Saturday, May 16, 2009

That shrinking feeling...

I've been absent for a while - a couple of months I guess. I thought about posting during that time, but Twitter seemed to suffice.

I wanted to talk about how much I was enjoying my Psychiatry rotation, but as I got closer to exams, I started to worry about failing again, so I decided not to tempt fate and only post if/when I passed.

Well, I'm posting, so that means I passed! Yay!

It'd be ironic if I ended up as a Psychiatrist. My first degree was in Psychology, and by the end of it I was pretty sure I didn't want to be a Psychologist. I distinctly remember saying, "I'm not interested in listening to people talk about their problems all day". Such a load of crap - obviously there's a lot more to Psychology than counselling, and if I'd gone on with it I imagine I would've ended up doing some sort of HR role. But at the time, the thought of doing a year of supervised training (with a small salary) turned me off the idea of Psychology as a career, and I never went back to it.

With Psychiatry, you can end up listening to people's problems all day, but that'd be more common in private practice I think. That's where the money is of course, but I know I'd get bored with it. Public psychiatry definitely has some appeal.

My first placement was with the drug and alcohol team. I mostly saw patients affected by alchohol dependence, though I did encounter some IV drug users too. It's a frustrating area, because relapses are so common, and recommendations so often fall on deaf ears. To work in that area, you'd need to redefine "success" - it's not curing someone, or even getting them off the substance they're using. Small victories are important - avoiding complications of their addiction, getting them into a rehab program (even if they don't complete it), and so on. I had a long chat with a 40-year-old man with longstanding alcohol dependence. He'd tried all the rehab programs, various pharmacotherapies, and so on. He had advanced liver disease and brain damage. He was due to be discharged the day after I spoke to him. I asked him the likelihood of him drinking again after discharge - that day, or that week, or that month? He said he would be drinking again by the end of the week: "I know I'm an idiot, I know it's making me sick, but I'm going to keep drinking."

My second placement was in the community. It was quite interesting, but I don't have any exciting stories to tell. The placement was interrupted by the Easter break, and also the registrar I was with had holidays in the second week, so I had a lot of spare time!

My final placement was in the acute unit at the hospital. I really enjoyed it. All the registrars were friendly and helpful, and I was lucky to be allocated to a good team with a friendly consultant too. I interviewed a lot of patients, mostly with psychosis. I practised my interview skills for the long case, which I did last week. My registrar also saw patients in the eating disorders clinic, so I attended that a couple of times. Those patients made me want to tear my hair out - so self-obsessed, so painful. Not an area I'm interested in. The consultant was really encouraging. One day she invited me to coffee with her and the registrar. All three of us were in our 30s, and had plenty in common, so it was great to just relax in the sunshine with our coffees and have a good old chat. We ended up being there for over an hour!

My long case went well. My patient didn't have many overt signs of psychosis, as she'd been in for a while and was medicated. I asked her whether she'd ever heard voices, received instructions from the TV, etc. and she denied it. However when I read her notes afterwards, she'd come in with all sorts of delusions and auditory hallucinations! After the long case, the examiner gave me some excellent feedback. He said that the questions I asked the patient were at the expected (medical student) level, but my interviewing style was more advanced. He said I'd fit in very well in Psychiatry. It was really nice to hear and I was a happy camper for the rest of the day!

The exam was a couple of days ago - 60 multiple choice questions. Some of the questions were easy, some ridiculous, many tricky. A lot of the questions had several reasonable options to choose from - for example: Naked man on a farm, talking to himself - what's your first step? Options included establishing rapport, asking if he has weapons, giving him some clothes, etc. We also got the pavlova and Vegemite question that Liz mentioned last year. Anyway, I felt OK about the exam, but I made the mistake of chatting to people afterwards and talking about the questions. I started to get nervous when I realised there were a few I'd stuffed up.

But I passed, and all is good in the world. I'm excited to have a week off! Holiday plans include exercising a lot, learning how to use Photoshop, playing with my camera, getting my recipe collection sorted and trying out some new recipes, working (my clients have saved up a lot of work for me because I've been unavailable while studying for exams), giving blood, watching lots of TV (the list includes Arrested Development seasons 2 and 3, Mad Men seasons 1 and 2, Scrubs season 7, Dollhouse, Brothers and Sisters season 3...), and playing my poor neglected violin.

GP rotation is next. I suspect I will be bored. Hopefully I'll get a chance to do things (e.g. procedures, examinations), instead of just sitting there watching the GP at work. I still don't know where I'm going for my rural or urban placements - apparently we'll hear about the rural placement this week.

Also - I submitted my preferences for internship. They're due on 1 June, so I've got time to change my mind, but I'm happy with them for now. Exciting! We find out on 20 July.