Dr Alan Spratt
is a foundation year two doctor
Old age Psychiatry is akin to an
Addenbrooke’s cognitive assessment.
- The general
populace of medics tend to avoid it (we’ll ignore the surgeons
- It seems it
will take a while to get through it.
- Although it
can seem simple to highlight a problem, the management and
repercussions are far from simple.
Few FY2 rotations are available in
psychiatry. Although I sought the rotation out, many do not. For a
specialty that is essential in many other specialties including
Emergency Medicine, GP and General Medicine, people do not have an
opportunity at foundation level to experience it.
Four months isn’t a long time
unfortunately to fully submerse into a specialty or indeed a
However, in a four month rotation I have
seen the division of care between community and hospital and the
importance of the community psychiatric team and the communication
skills to keep it linked together (meeting upon meeting followed by
phone calls and then referral letters).
Caffeine-laced on call duties where no two
referrals were ever the same provided exposure to acute admissions
across all sub-specialties. These were by far the most
challenging aspect of the rotation. In these situations
although help was never far away, when you’re on your own the most
prominent and lasting lessons are learnt. These situations are
meant to be stressful in medicine, it just so happens in psychiatry
you carry an alarm and the door opens both ways in the assessment
Now a humbling realisation is that care of the
elderly was the highlight of the rotation. Organic illness
will be an increasing problem in the future of the NHS. Regardless
of what specialty people end up in, dementia and Alzheimer’s will
cross your path and I guarantee you will have no idea how to manage
it as successfully as is done in psychiatry. It will affect you,
your patients or your family.
It is therefore worth spending four months
finding out about it and the challenges it brings.