Shaun Colley: Learning psychiatry in lockdown—a different type of bedside manner

While being able to connect with patients from home has many benefits, this blurring of different worlds can be an unsettling experience, finds medical student Shaun Colley

When lockdown was announced, our medical school stopped all placements immediately. I had been due to start my psychiatry placement at the end of April and was worried about missing out on this crucial area of my studies, especially given that one in four people in the UK experience a mental health problem each year. 

Psychiatry often presents a challenging experience for medical students, with examinations and investigations taking a backseat to detailed histories. An in-depth conversation becomes the tool of choice and you no longer rely on a battery of tests to get to the diagnosis. Management plans involve talking therapies, and pharmacological intervention is not always the most effective choice. 

I was fortunate therefore that my medical school was able to arrange for some of our psychiatry teaching to move online—not just lectures from psychiatrists, but conversations with patients. I was able to speak to “patients as educators” about their experiences interacting with mental health services. Our placement also set up virtual clinics via an NHS programme known as “Attend anywhere.” This had previously been available to patients, but as a medical student I was used to only seeing patients in person. 

It soon dawned on me that this was a very bizarre situation. Being in a student house, my desk sits right next to my bed and I am surrounded by things that remind me of my life outside of medicine. I have photos on my wall of family and friends, memories of summers and travelling and life before covid-19. Usually, a commute to and from hospital or another healthcare setting gives some time for reflection on the things you have seen during the day and a clearer separation of home and work. But I now found myself having extremely difficult conversations and, when these ended, I was left alone in my bedroom. 

During the online placement, topics were discussed that are often hard to imagine for those who have not experienced them. Delusions, hallucinations, thought disorders, and drastic changes in mood, all discussed and spoken about in detail within my bedroom. This was the first time in my studies that I had come across patients experiencing these often debilitating symptoms. Seeing and hearing about the effects these had on the quality of life of these patients was shocking. But I realised that it was not only having conversations about these symptoms in a non-clinical setting that was unsettling, but the fact that both myself and the patient had this new brief glimpse into each other’s lives. 

The mixing of these two worlds was something I did not expect to encounter in my studies (or my career), and I found myself worrying about my surroundings. Usually being at home is a chance to separate and remove myself from medicine, to talk about other interests, and to rest. Initially, I felt awkward that people could see my surroundings, my photos and pieces of myself, but I began to realise over time that this was not something to be ashamed of. I wondered whether this allowed me to form a better connection with those I was speaking to and whether patients felt this too. 

The patients I spoke to were also video chatting from within their own homes, whereas they would usually have had these conversations in a clinical setting. With both patient and healthcare professional in their own homes, there was a sense of shared experience. One patient mentioned that this was a unique experience for them, and that lockdown had forced them to adapt to new interactions with healthcare services within their home. I was able to relate to this and found that this was something I shared with a lot of the people I spoke to. It made me realise the importance of shared experience when working with patients in clinical situations and how this can improve outcomes for both patient and doctor. 

Staff members during the placement always made sure that both patient and student were comfortable at the end of consultations and emphasised that they were always available to talk. We also had weekly check-ins with a consultant psychiatrist tutor. I think that debriefs and weekly check-ins should extend beyond psychiatry and into other specialties, as talking through challenging situations I’ve encountered has helped to put me at ease, feel more confident, and deal with my own difficult thoughts.

Telemedicine in medical education has been rapidly expanding. At my medical school we now have our lectures recorded and stored online along with a whole host of resources we can use. As a student, I can see the massive benefits of being able to connect with patients online and how this could positively impact the experiences of some patients and their clinicians as well as some of the downsides. 

From my experience of an online psychiatry placement, I think that it is important to give medical students the option to virtually connect with patients in a place that ensures both parties feel comfortable in being able to talk openly with each other. While being able to connect with patients from home is an amazing accomplishment in our covid-19 era, a separation from our personal lives is, in my experience, often essential. 

Shaun Colley is a fourth year medical student at the University of Sheffield. Twitter Shaun__Colley

Conflicts of interest: None