10 How to work in…psychiatry
Behind misunderstandings and stigma attached to psychiatry, there is a fascinating and rewarding career to be found, write Dr Liz Ewins and Dr Dan Hodgson
L
ife as a psychiatrist is incredibly diverse. It involves the prevention,
diagnosis, and treatment of mental disorders through a mixture of inpatient, outpatient and community work; visiting people in their own homes or residential homes, as well as liaising with medical wards and sometimes prisons. Patients can have a huge
range of complaints, from depression, bipolar affective disorder, schizophrenia, eating disorders, anxiety disorders, post-traumatic stress disorder, dementia and drug and alcohol abuse. The management of these problems is equally varied, including medication and occasionally physical treatments, such as ECT, but there is also a great emphasis on psychological treatments. Sometimes patients have no insight into their illness, which can
require assessment and treatment by a psychiatrist under the Mental Health Act. Psychiatrists work together with a team of mental health professionals, including nursing staff on the wards, as well as community psychiatric nurses, psychologists and psychotherapists, social workers, pharmacists and occupational therapists. The psychiatrist works across a patient’s lifespan, from birth to old age, and it can be a privilege to hear in detail about people’s lives. Attention to detail and excellent communication skills are essential in order to obtain the necessary information required to make a diagnosis and initiate treatment, as there are few diagnostic tests available in psychiatry. This is all done on a solid background of medical training, which the psychiatrist draws upon to tease out physical and mental health problems.
LIFE AS A PSYCHIATRIST The big draw of psychiatry is that you have the flexibility to make what you want of it. You can choose to specialise in a field of psychiatry that interests you, and within that specialty, you can choose the way in which you would like to work, such as whether to undertake inpatient or outpatient work. It is one of the few remaining specialties where there is a combination of neurosciences, general medicine, psychology and psychoanalysis. It is this fascinating variety that makes psychiatry such an exciting and intellectually challenging area to work in.
SUBSPECIALTIES
General adult psychiatry This is the largest of the faculties and includes a range of specialties
involved with the provision of psychiatric care to adults of working age. This involves inpatient as well as outpatient and community work, and specialist teams, such as the early intervention team, which responds to first presentations of mental health problems involving psychosis, and crisis teams, who deal with psychiatric emergencies and gatekeep admissions, plus aid patients once they are discharged. Other areas of adult psychiatry include psychiatric liaison, which is a service that provides psychiatric treatment to patients attending general hospitals, whether they attend out- patient clinics, emergency departments, or are admitted to medical wards.
Addiction psychiatry This involves the assessment and treatment of people with complex medical and social needs arising out of addictions or addictive behaviour, which may include gambling. Substances may include alcohol, illicit drugs, prescribed or over-the- counter medication, and volatile solvents. There are a range of treatment options,
SPECIALTY FEATURE
NEW DOCTOR | VOLUME 4 | ISSUE 2 | 2011 | UNITED KINGDOM
www.mps.org.uk
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