Monday, 21 January 2013



A new week in psychiatry, though ruined a little towards the end by the ubiquitous snow which meant I ended up having to cycle through a blizzard! This week started with a mock test (to prepare us for finals), and had a selection of clinical placements and lectures through the rest. Sadly, one of the clinical placements I was most looking forward to, a placement based around people with HIV who had psychiatric problems, was cancelled. I thought it would be very interesting, as some psychiatric problems lead to people having much higher risks of contracting HIV (such as hypersexuality in mania), while addictive problems such as intravenous drug use, which are also covered under the psychiatric remit, can also lead to higher rates of HIV. As well as psychiatric reasons for contracting HIV, HIV infection can itself lead to psychiatric problems, such as anxiety and depression (from having the illness) and HIV dementia. The breadth of possible cases here could have been very interesting, but I suppose I will never know.

The mock clinical examination we had at the start of this week was sold to us a good chance to practice some of our history taking and examination, to help us start to prepare for finals in a few months (Finals in only a few months... Oh god...) but I thought it was more of a chance for them to scare us witless into revising really hard, so they don't have to explain why so many people have failed. It consisted of a range of stations, and the feedback I got from them seemed to conflict. The consultant running the chest pain history station told me that, while I got in all of the relevant questions [things like shortness of breath, and family history of cardiac disease] (one of the few to do so!) -I was too abrupt, and needed to be more personal towards the patient. The next consultant, in a station where the patient was suffering from weight loss, told me that I was too 'chummy' with the patient and I needed to me more formal and direct. While this does show that I need to change the style I use for examinations (and towards patients) it also shows me how objective some of these exams are - as I was being the 'same' (as far as I could tell) for each of these. I suppose some consultants prefer a much more friendly approach, while others may want you to be more efficient. I am sure that, whatever they prefer, they won't fail you on what they think of your style. At least I hope so!

Other than in the exams, I also saw some patients this week in a visit to the secure ward in the regional psychiatric hospital. I have been here before, during my third year psychiatric placement, though I can hardly remember that far back! I number of keypad and camera-operator opened doors let you in in an airlock type fashion into a rather nice ward. It is a far cry from the images of asylums in film!

Nothing like this at all.

In there I have some interesting talks with patients, whose circumstances were quite unique, so I will not go into them too much in the interests of confidentiality. There was an undercover policeman who had become so guilty at his work he had become a serious suicide risk and had to be supervised 24 hours a day, and an immigrant from the eastern block who had been in this country for years before trying crack cocaine, becoming psychotically confused and throwing bread all over a M&S supermarket, after becoming convinced that the people were seagulls. Once admitted to hospital, this man had become involved in a number of fights with other residents of the psychiatric hospital, though when talking to him myself, I thought he seemed very measured and in control, and he seemed to have great 'insight' meaning that he now understood that he was ill, that the hallucinations were not real, and that he needed to take these medications. The synopsis? Don't try crack!

1 comment:

  1. I'm convinved that OSCE examiners deliberately focus more on the points for improvement rather than the areas which students do well in, as a matter of course. Admittedly, I have very little experience with OSCEs compared to you, however, I don't know anyone who came out of our chest pain station with a glowing commendation from the tutor - everyone was told that either they were too abrupt, too dithering, that they'd missed bits out, forgotten to introduc themselves etc. It would be nice if the feedback given were more balanced imho!