Well I have just finished my 5th week of Psychiatry and I fell that I now (as expected) have a much better picture about what it involves. I don't propose I have seen it all, but I am very fortunate that the program at my hospital allows for rotation into many different areas and (when the tutors show up) excellent tutorials. I have seen acute and frank Mania and Psychoses, many flavours of underlying personality disorders, mood disorders, schizophrenia and eating disorders plus many more... There have been times when the thought of doing psychiatry (as a specialty) is very unattractive, but there are other times when it is appealing. The ability to sit down and philosophize and delve into the underlying causes of disease not just in that patient, but the community in general which few clinical specialties could match and the humane hours are major draw cards.
But I think even more importantly, I now see how relevant mental health issues are in general med. How MANY patient's recovery or indeed, poor health to begin with, are strongly influenced by their mental health (often a delicate construct on a background of predispositions, genetic vulnerability and exposure/experiences in earlier life). I feel with a bit of psych awareness, patients can be treated more humanely (not just handled better) and that recovery can be enhanced. To sum up my current thoughts - which unfortunately can be a tad 'circumstantial' (psych term for circular thought formation) I think I will be a better doctor (in any field, including critical care) for my psych rotation and I am glad for the opportunity, and I might even try to fit in a 3-6mth term as a junior doctor before the specialisation begins.
Again..sorry for any redundant thoughts in my blogs - I am just addressing my current thoughts and perhaps that will decrease as I become a more experienced blogger
Saturday 28 February 2009
Wednesday 4 February 2009
Psychiatry
I have approached my mental health rotation with a fair degree of cautious optimism, trying not to be too quick to judge (either positively or negatively), but now I am half way into my second week ( a long time I know ;) ) I feel comfortable enough to write on my experiences so far.
I must say I am pleasantly surprised by how the rotation is going. As is typical of my school, it is very poorly organised (numerous conflicting timetables given, very average orientation to the hospital and missing resources...end gripe) but the actual rotation is quite stimulating. Patients are fewer than in a typical medical ward, well at least a little harder to access - but this is balanced by the interesting presentation of symptoms and diseases.
In a little over a week, I have seen, many people with classical schizophrenia, depression as well as complete mania and catatonia (including a few "take downs" of those really psychotic), eating disorders and the personality disorders. Very commonly there is a typical history of troubled home life, mental problems in close family members, positive drug use (cannabis and amphetamines most commonly), florid alcohol abuse and smoking...everyone smokes. Not to tar everyone with the same brush, but the stories so far tend to go that way. If ever there was a good anti-drug message, teenagers should visit the wards - this of course is highly unethical and would further add to the stigma of mental health, and so mustn't happen.
One thing which strikes me is that mental illness is so debilitating if not adequately treated, cure is not really a possibility (life long control of symptoms, or at very least a life long vulnerability for relapse when life stressors occur is the best you can hope for). It is also a bit different from most other disciplines of medicine in that many of your patients don't want help (often no insight to their illness) and are not grateful - not that it is why you help someone, it just makes your efforts seem less futile. Also because the support network and environment outside the facility is SO crucial in helping the patient cope and get better, and many of those patients who need it have either lived in isolation or burnt too many bridges, it is disheartening to know they will almost certainly relapse.
The work hours of psych doctors are much more humane though. 8:30 to 5pm...occasional on call to 9pm for the registrars or a rare rostered weekend shift. If there are any real emergencies, a consultant may come in, but this isn't too often. Psychiatry also is much more cerebral, in that you see less patients (generally), but see them for longer, think holistically (biopsychosocial model that the medschool tries to drum into us ad nauseam is the model) and there is more time to reflect and read theory. Basically, read and discuss rather than be task oriented.
Overall, I am enjoying this rotation and I think it will help me in the future even though I am not intending to go into psychiatry
I must say I am pleasantly surprised by how the rotation is going. As is typical of my school, it is very poorly organised (numerous conflicting timetables given, very average orientation to the hospital and missing resources...end gripe) but the actual rotation is quite stimulating. Patients are fewer than in a typical medical ward, well at least a little harder to access - but this is balanced by the interesting presentation of symptoms and diseases.
In a little over a week, I have seen, many people with classical schizophrenia, depression as well as complete mania and catatonia (including a few "take downs" of those really psychotic), eating disorders and the personality disorders. Very commonly there is a typical history of troubled home life, mental problems in close family members, positive drug use (cannabis and amphetamines most commonly), florid alcohol abuse and smoking...everyone smokes. Not to tar everyone with the same brush, but the stories so far tend to go that way. If ever there was a good anti-drug message, teenagers should visit the wards - this of course is highly unethical and would further add to the stigma of mental health, and so mustn't happen.
One thing which strikes me is that mental illness is so debilitating if not adequately treated, cure is not really a possibility (life long control of symptoms, or at very least a life long vulnerability for relapse when life stressors occur is the best you can hope for). It is also a bit different from most other disciplines of medicine in that many of your patients don't want help (often no insight to their illness) and are not grateful - not that it is why you help someone, it just makes your efforts seem less futile. Also because the support network and environment outside the facility is SO crucial in helping the patient cope and get better, and many of those patients who need it have either lived in isolation or burnt too many bridges, it is disheartening to know they will almost certainly relapse.
The work hours of psych doctors are much more humane though. 8:30 to 5pm...occasional on call to 9pm for the registrars or a rare rostered weekend shift. If there are any real emergencies, a consultant may come in, but this isn't too often. Psychiatry also is much more cerebral, in that you see less patients (generally), but see them for longer, think holistically (biopsychosocial model that the medschool tries to drum into us ad nauseam is the model) and there is more time to reflect and read theory. Basically, read and discuss rather than be task oriented.
Overall, I am enjoying this rotation and I think it will help me in the future even though I am not intending to go into psychiatry
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