I have no idea if this is normal. Going to school in the Caribbean is great, but it isn’t the US, and for that reason I always catch myself wondering if my experience is a “normal” experience comparable to my US studentdoctor peers. Here goes:
I’m still in M2 and the school is interested in giving us a lot of clinical exposure before the clinical years. It’s the logic of pre-kindergarten. Twice a week I’m off to the hospital with my roommates to sample Peds, Med, OBGYN, etc. In addition, we have Clinical Skills, a class where we take non-sick volunteers and try to work them up for the Congestive Heart Failure that they don’t have. So once a week I’m reporting a 3rd heart sound that I don’t hear or a nodular liver in another healthy person at the urging of the tutor and feeling very silly. I am fine with all of this.
I am not fine today. Today, an announcement was made in the morning that there will be no Clinical Skills lecture before we see our patients. Mind you that this is four hours away and there will be no effort made by ANY of the physicians available to give a talk, even briefly, on how to conduct a psychiatric exam and the special challenges therein. Almost forgot: I heard a RUMOR that we were interviewing psych patients today. I’d like to get these sorts of announcements from the school before the day of, maybe posted somewhere, but that doesn’t happen with the frequency that logic would dictate.
So with no preparation we enter the room. The psych patients will not arrive for another half hour because they have to take their meds at the hospital before being bused over. What?! I don’t consider myself a cruel man, but it’s going to be hard evaluating someone for a psychiatric disorder when they’re TRANQUALIZED. Can’t we leave them unmedicated for a while, loosen the leash and let them explore the space? Don’t I need to SEE the problem if I’m going to learn to DIAGNOSE the problem?
“You feel fine? You don’t know why you’re here? You feel happy?”
“This patient is being treated for schizophrenia with delusions of persecution,” says the tutor.
“Well the patient can’t seem to remember any of that right now.”
“That’s because he’s medicated.” I know, you dolt.
What a waste of my time. I could have played tennis against a brick wall this last hour and at least had pit stains to show for it. And what a missed opportunity! This time the patients actually HAVE the problems that we study. I couldn’t have been given a heads-up about this for some time to prepare? I hope such poor execution isn’t normal.
So much of what I read online is written by folks in Psychiatry. We’ve all read House of God, some of us have read Mount Misery, and all of it seems fascinating. Who doesn’t like leafing through the DSM and thinking of the people in our own lives? The mind is why I loved and studied philosophy. It’s why I did well in Neuroanatomy. Hell, I’ve cut a brain out of someone’s skull and held it in my hands. It’s exciting that so little of what goes on in the brain is understood because that means there is so much more room for discovery. To hear people talk about the patients they treat, the things they say and the sometimes profound shifts in personality that medication can induce makes me want to abandon my dream of surgery and dive right in. I’ll admit that, as someone who likes to write, the laziness of just reporting the absurd that someone else invents is attractive.
Instead, it’s like hearing about the greatest tasting strawberry icecream and not having a tongue to taste it.
I won’t do something stupid and level judgment against a discipline because of a few patients but I will say that, so far, I have not liked psychiatry one bit. I don’t have the patience. I don’t like staring at a talking rubicks cube, trying to figure out the right moves to let some bit of truth slip out. I don’t like feeling that I have to trick a patient into contradicting himself to help him understand something. I cannot stand the repetition. I don’t like seeing people tranquilized, or talking to people with no memory, or watching someone fidget and pick at herself uncontrollably. I know that these people need the help to beat those problems; I just don’t think I want to be there for any part of that journey. I’d rather just read about the successes.
I hope it gets much much better. I’m afraid that it won’t. Any words of (dis)encouragement would be welcome.