The on-call experience
Being on-call for a
medical specialty and providing round the clock care is a unique
and challenging experience. As a trainee, it is probably the arena
where most professional development occurs, often out of necessity.
In psychiatry you work independently from the very beginning of
training and you gradually learn how to contain your own anxiety,
when to seek support and how and when to take decisions for which
you are clinically responsible.
A wide variety of
psychiatric referrals are made, many originating from the emergency
department. As a psychiatrist, you can feel like a guest and the
welcome can be variable. However, you are an ambassador for mental
health services by default and, by demonstrating a professional
attitude and showing a willingness to discuss clinical matters with
referring staff, there is a chance to address the underlying stigma
still associated with psychiatry (and those people who self harm in
particular).
Prolonged exposure
confers a sense of what is understandable behaviour in response to
life situations, and what is less so. More than any other
specialty, you look down the telescope of life and, if you do
enough assessments, you will access all layers of British society
and realise that good mental health is important to us all. In
return for the privilege of exploring the intimate details of
peoples’ lives, you will field diverse and challenging questions
from patients and their families alike. In the absence of a
textbook to refer to, you need to develop an ability to think on
your feet. As well as being asked directly what is wrong with them
and the world at large, you may be asked to intervene personally in
peoples’ lives, be issued ultimatums about being admitted into
hospital and be invited to ease an individual’s responsibility for
their actions. Many such questions do not have a straightforward
answer and, if this sounds daunting, it is worth remembering that
we tend to underestimate the simple act of listening.
Being on-call in
psychiatry is a rich experience. Mental distress and disorder can
be seen to have their roots in peoples’ real and imperfect lives
and you are reminded that we are complex, social animals. As
Engleby surmised when considering his own mental health problems,
“my own diagnosis of the problem is simple. It’s that I share 50%
of my genome with a banana and 98% with a chimpanzee. Bananas don’t
do psychological consistency, and the tiny part of us that’s
different - the special homosapiens bit - is faulty. Sorry
about that” (Faulks, 2008).
Dr David Brunskill
Specialty Registrar in forensic psychiatry