Have to say I really enjoyed my stint on my general practice run. It was delightfully focussed on the presentation at hand as well as looking at prevention at times. There was a lot of variety – minor surgery, paediatrics, elderly, psychological etc etc. There are inherent frustrations with it but it is an easy way to be part time and enjoy life as well.
Then it was a gentle easing into psychiatry. I have to say I have not enjoyed it as much as I did last year. Perhaps I have not seen many interesting presentations. Perhaps my short attention span is not so in awe of this whole new field that I had never come across before last year. Maybe it is the chills I get now from the flashbacks to One who flew over the cuckoo’s nest or Girl, interrupted – whilst observing things on the ward. I had watched these dvds in my holidays to get in the mood for psych!
One snippet of psych: I chatted to a very intelligent guy with bipolar disorder. He had done a masters in English literature – Shakespeare and Chaucer. Something I studied long ago fresh faced in university… However his life was in disarray partly stemming from his tendency to come off his meds and go off the rails. My team thought it would be of benefit to me to talk about his meds to him so he can have a better understanding of them. (I am unsure if this is a wild goose chase – I mean come on- he has been an inpatient many times and I am sure meds were discussed every time. So it must be a learning exercise for me).
He started talking about how sodium Valproate makes him sedated and knocked out. And feels he can cure his illness with natural remedies and good lifestyle…
I was hesitant internally whilst outwardly I was firmly telling him why he needs to go on the meds. This duality disturbed me. I wondered why I should be pushing for valproate – a drug I have never experienced myself, a drug I only know it from textbooks but not in reality – when he feels that it knocks him out and it is a foreign substance that he is medicating himself with. I know that it controls his bipolar symptoms and keeps him stable but this was not convincing for me deep down to fight his claims with.
I continued my argument saying ‘think of it as a supplement – like having iodised salt, it is like valproate salt…’ And thought – whatever doctor I become – I will only work in an area where I fully believe in my treatments and believe in its success when offering it to people.
What is bothering me currently is in the inpatient psychiatry ward, you are treating people who do not want to be treated. It is obviously part of their illness – but I need time to think this through and come to terms with the anti-psychiatry literature.
I really enjoy the reading around psychiatry – it is more in tune with ethics and other philosophical thinking – which I think drew me to it last year – a respite from the mind numbing science shoved down your throat in all the other medical and surgical specialties. Its dumb that doctors can be so single minded about evidence based medicine – there are limitations with that line of thinking which is not often thought about.
However -aside from the initial interest psychiatry generated – I need to work through whether it really appeals to me by working around – circumferentially – in true psychiatry style- considering all the negative rap and anti-psych thinking – before I feel I really understand what this specialty is about. To work through why so many people hassled me about psychiatry when I was positive about it last year. Is it true with me too or are they short sighted?
An almost doctor's blog 