Monday, 9 September 2013

Pathway 3: Psych and Babies - Psych

The third pathway essentially boils down to psych and babies.  To be honest, after the buzz of A&E nothing was going to seem brilliant, and psych being so far from the acute medicine I saw on my SSU probably didn’t help, but I really didn’t like the third term.  There were some good parts, it wasn’t all bad, but it was fairly boring.  The themes for the pathway were adult mental health, child mental health, gynaecology, neonatal ICU and pregnancy and labour. 

It was quite easy to become disenchanted with the mental health placements as the consultations were all really long, spread really far apart over the city and nine times out of ten the patients either don’t turn up or they don’t consent to allow a student to watch.  If they did consent, I usually found that they got bored half way through the epically long history you have to take for psych and left half way through.  I had a placement with the community mental health team where they asked me to sit and wait for four hours doing nothing whilst I waited to go out on a home visit.  This was my punishment for the medical school giving me an afternoon placement there, whereas they prefer to have students in the morning.  I had no computer access, no text books with me and I wasn’t allowed to leave and return later, despite only living a 20 minute walk away. 

I also got placed at the MDT meeting that discusses the progress of children at a day school programme for children with behavioural difficulties.  The meeting was three hours long, but due to more fantastic timetabling from the medical school my two placement partners were the ones that had spent the day with children and meet them, I just got to sit and hear about them.  Furthermore, at feedback sessions, no matter what the patient story was, the answer always seemed to boil down to feelings of abandonment as a child causing problems later on in life. 

Good parts of psych included the children’s outpatient clinics where I got to see two cases of Tourette’s, which is apparently pretty rare.  I also got to spend the morning at Shekinah mission which is a day centre in Plymouth for the homeless, ex-offenders and jobless for whatever reason to come and get a cheap, hot meal, clothes, socialise, life skills training with the aim to get them into employment, access to healthcare and dentistry and connections to the housing agency to find them housing, plus a starter kit of bedding and kitchenware to get them started.  They put me to work serving teas and coffee and dishing out lunch.  I was really surprised to see a couple of my patients from my GP surgery clinics I have run there, and utterly humbled to see how happy they were to see me again.  In the space of a few hours my perspective changed from a naive how can things be so bad for you to have to come here to I’m so glad you have somewhere to come where you can get help and support, make friends and get your self-confidence back.  It’s lovely to see you looking so happy, and actually there’s a few more people I’ve seen at clinic who could benefit from coming here. 

One of my feedback facilitators tried very hard to convince me I’d make a really good psych Dr as she could tell from my patient presentation that I like the story behind the person, and that was just what I needed to be good in that field.  Unfortunately, A&E proved to me that although I like stories, I really enjoy fixing things quickly, and making a difference in a short space of time.  Psych really isn’t for me.  

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