Sunday, September 30, 2012

Psychiatry - Weeks 3 + 4.

So I'm finally past the halfway point for Psychiatry and to be fair, it isn't that bad. I mean nothing can get any worse than my GP attachment. Anyways...I finally went to the ward and spoke to a bunch of patients. I spent a week in the Substance Misuse Unit and it was really interesting. It was interesting to speak to the patients and to hear about how they have abused drugs/alcohol. It was shocking to hear that most of these patients have started using drugs since the age of 12! I had one patient who told me: "Any drug you can think of, I've tried it."

There was one particular male patient who stuck out for me. He is a 50 year old male (who looked 80 years old) and he was trying to detox off of methadone. He has tried almost every drug you can think of and at the age of 13 had already experimented with LSD. He was actually quite pleasant to talk to and it was interesting to hear about his forensic history. It was crazy to hear that he has been convicted many times and have served several prison sentences. What stuck out for me was his memory. Due to the many many many years of drug abuse, his memory is horrendous. His short-term memory was fairly poor and when doing the Mini Mental State Examination (MMSE), he scored 16 which is very low and abnormal. I'm not kidding - I spoke to him for almost an hour to get his history/why he is in hospital and then left for 20 minutes and came back to do the MMSE. When I came back to do the test, he had already forgotten who I am and thought I was a social worker! It was definitely a bit of a curve ball as I knew his memory wasn't great, but I didn't think he would already forget who I am after speaking to him for an hour and only had left for 20 minutes. Furthermore, because the patient had been injecting for so long, his legs are completely wasted. He has ulcers all over his leg which won't heal as he has poor blood supply to his legs and has suffered with DVTs. When you look at him, he looks unwell, tired, not with it, etc. Apparently on admission he looked like a ghost who was completely out of it. It makes you realize how bad drugs can affect a person. He looks so much older than what he really is and I actually double checked his date of birth with him to confirm that he was only 50! It was incredibly hard to believe.

Also during the 2 weeks I went to the regular ward and spoke to a few inpatients. It wasn't particularly interesting, but I realized that some of the patients don't know why they are in hospital and refuse to accept that they are in hospital for a mental illness. On top of that, I realized that in psychiatry, you have to build good rapport with the patient to get just a decent history as there are a lot of personal questions that you need to ask. In a psychiatric history, you have to ask about their childhood and about their personal life such as relationships and any possible attempts of suicide/self harm. Some of the things you need to ask are quite touchy and personal and I find that quite difficult. At the end of the day I think as a medical student you just need to find a way to word personal questions and be prepared to get an awkward answer or no answer at all.

So at the moment, the placement is starting to pick up, but as usual, once things start getting productive - it means it is coming to the end of my attachment. 2 more weeks left and then onwards to Care of the Elderly (which I'm actually quite excited about as by chance I am placed in Orthogeriatrics).

1 comment:

  1. Psychiatry seems to be an interesting subject where you can study the mental illness of a person. I don't know why you don't really quite find it interesting.