諮詢精神病學服務，儘管有些計劃會提供少量的。

of outpatient training in this year.

的門診培訓，在今年。

As a PGY3, you'll focus on outpatient psychiatry, rotating in different specialty clinics, each

作為一名PGY3，你將專注於門診精神病學，在不同的專科診所輪轉，每一個

devoted to a specific diagnosis, patient population, or age group.

專門針對特定的診斷、病人群體或年齡組；

For example, you could attend bipolar clinic or anxiety clinic, or go to child clinic or

例如，你可以參加躁鬱症診所或焦慮症診所，或去兒童診所或。

LGBT clinic.

LGBT診所；

Your fourth and final year will be highly variable, although most commonly this will

你的第四年和最後一年將有很大的變化，儘管最常見的是這將是

be repetitions of rotations you've done in previous years.

是你前幾年做過的輪換的重複。

You'll also have more opportunity for elective and research time to pursue your interests.

你也會有更多的選修和研究時間來追求自己的興趣。

Hours in psychiatry residency are pretty relaxed, mostly 8-5 on most rotations, with some overnight

精神病學住院醫師的工作時間很寬鬆，大部分輪轉時都是8-5點，有的還會通宵。

and weekend call shifts, the frequency of which is highly dependent on the program,

和週末輪班，其頻率高度依賴於該計劃。

with some programs having none.

而有些程序則沒有。

In terms of competitiveness, psychiatry is more attainable, with an average Step 1 in

從競爭力來看，精神病學更容易實現，平均一步到位，在。

the 2020 cycle of 227 and Step 2CK of 241, and a 90% match rate.

2020年週期為227，步驟2CK為241，匹配率為90%。

In the MSI Competitive Index, psychiatry ranks at 18 out of 22 in terms of competitiveness.

在MSI競爭力指數中，精神科的競爭力在22個專業中排名18位。

Psychiatry has increased in competitiveness in recent years for a few reasons.

近年來，精神病學的競爭力增強，原因有以下幾點。

More medical students are understanding the importance of work/life balance, for which

越來越多的醫學生認識到工作/生活平衡的重要性，為此。

psychiatry has a strong advantage.

精神病學具有強大的優勢。

There are more options within the field than ever, thus attracting a wider variety of individuals,

該領域內的選擇比以往任何時候都多，是以吸引了更多的人。

and it's also becoming a less stigmatized field.

而且也成為一個不那麼汙名化的領域。

Mental health is finally becoming more mainstream, as it should.

心理健康終於成為主流，這是應該的。

After completing residency, you can subspecialize further with fellowship.

在完成住院醫師資格後，你可以通過獎學金進一步分科。

All fellowships are 1 year in duration, except for child psychiatry, which is 2 years.

除兒童精神病學為2年外，其他獎學金的期限均為1年。

In child psychiatry, you'll be working with children and adolescents, most commonly dealing

在兒童精神病學中，您將與兒童和青少年一起工作，最常見的是處理以下問題

with depression, anxiety, eating disorders, ADHD, and autism.

患有抑鬱症、焦慮症、飲食失調、多動症和自閉症。

You'll work closely with their parents as well, thus incorporating a high degree of

你將與他們的父母緊密合作，從而將高度的社會責任感融入其中。

psycho-education and family counseling.

心理教育和家庭諮詢；

Child psychiatry is more focused on non-medication based strategies, including therapy and mindfulness

兒童精神病學更注重非藥物治療的策略，包括治療和心態治療

practice, compared to other psychiatry subspecialties.

的做法，與其他精神病學亞專業相比。

Psychosomatic is best suited for those who want to work in the overlap between psych

心身學最適合那些想在心理學和心理學之間重疊工作的人。

and medicine, specifically with medically hospitalized patients who have psychiatric

和醫學，特別是與醫療住院的精神病人一起。

needs.

需要。

You'll manage complicated patients, such as someone with schizophrenia who is also

你將管理複雜的病人，例如患有精神分裂症的人，同時也是一個複雜的病人。

on chemotherapy, and finding the best medication for the mental disorder that won't negatively

化療，並找到最好的藥物治療精神障礙，不會對身體造成負面影響

interact with the chemotherapeutic agent.

與化療藥物相互作用。

Psychosomatic specialists are often embedded in clinics for a particular medicine subspecialty,

心身專家往往被嵌入到某個醫學亞專業的診所中。

such as oncology or palliative care, which allows psychiatrists to further subspecialize

如腫瘤學或緩和療護，這讓精神科醫師可以進一步分科。

with patient populations they are most interested in.

與他們最感興趣的患者群體。

Geriatric psychiatry includes working with older adults and learning how to manage psychiatric

老年精神病學包括與老年人一起工作，並學習如何管理精神病。

illness in more medically frail and complicated patients with other comorbidities.

醫學上更多的體弱和複雜的患者的疾病，並伴有其他合併症。

You'll also be doing life-processing, meaning coping with end of life stressors, such as

你還會進行生命處理，即應對生命末期的壓力，如

death of friends, spouses, and one's own mortality.

朋友、配偶的死亡和自己的死亡。

If you're interested in this field, you'll have great flexibility in where you work,

如果你對這個領域感興趣，你將在工作地點有很大的靈活性。

even in big cities, as there's high demand for the specialty with our aging population,

即使是在大城市，因為隨著我國人口老齡化，對該專業的需求量很大。

but currently low supply.

但目前供應量少。

Forensic psychiatry focuses on the overlap between psych and the law.

法醫精神病學注重心理與法律的重疊。

You'll evaluate patients in situations related to legal matters, such as insanity evaluations

你將在與法律事務有關的情況下評估病人，如精神錯亂評估。

if the defendant pleads insane.

如果被告辯稱自己精神失常；

When it comes to legal issues related to psych, these are the experts.

談到與心理有關的法律問題，這些都是專家。

For example, you'll act as an expert witness in court cases and evaluate medical records

例如，您將在法庭案件中擔任專家證人，評估醫療記錄。

to assess malpractice.

以評估不良行為。

This isn't a clinically focused subspecialty.

這不是一個臨床重點亞專業。

Rather, you'll be serving as an expert evaluator, but most forensic psychiatrists also do part

相反，你將作為一個專家評估員，但大多數法醫精神病學家也做部分

time outpatient general psychiatry work as well.

時間普通精神科門診工作以及。

Addiction focuses on substance use disorders and dual diagnoses patients, meaning they

成癮問題主要集中在藥物使用障礙和雙重診斷的患者，這意味著他們

have both substance use disorder and a primary psychiatric disorder.

同時患有藥物使用障礙和原發性精神障礙；

You'll often find yourself working in rehabilitation facilities or outpatient clinics.

你會經常發現自己在康復機構或門診工作。

Public psychiatrists practice in community or underserved patient populations, doing

公立精神科醫生在社區或服務不足的病人群體中執業，做的是

advocacy work for legislation that affects these communities, op-ed writing for publication,

對影響這些社區的立法進行宣傳，為出版品撰寫專欄文章；

and lobbying.

和遊說。

You'll be working with the most vulnerable patient populations, which can be very satisfying.

你將與最脆弱的患者群體合作，這可能是非常令人滿意的。

Interventional psychiatry is not an ACGME-accredited subspecialty, meaning it's not as official

介入性精神病學並不是ACGME認可的亞專業，也就是說，它並不像官方的

as the rest.

如其餘。

This is for those who are interested in psychiatric procedures, like electroconvulsive therapy

這是為那些對精神治療程序感興趣的人準備的，比如電休克療法。

(ECT) for severe depression or transcranial magnetic stimulation (TMS) for OCD and depression

(ECT)治療嚴重抑鬱症或經顱磁刺激(TMS)治療強迫症和抑鬱症。

treatment.

治療。

This also includes ketamine assisted therapy or ketamine infusions for depression.

這也包括氯胺酮輔助治療或氯胺酮點滴治療抑鬱症。

Some of your patients will have deep brain stimulation electrodes placed by neurosurgeons,

有些病人會有神經外科醫生放置的腦深部刺激電極。

and you'll manage the patient's psychiatric care before and after surgery.

而你要管理病人手術前後的精神護理。

Psychiatry is a unique specialty within medicine.

精神病學是醫學中一個獨特的專業。

It's the least algorithmic, meaning you'll never simply follow an algorithm when treating

它是最不講究算法的，也就是說你在處理的時候，絕對不會簡單的按照算法來處理。

a patient.

一個病人。

Rather, you must think deeply and holistically about each of your patients.

而是要對每一位患者進行深入、全面的思考。

If 2 patients have the same disorder, you likely won't be using the same 2 treatment

如果2個病人有同樣的病症，你很可能不會使用同樣的2種治療方法。

plans.

計劃。

If you enjoy spending time with patients, psychiatry is hard to beat.

如果你喜歡和病人相處，精神病學是很難被打敗的。

It's one of the few specialties left where you can regularly have 45-60 minute appointments.

這是為數不多的可以定期進行45-60分鐘預約的專科了。

And most of your patients will need your treatment long term, if you prefer longitudinal relationships

而且你的大部分病人都需要你長期治療，如果你喜歡長期的關係。

and having a deeper connection.

並有更深的聯繫。

You'll see them develop and improve with time, and being a part of that is satisfying.

你會看到他們隨著時間的推移而發展和進步，而作為其中的一部分，是令人滿意的。

Psychiatry offers flexibility in your career — you can work in multiple clinical settings

精神病學為您的職業生涯提供了靈活性 - 您可以在多個臨床環境中工作。

or with multiple patient populations and even have multiple jobs at once.

或與多個患者群體，甚至同時擁有多項工作。

You're able to tailor your career to meet your goals unlike other specialties, where

與其他專業不同，您可以根據自己的目標定製您的職業生涯，在那裡

you generally must take one job in one setting.

一般來說，你必須在一個環境中接受一份工作。