A Spotlight on Psychiatry

Now that I have officially passed all my pre-clinical exams, and I enter my clinical years come September, I decided to think back and look at what was an area of medicine that particularly shone out for me in the past two years. Despite having loved everything I have learned about, the human body is absolutely fascinating (expect the lungs - I hate respiratory medicine but more on that at a future date), a couple things have stuck out for me.

Firstly I have a lot of interest in trauma medicine, especially A&E, and as a matter of fact would love to work in trauma for a couple years, whilst I am young and can handle the hustle & bustle. But we don't really get exposed to trauma as a whole that much in the pre-clinical years. The same can be said about oncology, another area of interest where I think students, especially at my medical school, are not taught enough, or particularly well.

Actually if we are listing shortcomings of the medical curriculum I would also have to add Psychiatry to the list. At my medical school we are basically taught about this field and some common disorders over a weeks time span. Thus I have to say, that despite this I am proud of having gotten an extraordinary amount of exposure to this field, thanks to my medical schools close links with this speciality, consultants who I have been able to speak to and a special program which has allowed me to go visit different subspecialties and see what it involves.

Thus I decided to do a short spotlight on psychiatry to show that it is a wide medical field concerned with the diagnosis, treatment and prevention of mental health conditions. Mental illness are extremely common with various research papers quoting different figures, but approximately 1 in 4 people are believed to experience some kind of mental health illness at one point in their life. Thus I feel it is extremely surprising, and indeed worrying, to see psychiatry not being a bigger part in the medical curriculum.

Many misconceptions have developed in my cohort over the pre-clinical years ranging from the belief that patients with a mental health illness cannot get better, to their belief that psychiatrists cannot offer any treatments which can help improve their quality of life. This misconception often comes from students on rotations who will see a really unwell patient, or one who has been sectioned under the Mental Health Act. And of course, like any other speciality psychiatry does have its chronic patients, who will be coming in and out of hospital repeatedly, however on the whole these misconceptions are wholly untrue.

Psychiatrists have an enormous impact on patients’ lives, not only by offering a sort of speech therapy but, in cases where appropriate, providing medication which can help change their lives. And it is often in medicine possible to forget completely about the social life of a patient when treating them, and psychiatrists in helping their patients not only change their lives but also the lives of their family, and loved ones.

Moreover, the number of sub-specialities in psychiatry are absolutely mind-boggling, catering for every type of doctor and all interests and doctors might have. There of course exists acute psychiatry where doctors work primarily in A&E, with no continuity of care, often looking at acute representations of psychosis, suicide, overdoses and alcohol problems. There also exists a sub-speciality for older adults, aged 65 and over, as that involves dealing with atypical mood disorders, anxiety, alcohol problems, memory problems, depression but most prevalent dementia. This is made only more complex due to the ethical issues raised which include looking at how these older adults manage at home, and what to do if they refuse to go into a care home, but cannot manage alone at their own residence. There is also a lot of complex pharmacology because many patients will be on numerous medications to deal with different conditions such as heart failure, liver or renal failure, and it is important to get the balance of medications correct. It is also important to make sure when diagnosing a patient to see whether a presentation is organic or biological possibly due to the medications the patient might be on. For those looking for more work with children, CAMS exists, the Child and Adolescent Mental health Service, alongside neo-natal psychiatry for new mothers and psychiatrists dealing with eating disorder, to name a few.

 

While the above is a very brief introduction to psychiatry, and I will (hopefully) be writing more on it in the coming months, I feel i need to pass on some advice as well. One of the most important pieces of advice for students going on their psychiatry rotations is to pay extra careful attention to their attitudes towards patients, as it is critical we do not have stigmatising doctors. In particular as GP’s see the bulk of most patients in the community it is important for them to know when to refer, and in particular what to look out for. Thus I would say to go in with an open mind, and to call out anybody you see who appears to have a bad attitude towards a psychiatric patient!