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vendredi 12 février 2010

a spell in psychiatry

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A couple of months ago, I chose to do a rotation in one of the psych wards in Bordeaux. I had no idea what was waiting for me in those legendary grounds. Psychiatry was among those of the specialities that didn’t speak to me at all before that. I certainly came out of these 4 weeks as a changed and pretty disturbed person. Here are a few random thoughts about this world as I jotted them down during my spell.

I was dispatched along with another colleague in a ward dealing with Anxiety Disorders. Among these, we had mostly patients with Obsessive-Compulsive Disorder (OCD) and Social Phobia, but I quickly realised that we were mostly treating the depression related to these troubles. As a junior (l’externe), I wasn’t left on the field to talk to the patients. Rather, I’d  follow the daily interviews between the patients and my interns. The only few tasks I had comprised writing down prescriptions, running a couple of EKGs and writing down the biographies of new patients.

The psychiatry ward is a gossip temple. If you spend enough time in there, you might come up with a few movie scripts. Picture this: nurses are being paid to write down all the actions of their patients during the day. And they get to discuss it between the transmissions while adding their own personal views. “Mr X seems to love Mrs Y. Mr Z will get good company with the new boy in room A. Miss blablabla has fallen in love with her doctor…”  In a normal medical environment, this is trivial matter, but not in psychiatry.

Depression is somewhat contagious. It’s quite hard to get back home in a jovial mood after spending a day interviewing people who, almost everytime, start crying at some point. This might be the main reason why I wouldn’t want to specialize in psych. The reasons behind the patients’ break-downs could be classic: loss of job, loneliness, divorce, the ras-le-bol (exasperation) of life of teenage girls.  However, depression over your dog’s demise or even MJ’s death (yes, we had one such case) was a bit over the top for me.

OCDs are quite interesting to study. I never thought a person could be so obsessed by his school exams to end up in psychiatry. Above all, not a medical student. Others obsessions included dirt, the fear of killing someone at work, or simply the choice of the best photos for a photo album. It was amazing to listen to these patients describe their constant doubts and how they would spend hours casting these doubts away: by constantly cleaning, or verifying the mailbox, or making lists, or finding new ways to pile the thousands of photos they’ve taken of themselves. I started wondering whether online solutions like Remember the Milk or Evernote could fit in the treatment options for them.

The psych rotation was also the time to demystify the electroshock or its nicer name, electroconvulsive therapy (ECT). It’s quick (a dozen patients per morning session), it’s impressive at first and the outcome is excellent on patients who are hard to treat with pills.

I also got to spend 24 hours in the psych emergency department. In one day, several failed suicide attempts were sent to us. They are, by far, the most common patients in the ED and range from the teens to the lonely elders. I had a pretty good insight in the sufferings facing the dementia patients and their helpers. Lots of psychotic disorders showed up too with their delusions and hallucinations.

I wonder if it’s a french exception. It looks like people easily seek psych advice here, which isn’t the case in my country. Psychiatry is still taboo in Mauritius and it’s hard to convince someone to seek professional help, whereas in France, it’s culturally acceptable, even trendy, it seems, to have a personal psychiatrist or psychanalyst.

This rotation has given me an excellent overview of the mental state of the French society, its love for the meds and the trust it lays in its psychiatrists. Above all, I’ve convinced myself of the magic of the human touch and the necessity to take all the necessary time during a medical visit. This spell in psychiatry has indeed helped me to better understand the doctor-patient relationship.

That said I do have a few rants:

  • I feel like bipolar disease is being overdiagnosed. The problem might be with the very definition of the hypomanic episode.
  • There is a lack of coordination between health professionals in the region. When a patient gets discharged from a service, his stay report takes on average 2 weeks to be sent to his GP.
  • We still rely too much on fax machines.
  • In my ward, there was only one computer. “Economic measures,” they say. In other words, the paperless utopia is way behind schedule here.
  • Even the EMR software used on the network needs some serious reconfiguration in its UI. Different wards use it differently as per their convenience.
  • The number of medical students and healthcare professionals who turn psych patients is scary. (OCD, Mood Disorders)
So that was my 4 weeks as a psych externe. I wish my neurology rotation that followed had gone as smoothly… but that’s for some other time.

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