On 5 August 2009, like
many migrating junior doctors, I left the relative comforts of a
big teaching hospital in Aberdeen for pastures new and a job in
psychiatry in the North of Scotland. As a shiny new Foundation Year
2(FY2) doctor, the prospect was a little daunting.
The Highlands is vast,
both geographically and sociologically. My base hospital, New
Craigs in Inverness, has 84 beds and is the main referral centre
for the Highlands of Scotland. It serves a population of
approximately 234,000 distributed over an area twice the size of
Belgium. The most densely populated areas are Easter Ross and
Inverness. However, with only eight people per square kilometre,
the Highlands remain the most sparsely populated region in the
UK.
With such a large area to
cover, consultant teams work geographically. I was assigned to work
in the Easter Ross and Sutherland regions which essentially form a
diagonal strip on the map from just north of Inverness to the
wildernesses of the North West coast. This area is very socially
diverse.
The area of Invergordon
used to be an attractive prospect for work for people in this
catchment area, given the establishment of an aluminium smelter in
1968. Unfortunately, the plant closed in 1981 leaving in its wake a
stream of unemployment and deprivation.
My role is to look after
every aspect of both psychological and physical patient health.
Bloods and physical examination are performed on admission to
ensure that psychiatric symptoms are not a secondary manifestation
of primary physical morbidity as is sometimes the case. The junior
doctor’s tasks of arranging scans, chasing bloods and completing
physical examinations remains the mainstay of a FY2’s day here,
although with the additional privilege of being able to listen as a
patient opens up to you about their often fascinating life
experiences.
Weekly ward rounds are
significantly more relaxed than the daily, adrenaline-fuelled
apprehension I recall of a medical round. A multidisciplinary team
is involved, with nursing staff, medical staff and pharmacists
present before the patient arrives. The patient’s updated
presentation is then considered and a plan formulated for the week
ahead.
When on call, we are
often bleeped by GPs, A&E and other specialty docs asking for
advice, assessments or for patient admission. With such a large
area to cover, getting a patient to hospital can be challenging.
However, patients who are detained in the community are brought to
hospital by a ward based emergency escort team. I have enjoyed the
on call days, as it is then that I see the most potentially unwell
patients to assess their mental states as well as picking up
the ward jobs for unmanned teams.
The ‘on-call’
shifts were very daunting and challenging initially, as you are on
call for all of Highland and the potential for large influxes of
admissions and complicated cases is vast. There is considerable
support from the in-house Mental Health Assessment Team who are
usually available to assess patients with you, and a consultant is
always on the end of a phone if senior input is required.
I have been fortunate
enough to have a weekly clinic seeing and following up my own
outpatients, with the advantage of knowing that a senior colleague
is next door should there be any problems or the need to discuss
more complex cases.
Overall, mental illness
in Highland probably presents in a similar way to other areas of
the UK, but the logistics of seeing patients and assessing them in
hospital are markedly different.
Hannah Evans, foundation year 2 doctor
Page last updated on 7 June
by E Baker-Glenn