As a medical student, have you ever wondered what it feels like to specialize in child and adolescent psychiatry? Meet AMA Member Adrian Jacques Ambrose, MD, MPH, Child and Adolescent Psychiatrist and AMA Distinguished Physician Specialized “Shadow Me” series, which provides first-hand advice from clinicians about life in their specialties. Check out his vision to help decide if a career in child and adolescent psychiatry is right for you.
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“Shading” Dr. Ambrose
specialty: Child and Adolescent Psychiatry; Administrative Psychiatry.
Practice setting: Academic medicine, outpatient clinics.
Type of the job: hospital.
years in practice: four.
A typical day and week in my practice: As a night owl, I often marvel at my colleagues’ ability to set off to work at the first crack of dawn. After slowly crawling out of bed, I would brew tea and mentally inject caffeine directly into the nearest adenosine receptor. More human now, I’ve made it to the office to start planning my management meetings for the day.
As Medical Director, I spend approximately half of my time managing clinical practices, reassessing best practices, ensuring appropriate clinical growth, addressing clinical concerns from faculty and patients, and examining the financial footprint of our clinical services. The work is a beautiful jumble of multiple moving variables – explicit and implicit – and I often lose myself in the flow.
On clinical days, I often practice a combination of outpatient adult and pediatric psychiatry and interventional psychiatry for severe and refractory mood disorders. The day itself begins about the same with my cup of tea, but often ends with a variety of Lego bricks and toy cars scattered in my office. For interventional psychiatry work, I provide and supervise staff in the intranasal delivery of ketamine. My favorite “dad joke” to tell patients for the first time is, “We often stick our noses where Act Belonging” to my team’s resentment.
The most challenging and rewarding aspects of child and adolescent psychiatry: Often the most challenging part of my work in psychiatry is the invisible barriers to receiving mental health care for both patients and caregivers. For some patients, mental health care is often part of their insurance plans. As a result, many drugs or even treatments are not covered, highlighting one of the fundamental health inequalities in our healthcare structures.
Plus, for some of my patients who provide health care themselves, it’s heartbreaking to hear their stories about how they maintain an “all is well” facade at work for fear of treatment or discipline. In many states, licensing applications often inquire about any past history of mental health treatments, which not only stigmatizes the aspect of psychiatric care but also alienates providers with mental health conditions.
On the other hand, the surreal experience of sharing some of the most private and personal aspects of our patients’ lives is a wonderful one. It is an absolute honor to talk about patients’ deepest thoughts and walk with them through so many laughs, heartaches, disappointments, triumphs, births and deaths. These stories and experiences made me realize how incredibly similar we are to humans and how resilient and creative we are.
These moments are the most rewarding and unforgettable parts of the field. I wonder how the world would be different if we could hear each other’s stories and see each other’s commonalities, rather than just our differences.
How life in child and adolescent psychiatry has been affected by the global pandemic: Fortunately, with the advent of technology, most of the work has moved to the telehealth platform. Comfort actually works well for many patients.
Long-term impact of the epidemic on child and adolescent psychiatry: The pandemic has raised awareness of how common mental health challenges are. Mental health challenges are not moral failures or personal weaknesses, but rather treatable medical conditions.
Three adjectives to describe a typical child and adolescent psychiatrist: Dedicated compassionate type.
How does my lifestyle match or differ from what I imagined: One aspect I didn’t realize about psychiatry in medical school was how varied and adaptable the training was. As a result, psychiatrists’ lifestyle can be diverse and tailored to their liking. If you don’t want to answer calls, you can have it. If you want to keep working more than 90 hours a week, you can have that. If you want to have a family and a career, you can definitely have that.
Skills every clinician in child and adolescent psychiatry must possess but will not be tested in a board exam: In psychiatry, it is very important to have empathy. There have certainly been situations where I disagree with a patient’s choices or feel very frustrated with their behaviour. However, at the end of the day, empathy helps me understand that these patients are suffering and hurt, and their frustrating behavior can be a form of communication.
One question clinicians in training should ask themselves before pursuing child and adolescent psychiatry: “How much do you want to understand yourself?” It sounds a little silly, but the training and clinical encounters really force us to understand ourselves better. As one of my dear mentors used to say to me, “You are a diagnostic tool; do you know how to use this tool effectively?” It is about knowing who we are as individuals and what we bring with us in the psychological setting of clinical care. I never expected to “turn the mirror inward”, but I am so grateful for the opportunity to continue learning about myself and life.
Every medical student interested in child and adolescent psychiatry should read: Instead of books, I would say that keeping up with different political viewpoints on contemporary events in the world is crucial in this field. Most of the time, our patients read these same articles, and it pays to navigate the clinical setting if we can put the news in the context of the specific clinical case. I used to routinely check different websites – across the political aisle – to ascertain their views.
Online resource students interested in child and adolescent psychiatry should: I would like to shamelessly promote the official blog of the American Psychiatric Association. They do an exceptional job of curating psychiatric related news for any interested psychiatrist.
Quick insights I would give to students considering child and adolescent psychiatry: To borrow the rhetoric of Mr. Fred Rogers: “As human beings, our task in life is to help people realize how rare and valuable each one of us really is, and that each of us has something that no one else has—or will ever have—something within us that is unique at all times. “.
This is the cornerstone of psychiatry, in my opinion. Plus, you get paid to do it! If you never want to Bored with medicine, I’m going to think highly of psychiatry.
A song to describe life in child and adolescent psychiatry: I have a nice spot for the classics: “Here Comes the Sun” by The Beatles.