More Things I Have Read: Shrink Rap

I have been reading their blog and listening to their podcasts for years, so it is no surprise that I rushed to pre-order and then read the book Shrink Rap, written by the three psychiatrists (whom I will always think of as Roy, Dinah and ClinkShrink) behind the venture.

What did I think? I am quite biased, as I really enjoy psychiatry, but I think this is a fantastic book and that anybody who is interested in the way that healthcare deals with psychiatric patients should go out and read it.

Clearly my experience is from a different country, but most of what they describe (aside from the major differences between our medical systems) is very similar to the things that I have seen in psychiatry here. They explain the processes very well in an accessible and easy-to-read way, and I really liked the way that they use fictional characters to illustrate examples of both the illnesses themselves and the ways that psychiatry may deal with them.

Many clinical books have case examples in them, but these stories feel more lifelike than the all-too-often dry scenarios that textbooks present, and as a result they become more interesting and believable. I think that anybody who has been in contact with the hospital system for any period of time (or, indeed, with humanity) has seen many people whose stories closely mirror those told in the book.

I would also encourage medical students to read it, as it humanises the patients in a way that brief clinical contact and textbooks cannot, and can help give a better picture of some of the disorders described. I also really enjoyed their discussion about things they disagree on, and their honesty in presenting some of the failings of modern psychiatry.

If somebody were to ask me to recommend a book to help them understand what psychiatry was about, it would have to be this one. I'm looking forward to seeing what they come up next, as clearly Dinah Miller, M.D., Annette Hanson, M.S., and Steven Roy Daviss, M.D. love their work, and love teaching other people about psychiatry.

P.S. This blog isn't going to be all book reviews from now on. Honest.

Fools rush in

I keep running into doctors who used to want to do psychiatry for the same reasons I do, and didn't go into it in the end because it was too draining emotionally.

These same people keep trying to talk me into following radiology.

I enjoy imaging, don't get me wrong. There is something really nice about looking at a picture and understanding what is in front of you, and being able to label the anatomy with certainty, understand the physics and the likelihood of the pathology.

I'm just confused. Fortunately I have an elective scheduled where I do four weeks of each, one after the other. This will help me make up my mind.

God knows, maybe I'll end up in a completely different field. This would also be okay. :)

I'm starting to think that I really should take my time getting into something and pay attention to the old proverb of "Fools rush in".

ENT and a long story, old-timer-style

We have spent this week in ENT. It has been interesting, and the staff are really nice and keen to teach.

This is fortunate, as it isn't really an area that I'm interested in, and I am feeling like I'm disinterested in all things study-related right now. You know how it is - some weeks you feel like hitting the books, other weeks you open a book and close it again and walk away.

I also have a couple of weaknesses in medicine - one is the neck area, the other is phlegm/drool, and ENT is filled to the brim with both things. I haven't actually dry-retched yet, which is nice, and I tend to feel really bad for the patients. Seeing something that you aren't comfortable withon somebody else is nothing compared to having that actually be something that you have to go through yourself.

The nice thing is that I am getting my elective organised. I'm going to do the whole thing in psychiatry, since in the last month or so I have settled firmly on pursuing it as a career. It really feels like the right decision, and I'm entirely comfortable with it.

I can't afford to go overseas for the elective, and just about everybody else around me is organising overseas electives and flying around the globe, which makes me a little sad and jealous from time to time, but that is how life is. I hope medical students realise just how privileged we are as a group. When I did radiography it was a big thing for somebody to go interstate for elective. Medicine is another world entirely.

People are really well-off, but I don't think they realise it, because they study next to other people who fly overseas for skiing holidays on a regular basis, whose parents own massive mansions and have actually bought them accommodation to stay in that is close to where they are studying. They don't really flaunt it, it is just there, unstated. I'm not really close to these people, and I don't get asked to go on their jaunts, which is probably a good thing. I don't fit in as one of the rich kids, and I'm glad. Everything I have, I have earned though my own blood, sweat and tears, and even if I don't have as much, I am bloody proud of what I have achieved.

I'm not saying that these aren't nice people - some of them are, some of them aren't, just like the rest of society. Some of those who travel overseas regularly are lovely people, and a lot of my close friends are going overseas for elective, and I care for them a lot. It is just a different perspective to mine. Perhaps it is even a generational thing, or a personality thing.

Sometimes I really wonder how I got to be in the middle of a group of people who don't even blink at buying tickets for a quick one week overseas holiday. I have never been in that place. I think that it probably has to do with growing up without much. When we flew, we did so for free in the back of a RAAF Hercules (cargo plane), sitting sideways on canvas seating that were less comfortable than your average canvas deck chair, with industrial ear covers on to protect our hearing for the entire flight.

There was no food, and in-flight entertainment consisted of trying to read whatever you could while the plane shuddered, and attempting to not be airsick. The first time I went on a proper commercial plane, I was confused because we didn't have to wear ear protection. I kept expecting the flight attendants to hand out earplugs, at the very least. The fact that they wore makeup and dresses also confused me as I had only seen this on the TV before.

Dad was in the Royal Australian Air Force as a fitter and turner, which explains the free flights in the belly of a plane that travels at half the speed of a standard commercial flight, and Mum worked occasionally as a supply teacher. We lived in Housing Commision houses, generally in areas that were set aside for defense force personnel, but often side-by-side with the other families who qualified for free government housing. The neighbourhoods were not the poorest in town, but weren't far off it. Once we even rented furniture because the regular stuff was in storage far, far away, for safe-keeping. You got a little bit of assistance with moving and so on in those days, but nowhere near as much as they get now. As a RAAF kid, and somebody who didn't live in the nicest area of town, it was often harder to fit in. I still have a massive chip on my shoulder, and tend to be quite sensitive sometimes if I think that I'm being slighted or rejected by people I want to be my friends. Meh.

I know that some of this may reek of the old-timers telling stories of how "when I grew up, I was so poor that we had to paint our feet instead of wearing shoes!", but in a way it is also fascinating and entirely different.

People compare notes about which medical specialty earns the most, and some even target their careers towards the specialty which would give them the lifestyle that they want. When I was a radiographer, I was earning more than my parents ever did. We are comfortable at the moment, even without me working, and even without being able to fly overseas for electives/holidays.

(We are going to Hamilton Island for a week in the middle of this year because we got REALLY cheap flights and have organised some reasonable accommodation, and I saved quite a bit after working over Christmas.) Choosing a specialty based on money has never even occured to me, as no matter what I choose, I'll be earning far more than I could imagine when I was a radiographer. If I even complain about how "little" I earn, please slap me. Clearly I would have lost perspective.

A reflection: one down, nine to go!

Today we finished our first rotation for the year, and the first out of the ten total that we have to successfully complete before graduation from medical school.

When I think about the rotation, there are a few things that come to mind. 

We needed to study and learn, but because we were seeing the content in the context of real life, it was infinitely easier to understand and retain. Due to this, I didn't need to study as much as I did during the first two years of the course. I still studied, but my retention rate was higher.

There is no such thing as a perfect rotation, even if it is an area that you are keen on. In truth, this was no surprise, as I did not come down in the last shower and haven't lived a happy little life completely devoid of boredom and pain. 

You can only get as much out of something as you are prepared to put in. If you hang around expecting to be taught but don't see any patients, ask any questions, treat people with respect or ask questions, you will learn nothing. 

I always kept in mind that staff don't get paid for teaching us, and that we are not their main priority. Staff were lovely and apologised when they had to put urgent work ahead of teaching us, and I really didn't even think twice about this - seriously, I'm going to be here for weeks and there is really nothing here that I can't learn later. Plus, if there is urgent work that I can observe or being involved with, I may just learn something different in the meantime. :) 

I am a much happier person undertaking practical activities and talking to patients and staff rather than sitting down with a textbook in a room by myself (in spite of being an introvert), so I find being on prac much less stressful. Plus, the fact that we no longer have huge exams every six months is a godsend.

Anyway, these are some random reflections to celebrate the end of my first rotation. (Yes, I loved it, yes, I want to be a psychiatrist.) I am looking forward to the start of my next rotation, but for now I have a week off. Such luxury! I should enjoy being a student while I can. 

Picture Source

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. 

Me and my motor mouth - I spoke too soon!

Whoops! Today was awesome, and I really enjoyed it. Even though the patients are very ill, they (for the most part) are friendly and I like talking to them. I think we need to be more proactive, and this week I have probably been more guilty of the "student huddle" than I have ever been in the past. (We weren't as bad as I have encountered as a staff member working around medical students, but still . . .) This changed, as of today, and as a result we got a LOT more out of the day, and plan to continue on like this in the future.

One thing that I find fantastic about psychiatry is that you don't consider the aspects of their illness or personality in isolation. It needs to be considered in the full context of their life - personal history, health, family history, genetics, support networks, coping skills, life stressors and so on and so forth. It really is a wonderful way to look at a person, and I love the way that it allows you to see them as a WHOLE person and not just a walking example of a DSM-IV category.

I have always been a sucker for a complex story, and psychiatry is really getting stories out of people for a living, so I suspect that as I get better at the interview and see more professionals do it, I will enjoy it more and more. 

I think that to understand patients (and indeed everybody in your life) properly, you have to see them as multi-faceted people who have both positive/healthy and negative/pathological traits, and who have the capacity to change (some more than others) with work and guidance. Everybody has potential to live a more comfortable and happy life, and I think that is something worth striving for.

Why is it so?

Clinicians generally give the lectures that I find the most interesting. I won't say that they give the most interesting lectures, as this clearly depends on your point of view and personal interest.

However, I have noticed that psychiatrists as a group tend to give the most interesting and engaging lectures of all. Their voices are very natural and conversational in tone even as they lecture on academic topics, their communication skills are excellent, they look relaxed, and of course, they tend to have fantastic (yet anonymous) anecdotes.

It isn't just me who feels this way - other people I am close to who have no interest in psychiatry also love these lectures.

Perhaps we are lucky in our group of lecturers at my university. Perhaps psychiatrists who lecture also perform a lot of academic work and are used to lecturing large groups. Maybe spending all day communicating with patients rather than performing dry scientific research helps. Or is it that a lot of people go into psychiatry because they enjoy communicating and expressing themselves verbally to begin with?

Whatever the reason, psych lectures rock.