IN TRAINING

The Psychiatric Residents

Three of the nurse/doctors are in their psychiatric residencies. Not one of these women intended to become a psychiatrist when she entered medical school. Each of them had a certain hesitancy about doing it, and heard objections from family and friends. Why go to all that effort of medical school to do something as "soft" as psychiatry?

Marilyn Cooper, a nurse/doctor who finished her psychiatric training in 1975, had done a year of internship and a year of residency in internal medicine before switching. "I wound up getting a number of psychiatric consults on patients who were 'noncompliant,'" she said. "I became more interested in understanding this area as I learned internal medicine was quite often an art and no more exact than psychiatry." There is an obvious link between a nursing background and the choice of psychiatry as a specialty. Nursing is the "caring" profession. Medicine is the "curing" profession. These three nurses, going through clinical rotations during medical school, found that for them the "curing" was lacking in an element they had especially appreciated during their nursing careers. Nursing is attuned to the psychosocial aspects of patient care: the patient's emotional state and his/her psychological welfare.

Each of these residents saw what the inhumanity of training did to the medical and surgical residents. Choosing psychiatry became a way to maintain their own integrity in medicine, and to retain certain elements from their nursing experience which they felt were a part of their personalities.

One of the topics each resident comments on is the subject of responsibility, and how the transition from nurse to doctor is being accomplished with reference to it. In looking back on her own experiences, Marilyn Cooper remarked, "I believe there is a different kind of stress that the bedside nurse feels than the bedside doctor feels. The doctor is protected to a greater degree from helplessness by the authority of give orders. They both feel responsibility."

Some of the psychiatric residents mentioned their desire to work with broader issues in the public health arena. Cooper says, "I was appointed to the W. County Board of Health with a budget of 7 million dollars. I have tried to improve the collection of data and flow of information in order to facilitate informed decisions. I have agitated for hiring a psychiatrist as Mental Health Division Director, or at least a nurse with a master's degree in psychiatric nursing."

The nurse/doctors in psychiatric training are faced, as are all physicians, with a changing health care situation. Cooper said, "I abhor the fact that all medicine and nursing are being terrorized by layers of bureaucracy. The practice was more fun twenty years ago for all of us." This theme will be echoed by several other doctors in this book, but these psychiatric residents are focused on the present and whet they will be able to accomplish in the future. Perhaps one advantage of contemporary training is that they have never known the more freewheeling practice of the older doctor.

Though Cooper would never recommend to anyone that they be a nurse first, she enumerated its advantages: "I was able to earn money as a nurse in both college and medical school. Being an RN before medical school gave me a level of comfort in the hospital and around the sick I never would have had otherwise. I already was able to recognize changes in the patient status and patterns of illness."

DL, DM, and Judson are well aware of the advantages nursing has given them. They are still close to their nursing careers and see medicine through that filter. For a variety of reasons-the independence nursing gave them, the understanding they gained of what would best satisfy their own needs, their current family situations and the lifestyle psychiatry promises-they have chosen this specialty, and none of them seems to particularly regret having taken this route to becoming a physician.