29 Sep, 08 | by BMJ Group
Who’d be a psychiatrist? The emotional burden of caring for patients presenting in real distress; trying to negotiate a way forward when dealing with someone with a skewed sense of reality; potentially life and death risk assessments on a daily basis; general lampooning from medical colleagues… No wonder psychiatry’s not such a popular choice among UK medical graduates.
But it’s something much more fundamental that would stop me from pursuing a career in the shadow of the Victorian asylums: the thought of repeatedly depriving people of their liberty and, more importantly, the impact this has on the doctor-patient relationship.
Sure, like police officers and judges, I know that in certain circumstances all doctors may have to act to detain someone in that person’s (or society’s) best interests – it’s just that I don’t want to be the one doing it. Having worked for six months as first on-call covering acute psychiatric wards as part of my GP training, it seemed rather alarming that by filling in one side of A4 paper I had the power to hold someone, against their will, for up to three days.
Perhaps, more worrying, was a colleague’s comment that this power made him feel rather intoxicated. I was more concerned about how this ‘elephant in the room’ would affect interactions with both voluntarily admitted patients and those already detained under the Mental Health Act.
But it wasn’t all doom and gloom. I loved the fact that for the first time there was a sense of true multidisciplinary working, with doctors, social workers, community psychiatric nurses, psychologists and ward staff all focused on a common goal. And I had to pinch myself when I was told there was one hour allocated for out-patient appointments with new patients. Integration of community and secondary care appeared fairly advanced too, with psychiatrists embedded in community teams while also covering the acute hospital.
And the crisis team staff were – to put it mildly – an inspiration.
These poor sods spent day after day (and night) at the very sharp end of emergency psychiatric care. Yet their compassion and professionalism – not to mention astute judgement – was truly admirable. I learnt much from their sophisticated risk assessment tools and thorough approach in clinical encounters and particularly documentation. And the team spirit and debrief – often informal and with a good dollop of black humour – was a model of team self-care. Then again, they weren’t the ones signing the section papers…
Bruno Rushforth is a GP trainee