You learn some weird things in psychiatry. In any other specialty, you learn anatomy and physiology and pharmacology. In psychiatry… you have to learn the different ways people can kill themselves. You need to learn the different possible things people can hear or see. You need to learn the different types of thoughts people can have.
And, you need to know about all the drugs out there. The illegal ones. You gotta speak their language.
I had to take a drug and alcohol history from a patient today with my consultant. In every other specialty I’ve taken this history in the past 4 years, the results are always the same. “Have you ever been a smoker?” “How much would you smoke in a day, when did you start, etc.” “Do you drink alcohol?” “How much in a week, etc.” And the “do you use any other drugs” question generally results in pretty mundane response of either “no” or “smoked cannabis once when I was 15”.
But in this particular specialty, all patients are on every drug you can think of, and all the ones you can’t think of. As you can imagine, my knowledge on the subject was very minimal.
Me: So Mr. S, how much cannabis were you smoking a day?
Patient: Oh just a tinny’s worth aye
Me: Oh okay, how long have you been smoking for?
Me: How much methamphetamine were you smoking daily?
Patient: Oh about half a gram
Me: Oh okay. When did you start smoking the meth?
Later, my consultant asked me how much a ‘tinny’s’ worth of cannabis was. I blinked for 10 seconds and replied with “ummmm”.
He then asked me if 0.5g of methamphetamine was a large amount. I blinked for 30 seconds this time and offered a very quiet “no”.
Both were very wrong answers. A “tinny” is a word used only in NZ apparently. It amounts to 1g of cannabis. It’s the standard amount you can buy on the market. And it’s a pretty substantial amount to smoke in a day. With methamphetamine, the standard amount you can buy is called a “point” which is 0.1g of methamphetamine. Mr. S was smoking the equivalent of 5 ‘points’. This was a very high amount of methamphetamine. Apparently.
I did not know any of this. My consultant expected me to know that he was smoking quite high amounts of both drugs and to have asked him about his thoughts regarding this high amount and the possibility of cutting down.
For the first time in my life, I felt that not knowing about illegal drugs was a bad thing. And it really was. My consultant definitely gave me the ‘look’. I’m used to getting the ‘look’ from consultants for not being able to answer questions in courseguides and textbooks about medicine. It was the funniest thing to get the ‘look’ for something like this. Only in psychiatry would this be the case.
The problem is, when I get a question wrong in other specialties, I can go read the textbook or do research to learn about the thing I got wrong. But in this case, how on Earth do I learn more about illegal drugs?! Seriously. Google ‘illegal drugs in NZ’? I actually did do this, but I ended up on the government website with details about offences. Which is interesting, but not exactly what I’m looking for. Sigh. I’m just not Street enough for this. What a strange feeling of being ‘too’ normal.
Man. Psychiatry is weird.