including within the medical profession. It absolutely enrages me.
Do you ever feel that a lot of skills acquired at medical school are lost in psychiatry? This is an interesting question. Medical school gives you a good, all-round basic understanding of medicine. No doctor will ever use everything they learn though. A cardiologist, for example, isn’t likely to use their knowledge of hand anatomy. People assume that because it’s psychiatry, you never need your knowledge of physical medicine, but this is not true. Many of our patients have multiple physical problems and are on lots of medications. On psychiatric wards you are responsible for the patients’ physical welfare as well as their mental health and this means your knowledge of physical medicine and your examination skills have to be exemplary. In fact, I’ve found that in psychiatry, I’ve had to use far more general medicine than in other specialties I’ve worked in, such as surgery.
What do you think about the way psychiatry is portrayed in the media? Generally, I think it’s quite poor. It’s either akin to One Flew Over The Cuckoo’s Nest or it’s lying on a couch talking about your mother. There is a great deal of misunderstanding amongst the general public – and even some doctors – as to what psychiatrists actually do. I don’t have a couch and I don’t read people’s minds. What is more worrying, however, is the way that people with mental illness are portrayed in the media. They’re often viewed as dangerous and out of control. In fact those with severe enduring mental illness pose far greater risk to themselves than anyone else and deserve our help, support and understanding, rather than vilification.
working in care of the elderly and dementia care, although I’ve interwoven some stories from on-calls in medicine. I wanted to set these experiences against the backdrop of wider political issues affecting the NHS, as well as various social and ethical issues, including how we view and treat the elderly in our society. My initial idea for the book
How do you balance your career in psychiatry with your career in publishing? I’m not particularly good at time management, but I don’t have a television and I don’t have children – with these two things absent from your life, you’d be amazed how much spare time you find you have.
In your second book, Where Does It Hurt? you write about your experiences working with the homeless. What was the biggest lesson you learned? What struck me was that there are a great number of homeless people with severe mental health problems, such as schizophrenia, who have been sorely let down by the system. I also worked with people addicted to drugs and learnt that addiction – be it drugs or alcohol – is a symptom of an underlying problem, rather than just a problem in itself. People use substances to anaesthetise themselves from something that deep down is causing them great pain. Merely treating the addiction is unlikely to have any lasting, meaningful change – you need to identify and deal with the underlying psychological problem. Unfortunately, most of the NHS treatment still focuses on simply dealing with the physical addiction.
Are you aware of any similar, rather unusual projects and work settings that trainee psychiatrists can find themselves working in? I’ve done a wide range of jobs in my training, from paediatric palliative care through to working in prisons and the forensic service. Lots of psychiatrists have outside interests or combine their career with academia. There are psychiatrists working in anthropology, film studies, philosophy and of course, journalism. I met a psychiatrist recently who works full time in sport and is currently the psychiatrist for the 2012 Olympic team. Another psychiatrist I know is an expert in stalkers and works for the Fixated Threat Assessment Centre. He reads all of the bizarre or troubling letters that the Queen gets and profiles the senders. A fascinating job – I bet he’s very popular at dinner parties.
Can you tell us about your new book? Why did you write it? It’s called The Doctor Will See You Now and charts a year
came after a summer holiday before starting medical school when I worked in a nursing home where many of the residents had dementia. The experience had a profound impact on me. While working there I witnessed harrowing abuse and neglect. Yet this experience was in contrast to another job I did later, working in a day hospital, which aimed to value each patient. These two experiences showed me the different ways that older people and those who are incapacitated can be treated and I wanted to explore this in the book. I liked the idea of telling the stories of people who have no voice. I’m often asked about the colleagues and flat mates that feature in the books. It was clear that people identified with some of the characters and wanted to know more about them, so in the book I’ve developed these characters further and tried to provide more of a back history for some of them. Each of the characters has something to contend with. And no, I’m afraid Ruby’s taste in men still hasn’t improved. Hope doctors and non doctors like it. Max is a doctor, journalist and writer. He has written three books: Trust Me I’m a Junior Doctor, Where Does it Hurt and The Doctor Will See You Now. Find out more about Max on his website – www.maxpemberton.com
Dr Anna Rebowska is an F1 doctor currently on surgical rotation at North Manchester General Hospital (Pennine Acute Trust).
NEW DOCTOR | VOLUME 4 | ISSUE 2 | 2011 | UNITED KINGDOM www.mps.org.uk
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