I’m Over Psychiatry 

Yup. It’s been one week. And yup. I’m already tired of my new rotation. I kind of knew I didn’t want to be a psychiatrist but this feeling of being underwhelmed seems to be a recurrent theme for me. I’m worried I’m not going to find any specialisation that I really enjoy. Sigh.

But anyway back to psychiatry. I’ll tell you why I’m already over it on here so I can decide whether it’s just me jumping the gun and disliking a run straight away after one week or whether I’m justified in my unimpressed-ness on this rotation.

So. Reasons I’m ready to fast-forward the next 6 weeks:

1. Taking a psychiatric history has a minimum duration of 1 hour. This includes patients who are already admitted and whose progress needs to be monitored. And this is by the consultant. Not just an entry level house officer.

2. The pauses within the history taking.

Doctor: So how has your mood been?

Patient: …………………………………………………….. Yeah

Doctor:……………………………………………………………………………………………………………………………………………. How are the medications?

Patient:………………………………………………………………………………………………………..*shrugs*

I mean, come on! I admire the psychiatrist and their patience but as the observer, I was dying. Of sleep.

3. The 50 million unnecessary labels for conditions.

  • schizophrenia
  • Schizoaffective
  • Schizoid
  • Schizofreniform

Omg. And you know what the funniest part is? There was a patient whose regular psychiatrist had diagnosed him with bipolar disorder and who was being treated with Lithium. At the Mason clinic, another psychiatrist spent 1.5 hours with the patient taking a history (while I was falling asleep in the corner) and concluded that the patient had Schizoaffective disorder instead. I asked what that was. Apparently it is a combination of schizophrenia, bipolar disorder, AND depression. The psychiatrist spent a further 15 minutes explaining to me how to distinguish between schizoaffective and plain old bipolar.

I then asked her what the management was for this. She replied: “Oh there’s not difference. We just need to change a lithium to Sodium Valproate because Lithium isn’t working for him. Otherwise it’s just treating the bipolar”

-_____________________-

I felt like I had been trolled. The treatment is no different, yet it has a scary name distinguished only by “affect”.

Why.

Just why.

4. There are only about 5 treatment options for all psychiatric illnesses. You’re either on an antipsychotic, an antidepressant, a mood stabiliser, given cognitive behavioural therapy, or electroconvulsive therapy. For literally EVERY psychiatric condition. And it does not cure them, unfortunately. So then why is there so much hoopla about the psychiatric history. One of my consultants actually asks patients such specific questions like “Do you see spirits rising up out of the ground?” and “Do you believe that any of us here are working for the secret service and spying on you to pull the thoughts from your head?”. I failed to see how this was relevant. Because he had asked these questions after the patient had described the nature of his delusions/hallucinations. What exactly was the psychiatrist intending to do with the specifics of his hallucinations once it had been established that he was having hallucinations? Was the treatment going to be any different? Nope. Were we going to help change or rid him of the hallucinations? Nope. Then why these leading questions that may have in fact put such hallucinatory ideas in the patient’s head?? For their entertainment?

I just don’t get it.

And those are the reasons why I’m over psychiatry. I just don’t think I have the patience to be a psychiatrist. I admire them though. Such patient people with great listening skills. The consultants are actually lovely people which is great. But yeah I’m not really cut out for psychiatry I don’t think. I think psychiatry is really interesting and I’ll probably enjoy seeing a psych patient in ED (where it’ll be a short history with a quick referral. xD) but that’s about it.

Well. 1 week down. 5 to go. Hopefully it gets better. Or goes by quickly. Whichever. 

12 comments

  1. Karla · July 29, 2017

    At least you’re getting to know what you like and dislike!

    Like

  2. thehaystackonthehill · July 30, 2017

    I quite literally recorded a voice memo for a blog saying pretty much this on the way home on Friday

    Like

    • abracadabra25 · August 4, 2017

      Well. Good to know I’m not the only one with these thoughts

      Like

  3. ckj261281 · August 12, 2017

    I would like to think if you believed there was any misconduct you would deal with it appropriately

    Like

    • abracadabra25 · August 18, 2017

      Absolutely. But this wasn’t the case here. I suppose it’s just understanding things better!

      Like

  4. Harley Quinn · August 17, 2017

    the fact that medicines are multi-purpose is kinda weird to get, but makes sense sometimes. I had a diagnosis of Bipolar 1 with psychosis for YEARS. One question that both my therapist and psychiatrist asked was “do you just have the hallucinations/delusions, etc. when you’re within a bad mood swing, or do you have them while your mood was fine?” My answer to this sentence changed my diagnosis to Schizoaffective Disorder, Bipolar Type (which, by the way, that doctor either doesn’t know how it works or didn’t want to be bothered trying to explain it to you). The only reason that I had gotten through life up until this is that I was almost always on an anti-psychotic med. Let me tell you though, proper treatment made a HUGE difference for me, and my friends from high school (long time ago…) said that it made so much more sense to them than me having the bipolar diagnoses. Unfortunately, each year I steadily get worse (that’s always happened to me), and I’m already maxed out on anti-psychotics.

    Anyway, I say you stick with it for at least another 2-3 weeks and try to figure out what a person’s response is to questions. And don’t put up with a psychiatrist that doesn’t know the meaning or specific differences in each disorder. Test him. Especially, if I go on Lithium, it’s quite dangerous.

    Liked by 1 person

    • abracadabra25 · August 18, 2017

      Thank you so much for this comment! You’re right about schizoaffective! because I had seen it in reverse (bipolar first then schizophrenia) the point was kind of lost on me. It’s my 4th week now and I think I’m appreciating the nuances between the different conditions a lot better. And yeah it’s definitely worth asking a few more questions to my consultant until I’m sure I’ve gotten a full picture of the condition and it’s management and what makes it unique.
      Hope you’re doing well! Thanks for giving your perspective on this, it makes me understand things a lot better and it’s definitely something I’ll keep in the back of my mind when faced with a condition like this in years to come. 🙂

      Liked by 1 person

      • Harley Quinn · August 18, 2017

        You’re very welcome! I can’t count the number of people who confuse it as schizophrenia or bipolar 1. My own hospital lists me as schizophrenic. I found this out when I had to be brought in an ambulance. Once they wheeled my gurney into a room, then they started trying to find out what was wrong. Then someone I couldn’t see then announced to the room that I had schizophrenia. And I couldn’t speak to correct it. The urgency then calmed down then a nurse said that I might have the type catatonic type since I couldn’t move or speak. Then they wanted to admit me. I was verbal by then, and when a woman came into the room and told me she was a social worker. I then yelled there was no way in hell I was going up to their psych ward, and proceeded to list all of my grievances, starting with how I detested the group sessions and that they weren’t even professionals running the group therapy sessions. I continued with a long list of more things, and they, for some reason wanted me to go to the psych ward. I told them I didn’t understand why they wanted to do that. The answer? “You’re schizophrenic”.

        Like

      • abracadabra25 · August 18, 2017

        That sounds terrible! I’m sorry you had to go through that. I sincerely hope things are more clear for the people interacting with you now! It’s just awful when people assume something they don’t understand.

        Liked by 1 person

      • Harley Quinn · September 17, 2017

        Just checking in with you to see how everything went.

        I should probably just follow you lol.

        Like

      • abracadabra25 · September 17, 2017

        Thanks for checking in! And thanks for the follow haha. I made a final review post of my psych run. But to give you a summary, I definitely learnt a lot more about the importance of the different conditions and reflected a lot about the people I met. Pretty grateful for the whole experience on the run. 🙂 Thanks again for your thoughts!

        Like

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