I have to say that this was one of the best weeks of medical school so far (finally!) Last week was a pretty uninteresting lecture week so I decided to give you a break from me. This week, however, I started Psychiatry, which is one of those placements that challenges you in ways you never really thought about. Read on to hear about my experiences, as well as some personal achievements!
- Flying over the cuckoo’s nest
If the cocaine, amphetamines and alcohol didn’t get the patient in trouble, the hammer they’d decided to bring with them was probably a sure fire way to attract attention.
A common presentation in Psychiatry is a patient whose symptoms lead them to get into difficult situations in the community, ultimately resulting in police activity and “sectioning”. The phrase “being sectioned” is often misunderstood; it brings to the mind the idea of a small padded room, with a writhing patient desperately trying to escape the confines of a straightjacket (picture the caterpillar from A Bug’s Life if Tim Burton directed it). In reality, it simply means you can use the Mental Health Act sections to decide what to do, e.g., detain a patient in hospital so they can be treated.
Psychiatric patients present some unique challenges, but luckily I’m quite a unique medical student. Having done a whole Psychiatry placement back in 2018, before I took a year out, this wasn’t my first rodeo. I’m by no means saying I’m an expert, but it made the experience slightly less surprising. Here are some tips for those of you who have Psych placements in the future:
Tip 1: Be polite but guarded
Psychiatric patients are still patients, even if their illness might make them behave in…antisocial ways. It’s still important to smile, say hello, introduce yourself and be generally courteous, but remember that they may have severe symptoms even if they appear “normal” on the surface. Personality disorders, delusions, hallucinations, mania, past trauma and so much more can cause a patient’s responses to be unpredictable, inappropriate or even put you in an unsafe position.
Tip 2: The staff are your friends!
You’ll often hear me rave about allied health professionals (AHPs); nurses, healthcare assistants, pharmacists, porters and everyone else involved with patient care are truly unsung heroes. As doctors we get put on a certain pedestal, better pay and arguably some of the least challenging aspects of patient care.
In Psychiatry, appreciation of the AHPs is essential! After all, they see the patients on a daily basis and understand their idiosyncrasies. They can provide you with essential information about patients, such as how to get on their good side, how to avoid distressing them and whether they will be good to talk to from an educational perspective.
Tip 3: Observe the experts
There is a wonderful finesse to obtaining information from Psychiatric patients. As a medical student, we’re taught history and examination techniques in “ideal” settings; patients who are not acutely unwell, who are good historians with voices like Brian Blessed and murmurs so loud you could start a Grime set.
It was around the time that the patient began stripping all their clothes off, despite clear instructions that this was unnecessary, that I realised psychiatric history and examinations may throw up some unusual challenges. The best way to approach this is to see how the consultants handle the WIDE range of patients they may need to speak to: some can’t be interrupted, some won’t speak at all, some will repeat the same points continuously, some will be aggressive and defensive, and yet all require (and deserve) the best standard of care we can give them. Bottom line, we need to be able to talk to all of them- and Psychiatric doctors do it really f*cking well!
2. Personal achievements this week
Usually I would keep these quiet, but I want to reassure those of you whose veins pulse with impostor syndrome and inadequacy that I, too, have felt deeply inadequate throughout my medical degree.
It’s an unfortunate issue present throughout medicine; competition, pressure from seniors, an intolerance of anything less than perfection, it really is a toxic mix. The last thing I want to do is cause impostor syndrome in anyone reading this, so please remember that behind every achievement is a lot of hard work and quite a lot of disappointment, just like you.
This week I got two publications confirmed (one letter and one editorial) which were both great fun to research and write. If you haven’t realised yet, I quite enjoy writing so it was great to see initiative being rewarded. As an added bonus, the FPAS scoring system allows up to two points for publications, so the tick-box part of this (which should never be the main reason to do it) is done!
I was also told by two separate psychiatry doctors that my knowledge and history taking was at an F1 level, which was pretty incredible. I actually don’t think this is true, but just knowing that I’m getting more comfortable with psychiatric histories is great to know.
I was also recently appointed as one of the Social Prescribing Student Champions for Cambridge University! I’ve been exploring SP for a while so it was a natural step, and I’m excited to educate my peers on its importance and why they should care.
Next week I continue with Psychiatry as the last week before the Xmas holidays. As always, email me or message me on LinkedIn if you’re interested in discussing anything or want to collaborate on a publication (I feel like I can say this now I actually have some). Take care!
Hardeep Lotay 