Child Psychiatry: Looking At The Bigger Picture

Session 214

Dr. Haiyan Wang is a community child psychiatrist at Beverly Mental Health Service who specializes in Anxiety and OCD. Let’s chat about what it takes to be a great family psych doctor!

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[01:04] Interest in Psychiatry

Haiyan says it took her a long time to realize her interest in child psychiatry. She did a lot of research on neuroscience and psychiatric drug discovery, and did translational medicine before doing psychiatry residency.

It wasn’t until her second year of residency that she had to decide the next step and she realized she has always wanted to work with children.

'A psychiatrist needs to see a person's life through the lens of developmental point of view and a trauma point of view.'Click To Tweet

Haiyan wanted to understand the early childhood experience, and the developmental piece and how that impacts later on a person’s life.

[02:49] Traits that Lead to Becoming a Good Child Psychiatrist

Haian stresses that in child psychiatry, it’s not just the child alone but so much about the family. So she prefers to call it family psychiatry. Because they also talk about genetic biological factors and environmental factors.

For children, their environment is family and school. And so, if we don’t address the family dynamics and their high school, it’s hard to improve a child’s wellbeing just by treating the child alone.

It’s important to be able to accept the whole family as your target treatment group at the same time. You also have to understand that the child problem comes from a lot of trauma from the parents and the intergenerational trauma, and a lot of anxiety issues and depression from parents.

[04:51] Types of Patients

Haiyan sees patients with OCD as well as anxiety and depression. The age of her patients range from five years old to 70 years old. She also handles the adult population, which she is also board-certified in. The other part of her special interest are cultural populations and minority groups. And it’s important to raise mental health awareness so people can get the care they need.

[07:25] Typical Day

Haiyan’s current setting is completely telehealth. She works from about nine am to five pm. She also does communication meetings with her team members including therapists and behavior specialists to talk about the next step of the patient.

On the other hand, her private practice is very flexible and depends on the needs and her time availability.

[09:55] New Diagnosis vs. Existing Diagnosis

Haiyan explains that even for patients coming in with a diagnosis, every psychiatrist can have a different kind of philosophy and approach. For instance, she is a big believer in trauma. For a lot of patients, even when they already come in with a diagnosis, she has a big role as a child psychiatrist is to find out if the condition is real.

For the child psychiatry population, about less than 50% of patients will come in with a diagnosis. Most of the time, they are referred by a therapist or school counselor. Haiyan’s initial assessment takes about two separate one-hour sessions.

For mature adults or young adults, they often come diagnosed with depression and anxiety. But she clarifies there’s more to it than that since there are a lot of reasons to be under the symptoms and that you need to test yourself.

[12:15] The Training Path

After you finish your medical school, you apply to adult residency. At the second year of your adult residency, you need to start to think about what you want to do. Because for child psychiatry fellowship, there are two ways to do it. One is that you finish your four years of adult residency, and then do another two years additional child fellowship.

You can also start to apply to your child psychiatry fellowship before the third year. This allows you to prepare and get a sense of it. Then you finish your third year residency and go into a child fellowship for a total of five years.

'Focusing on young adults or mature adults helps you to be more complete as a psychiatrist and understand adults better through the lens of developmental and trauma perspective.'Click To Tweet

[14:18] Overcoming Bias Towards Osteopathic Physicians

Haiyan thinks that the combination of medical experience and knowledge class, plus your personality traits and your passion about psychiatry make you a better psychiatrist. And so, regardless of whether MD or DO, you have to have the passion about helping this particular population. That being said, Haiyan knows of some excellent doctors in psychiatry who are DOs.

[15:41] Taking Calls

Haiyan is not taking any calls at this point. That being said, you can choose different settings to work in including inpatient and outpatient, partial hospitalization program, intensive outpatient program, and residential program.

[17:14] Message to Future Primary Care Physicians

Haiyan explains that more and more primary care settings are now starting to do basic screenings for anxiety and depression. And this is a good starting point. Additionally, she wishes pediatricians or primary care doctors to keep in mind that it doesn’t matter what kind of physical illness you have, but consulting a psychologist or therapist is helpful.

Back in the 50s or 60s, it was so much about psychoanalysis and psychodynamics. But that’s now shifting more and more into biological intervention, which has proven to be very effective.

[18:58] Other Specialties They Work Closely With

Aside from pediatricians, the most common specialists they work with are neurologists and cardiologists.

For instance, bipolar or schizophrenia, the first onset of episodes of manic or hypomanic symptoms or psychotic issues and symptoms are referred to neurologists. That’s to have them rule out if there are organic reasons for the presentation before they focus on psychiatric treatment. As with cardiologists, they use stimulants a lot. So they want to make sure there are no cardiovascular concerns that are contraindicated for stimulants.

They also often refer patients to nutritionists for those with eating disorders and help their family plan their meals and help kids learn how to eat healthy.

[21:47] What She Wished She Knew

Haiyan says you have to be prepared in terms of writing because psychiatrists write very lengthy and detailed notes. It’s much about your clinical judgment and your experience. Then you formulate a thought process and present it and document it in the way that backs you up in the way that you present to the patients and their treatment plan. They also get a lot of help from scribes who write notes for them although they still have to manage their notes.

Moreover, you also need to learn how to manage your emotions, especially set boundaries with your emotional well-being and after work, how you manage your own personal life.

[24:44] The Most and Least Liked Things

Haiyan loves to see children and teenagers get better and achieve their potential, especially, when you put them in the right medication and they just shine.

On the flip side, what she likes the least about the specialty is when she hears about kids being traumatized.

Haian says that as a child psychiatrist, you can contribute to clinical care as well as to research opportunities. Due to the pandemic, the quarantine, and social isolation and virtual online school, she sees so many more and more anxiety, depression, and OCD. Mental health awareness has increased as well.

[27:35] Final Words of Wisdom

If she had to do it all over again, Haiyan says she would still be a child psychiatrist. And if this is something you’re interested in, more important than anything is to have that passion about this field.