Psychiatry

Never before have I come across a speciality that involves so much conflict and clashing agendas. I've learnt that to be a good psychiatrist, you need to be a master at the art of negotiation, delicately choosing words that would cause least patient resistance. It's difficult trying to convince a mind to adhere to medication when that same mind is in the throes of psychosis.

The patients have been interesting; whilst many neglect personal hygiene, and it may take some time getting used to the smell, what really does keep you intrigued is the extent of some people’s psychoses. From believing that the world is only 42 years old and built by a computer, to fearing the world (doctors included) is out to get them. Unfortunately I also saw some of these thoughts reinforced by family members, probably based on cultural norms back home; the brother of a patient was open to the possibility that the patient's ex-wife had colluded with the doctors to admit him. Let's say the ward rounds, despite their hours-long duration, always had something interesting going on.

As well as having the ability to negotiate with patients, psychiatrists need to be able to detect subtle cues extremely well. They could be the difference between someone being well and potentially extremely dangerous to themselves or others. But they must also bear in mind the definition of 'normal', taking collateral histories from relatives to establish a 'baseline', as well as realising that really, no one is truly 'normal'. Psychiatry makes good use of extended silences to allow the patient to say what's on their mind, and whilst acknowledging that the patient is mentally unwell, it is essential to listen to their wishes when it comes to management of the condition. It depends on the individual patient, some may prefer (or need) the paternalistic approach instead.

During my stay, I learnt there's something that I cannot ever get used to (and this was even after visiting the child psychiatry section), and that's seeing people who experience auditory hallucinations. There are many different types of auditory hallucination, from someone talking directly to you (usually in a derogatory manner, or giving you orders), to repeating your thoughts out loud, or even hearing two people talking about you. The amount of mental toughness needed to blank out these voices and try and live a normal life is phenomenal.

Overall, whilst my time in psychiatry has been enriching, and it's been a beautiful reminder of how easily my life could be dramatically different, but I think paediatrics is still my calling :)