Articles and Case Studies

What I like about psychiatry

20 Nov 2019

by Dr Benjamin Veness

Psychiatry

I didn’t always want to do psychiatry. My initial interest was in ophthalmology – I devoured Fred Hollows’ autobiography and was amazed by the black cataracts and enormous ocular tumour I saw on my medical school elective to Myanmar.

Over time, however, I developed a deeper interest in the social determinants of health and in trying to understand how the mind works – and how it can spectacularly malfunction. Here’s why psychiatry is the ‘good enough’ specialty for me.

Psychiatry is fascinatingly diverse

Our work spans from perinatal and infant mental health, through to psychiatry of old age. We work pretty much everywhere, and ideally try to see our patients where they live: outback communities, homeless shelters, suburban homes, inner-city apartments, prisons – you name it, a psychiatrist has probably seen a patient there.

Psychiatric practice combines psychotherapy, pharmacotherapy and sometimes procedures (e.g. electroconvulsive therapy), and most psychiatrists will use a combination of these in their work. I plan to spend the next two years doing advanced training in child and adolescent psychiatry, which primarily involves psychotherapy and working not only with a patient, but also with their family and school.

Psychiatry teaches you how politics affects health

During medical school, a generous psychiatrist, Lisa Brown, took me with her to visit patients in a women’s prison. I remember meeting one young woman who had stabbed her mother, and as Dr Brown took her developmental history, it struck me that it was like ticking off every box in a list of risk factors for social disadvantage. My friend and fellow registrar, Marie Bismark, describes psychiatry as “the point of closest connection between health and social justice issues, including housing, employment, gender-based violence, inequality, discrimination, and stigma.”

We have time to talk to our patients

Psychiatry is one of the few areas of medicine where it is expected that interviewing a patient takes a long time, especially the first occasion you meet them. There are no hard or fast rules, but 50-minute interviews are common. If you enjoy getting to know your patients in depth, then psychiatry can be very rewarding.

Psychiatry suits doctors who are curious

Psychiatry encourages and rewards curiosity, because curiosity opens up different diagnostic possibilities and provides the data and ideas for richer formulations. A formulation seeks to explain why this particular patient has presented at this particular time with these particular problems, and what their treatment and prognosis might be.

There’s a lot of work for psychiatrists

After a long history of stigmatising mental illness, Australian society is slowly coming to terms with the immense burden of disease that it causes, and the enormous economic and social benefits of increasing access to psychiatric care. I expect to see increased private and public investment in psychiatry throughout my career. The Australian Government predicts a shortage of psychiatrists in the medical workforce,1 which is not the case for many other specialties.

I can live with the downsides

Everything has its downsides, and when choosing your specialty, it’s imperative to ask yourself whether you can live with these. In psychiatry, our training tends to focus more on pharmacological than psychological therapies, but there are many opportunities for continual learning as a psychiatrist. Our training is quite long (at least ten, six-month rotations) and there are continual assessments, with a high paperwork burden. Other areas of medicine can speak disrespectfully of us and our patients, which is perhaps surprising given the burden of mental ill-health among doctors.

Patients get better

While I often wish for better psychiatric treatments, patients can get immeasurably better with the tools we already have. Lives can literally be turned around, with enormous positive impact on patients and their families. Even illnesses like schizophrenia are not synonymous with permanent disability. For a good example, see the 2012 TED talk by a professor of law who has schizophrenia, Elyn Saks.2

I’ve found my tribe

Someone once told me to ‘find your tribe’ in medicine. I really like my colleagues in psychiatry, who have a diverse mix of interests outside of work. They enjoy the arts, care deeply about human rights, and approach their work with curiosity and kindness. My study group has four wonderful female psychiatry trainees and I never thought I’d say this about studying medicine – but with them, it’s always fun!

Benjamin Veness is a psychiatry registrar in his third year of training, based in Melbourne. He is an MDA National member and is also a member of the MDA National State Advisory Committee in Victoria. You can follow him on Twitter @venessb

 

References

1. Department of Health. 2017, ‘Psychiatry 2016 Factsheet’, Commonwealth of Australia.
2. Saks, E. 2012, ‘A tale of mental illness – from the inside’, TED.


Employment Essentials, Psychiatry
 

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