Monday, March 16, 2009

Another clue

I think I have worked out why I am comfortable in psychiatry - I feel open to talking about just about anything with anybody, and I like knowing the details in their stories. I also love having nearly an hour in which to do this, as opposed to the standard ten minute interview that we get in other areas of medicine.

If somebody tells me that they are hearing voices, I want to know where they are actually hearing the voices (in their head, from the television, outside the room etc), whether the voices sound like somebody they know (their neighbours, somebody famous), what the voices are saying to them, whether they think the voices are actually there, what the voices are telling them, whether the voices are talking about them, whether they listen to the voices and what they do when they want them to go away.

It is the same when talking to patients about suicide attempts, self-harm, drug-taking, anxiety or many other aspects of life that we are discouraged from talking about openly in everyday life by society. 

I'm really non-judgmental and relaxed, but am still surprised when people are so open and trusting with the details of their lives. Of course, I know that a lot of them won't tell the whole story, and that many people will consciously lie. However, most are quite ready to open up and talk about their lives to somebody who is interested and who they don't know in everyday life.

I have thoroughly enjoyed my psychiatry rotation (except for the odd slightly rough patch, but no area is perfect) and it is a huge relief, because it is an area that I have been keen on for years. It has been a wonderful way to start third year, and I hope that the rest of the year is just as good. The other rotations will have a lot to live up to. 


The Shrink said...

Oooh, oooh oooh!

"I feel open to talking about just about anything with anybody . . . "
A key approach to psychiatry is being able to talk. I realised this abruptly when I was with a female Consultant Psychiatrist doing forensic psychiatry and we were in prison assessing a chap who we were meeting for the first time. Some twenty minutes in she asked the patient, "So, what do you fantasise about when you're masturbating?"

In what other area of medicine are you obliged to do that?!

"I'm really non-judgmental and relaxed . . . "
A key personal quality in psychiatry. You need to be able for folk to talk without feeling inhibited 'cause you'll judge them. Also, if you're too opinionated on others' lives then you'd find it frustrating that most folk we meet don't have the same values and attitudes we might. Being open minded is essential. And you are, huzzah!

". . . it is an area that I have been keen on for years."
Yay, to have enthusiasm for the discipline's key, too. If you're not passionate about it, it becomes hum drum and frustrating and the work's poor (for you and your patients).

". . . I like knowing the details in their stories."
This, above all else, is what matters.

Good psychiatry lives or dies on being interested, truly interested, in the patient narrative. The curiosity, the interest, the shared understanding . . . without this, we're technicians not therapists.

If you're wanting to do an elective in older adult mental health, get in touch :)

The Girl said...

Thanks for the excellent response!

Funnily enough, the time we spent in Older Adult Psychiatry was my favourite out of this rotation, and it is currently the specialty area in psychiatry that is at the top of my list. Thanks for the offer. :)