Wednesday, October 10, 2012

Psychiatry - Final Week

This placement went by QUICK! I think it was the fact that the placement wasn't too bad and that I was quite busy doing my other work - time has just flown by. To be honest, I haven't seen too many exciting things as I had hoped to have seen. There's always a lot of misconceptions about each specialty and I think psychiatry is no different. Before I started the placement I was a bit unsure what to expect. I was a bit scared as on our first day we were each given a personal "alarm" which we would put on our belt loops. In addition to those alarms, when we entered the ward, we got another alarm which has tracking on it as well. You can't help but think that psychiatry might not be the safest specialty. We were also taught a lot about risk assessment when interviewing a patient. I remember we got a tutorial on where to sit and what to look out for in a room. We were told to always look out for objects that can be easily thrown and to sit near the door but not with our backs towards the door so if we need to escape we can just go out without turning around.

Okay yes, there are some "dangerous" patients who are known to be quite aggressive, but I never really felt "in danger" while on the wards or in clinic. I guess the only time I felt a bit "iffy" was today in clinic. The final patient I saw on my psychiatry attachment is known to have a very short temper and when he snaps - he snaps in a big way (throw objects, get violent, etc.). As the consultation went on, I could tell the patient was starting to get agitated and worst bit - I was sat furthest from the door and the patient was sat between the door and I (so much for remembering about risk assessment). To be honest - the clinic room wasn't appropriately arranged so there wasn't much one could do other than hope for the best. The consultation came to an end and for no reason the patient just "lost it". He lashed out but thankfully he didn't throw anything and instead stormed out the door and slammed it with a considerable amount of force. You could actually hear him leave the clinic as he was slamming every door along the way. I expected it to happen but it wasn't a nice situation to be caught in knowing there isn't really anywhere to go other than curling up into a ball.

Other than that incident - all the patients I have seen are all quite "alright". Despite some having a history of violence/aggression, these patients all seemed fairly cooperative. We are told of the ones who we shouldn't go speak to as they aren't cooperative but the "okay" ones are fairly normal. Of my 6 weeks in psychiatry, there hasn't been any major incidences. I'm sure more incidences/violence occur in A&E than in psychiatry. I think the one thing about psychiatry is the need for patience. Some of the patients are great historians...some are terrible and will not admit to anything/are not cooperative. With new patients - the clerking can take up to 1 hour and most of these inpatients don't have the patience to speak to you for an hour. I personally don't even have the patience to ask questions for an hour/listen to their history for an hour. I find it very time consuming. The number of times I have nearly fallen asleep during a consultation has been ridiculous. I drift off not because it is boring, but it's the fact that sitting and listening to a history for an hour is very difficult. Again with this attachment, there wasn't much I could do other than observe, but the good thing I had over GP was that when in the hospital - I can actually wander around and am not constrained to one building/area. Psychiatry is definitely different and I have definitely learned a lot since it is a new topic. I'm fairly certain it isn't something I can do, but it is quite interesting as you see a range of people and personalities.

Unfortunately I don't really get a break between this placement and the next other than a 3 day weekend. My next placement will be in Care of Old People - specifically Orthogeriatrics. Talk about luck. I'm actually really looking forward to it as I'll get to see and deal with something I'm interested in and maybe I can sneak off and see a few surgeries as well. I also know the team in the department - so I don't need to endure the whole awkward introduction/getting used to the ward/staff. It will be a short placement but I think it will be one that will pick my motivation back up and get me going again just in time for exams. Eek!

1 comment: