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India Corrin is a 5th year medical student at Cardiff University.
Psychiatry is quite often a misunderstood specialty. It is far more than those wild rumours that go flying around the year group about what really happens on placement. It’s a unique specialty that treats possibly the widest patient population there is to offer – it transcends ages, genders and socioeconomic backgrounds and is constantly changing to adapt to the variable pressures affecting both individuals and populations.
Despite this, many people approach their psychiatry placement with trepidation. Mental health still holds huge stigma, due in most part to a lack of information and understanding, which understandably induces fear in many when they approach their psychiatry block. In truth, as practicing doctors, we will all need to be a little bit like a psychiatrist when we come to treat our patients, as co-morbid mental health issues will undoubtedly affect many of them. The ability to appreciate and accommodate for these will be crucial in delivering holistic care, so grasping the chances you have on your psychiatry block will extend far further than you may initially imagine. So here is part two of the placement series, Do’s and Don’ts: Psychiatry edition.
Brush up on your history taking skills
Psychiatry is like no other specialty, where there is no physical examination we can do to help our investigations. The entirety of our assessment is made up entirely from the interactions we have with patients, drawing on skilled interpretation of the myriad of verbal and non-verbal cues to lead us to a diagnosis. In psychiatry, more than ever, the ability to take a thorough and comprehensive history is crucial, so it might be worth having a look over your history taking structure before you start talking to patients.
See one, teach one, do one
A psychiatric assessment is an art and not something you will master on your first go. Make sure to spend a good amount of time watching doctors do a mental state examination on patients – everyone does theirs differently, so use this opportunity to observe a variety of techniques before you start honing your own. Familiarise yourself with the structure of the assessment in the clinical environment first, practice at home on friends and family, then go out and give it a go on as many patients as you can!
Leave your expectations at the door
Due to the nature of mental illness, every day is wildly different from the next in psychiatry and you will be exposed to a wide range of patients with varying needs. The media has done little to dispel the myths surrounding mental health and it can be easy to go into psychiatry with the preformed opinions we may already have about certain conditions. However, no one psychiatric patient will be the same as the next, and what may manifest itself as one thing in one patient is certainly not applicable to the next. Try to maintain an open mind and use the patients as your teachers – don’t let fear put you off from getting stuck in.
Take good notes
Whilst we are taught that we should be listening to patients when we talk to them, as opposed to furiously scribbling down notes, there is a case to be made for making an exception when on psychiatry placement. When you start off doing your first few mental state examinations, there is a lot to remember and it can seem quite daunting. I found it helpful to write out the subheadings of the examination on a few pieces of paper at home so when it came to doing a mental state examination, I had a cheat sheet ready to go. Once you have filled in a few of these for patients with different conditions, you’ll have a great set of revision notes that are more personal and memorable.
Forget that patients are humans too
This applies to all patients we see, but I personally found it to be most pertinent when I was on my psychiatry block. Despite the way a mental illness might alter how a person behaves or interprets things, it does not fundamentally change who they are as a person – this doesn’t change when they’re living in the environment of the psychiatric unit. Not every interaction has to be formal history taking or assessment, sometimes what patients may miss the most is the chance to have a ‘normal’ conversation with someone, be that about their hobbies or the result of the football game from the weekend. What may seem to you to be a fairly run of the mill chat may be far more valuable to a patient than you realise.
You will soon learn that there are many measures in place in psychiatric units that are designed to keep both patients and staff safe. Whilst psychiatry is not a dangerous specialty, it can certainly be unpredictable, and it is imperative that you respect these measures to ensure no one comes to any harm. Some of the universal ground rules include:
Bottle it up
It goes without saying that some of the things you see in psychiatry will be emotive and challenging. As much as this exposure will help your learning, there are some things which will undoubtedly be unsettling or upsetting. It cannot be emphasised enough that if you’re struggling with something that you’ve seen on placement, then the best thing to do is to have a chat with someone about it. It doesn’t have to be a doctor or one of the clinical staff, even if it’s just having a word with your tutor, medic support or one of your friends over a cup of tea – make sure that you prioritise your wellbeing first.
Mental health issues continue to affect a growing number of the population. The most recent statistics from 2016 revealed that 1 in 4 people in the UK will experience a mental health problem each year; further to this, 1 in 6 people reported experiencing a common mental health problem (such as depression or anxiety) in any given week. Whilst many may write off psychiatry, thinking it’s simply ‘not for them’, it is clearly an area of medicine that will touch most of us in our clinical practice – so try and get the most from your psychiatry placement when you have the chance. For more information, the Royal College of Psychiatrists have a dedicated section on their website for medical students, which can be found at: https://www.rcpsych.ac.uk/discoverpsychiatry/acareerinpsychiatry/medicalstudents.aspx