Continuity of care

Psychiatry is one of the most under-rated and fascinating branches of medicine.

In Britain the same team of doctors sees a patient both in the outpatient clinic and when they are in-patients in the hospital. This usually leads to very good continuity of care. It is invaluable for psychiatrists to see people with serious mental illnesses both when they are ill and when they are at their best. It is amazing how many patients turn out to be delightful people once an acute relapse has passed, even if they did not appear so at first.

Diagnoses

The main diagnoses are depression, schizophrenia, bipolar disorder, neurotic conditions etc. It is unusual for anyone whose only diagnosis is alcoholism to stay in a psychiatric ward for longer than a week. Alcoholics are ‘dried out’ in the community if possible and if they have to be admitted to a ward for detoxification they are normally discharged one week later, whether they like it or not!

Team work

Although psychiatrists see plenty of patients who are depressed, working in this subject is rarely depressing. There are many reasons for this. Much of the work is done in teams, so it is a sociable job. Colleagues from other professions as well as doctors belong to the team and most of them are pleasant and well informed about their own field and its use in psychiatry.

New drugs

Another encouraging aspect of mental health work is that since the invention of the benzodiazepines the pharmaceutical companies have realized that mental illness is common, and that some patients need to be on medication for long periods, even years. Drugs companies can therefore make large profits if they discover a successful compound. This has resulted in a steady stream of new and better psychiatric drugs in recent years, and many more are being developed.

Research

Research is active in psychiatry and periodically there are new and exciting discoveries. Trainees are expected to do some research and audit during their training and some may spend a few months in a research job.

Who works in psychiatry?

Some doctors start psychiatry straight after their pre-registration year, others come to the subject later. Psychiatry is a good choice of career for people who have done other specialties first, because their experience, both of life and of other branches of medicine, can be very useful. In addition, because there is a shortage of psychiatrists in Britain, the prospects of promotion are good.

Many who want to be family doctors work in psychiatry for 6 months as part of their training. About a third of consultations in general practice are said to be partly or wholly psychiatric, so a few months learning about mental health are valuable.

A significant proportion of the doctors and nurses in mental health come from abroad, and if they cook for a staff party the food is cosmopolitan and delicious!

Promotion Prospects

There are about 1,500 jobs for psychiatrists in Britain and substantive post holders do not currently fill about 400 of these. The recent promise by the British government to create 7,500 new consultant posts make promotion prospects even better. Opportunities are therefore excellent. In theory at least it is possible to become a consultant after 6 years of psychiatric training, provided that the doctor has passed the MRCPsych. (Membership of the Royal College of Psychiatrists) examination or a specialist qualification obtained abroad that has been accepted as an equivalent.

Training in psychiatry

Doctors start as senior house officers (SHOs). An SHO works for a consultant (a fully trained specialist). Usually an SHO looks after several ward patients and also assists the consultant once or twice a week at an outpatient clinic.

In British psychiatry the training of doctors is taken very seriously, and trainees are given plenty of opportunities to learn. In term time they are expected to go to a regional centre for lectures half a day a week. More locally they meet for an hour or so a week to learn about psychotherapy, which is an excellent way of improving on interviewing skills. Another weekly activity is the academic meeting attended by doctors of all grades and other mental health professionals. A trainee often presents the case of an interesting psychiatric patient they have known and worked with. The doctor is expected to have read about the illness in question and tell the audience about it. A journal club, where instructive articles are discussed, may also take place periodically.

A trainee usually sits the first part of the Membership of the Royal College of Psychiatrists examination after about a year, and the second part about two years later.

A typical timetable

Monday morning: Outpatient clinic in a nearby town: The trainee clerks (interviews and takes detailed notes about) a new patient referred by a GP (general practitioner, family doctor). The trainee then presents their findings to the consultant and management is discussed. The trainee may then see about two or three ‘follow-ups’, in other words, patients the doctor has known before, either from the clinic or from the hospital ward. If the doctor is in doubt about anything, for example about how to adjust the medication, they are expected to ask the consultant for advice.

Monday lunchtime: Meeting with the community mental health team:

The team includes community psychiatric nurses, who have had several years of training and experience in psychiatry, and social workers specialized in mental health. New referrals to the team are discussed, along with any known patients causing concern.

Monday afternoon: Ward work at the hospital.

Tuesday morning: ECT rota. Electroconvulsive therapy is used for a small number of extremely depressed or suicidal patients who have usually not responded to adequate doses of antidepressants.

If not on ECT rota that week: Ward work

Psychotherapy training: Attend lecture course at regional centre.

Wednesday: Ward work. (Occasionally there will be visits with the consultant to see patients at home, in a hostel, at the police station etc.)

Half day off if the doctor has been on night duty.

Thursday: Ward round. The consultant attends, along with representatives from the community mental health team. The SHO and the nurses discuss all the patients. Senior nurses have years of experience and a thorough training in psychiatry, and in the ward they often spend more time with patients than other staff. Wise doctors listen therefore listen very carefully to the opinions of these nurses.

Friday: Ward work.

On-call Rota: In addition to the work described above one of the juniors is on call during the day for medical or psychiatric emergencies throughout the hospital. They also deal with problems with the inpatients and new admissions (newly arrived patients) of any other doctor who is unavailable There is also a night duty rota with similar responsibilities. An SHO may be on call at night about once a week.

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Last modified: June 27, 2005