Being on the other side of a Mental Health Consultation
For almost two years, I have been having regular Mental Health consultations. They have become part of my life now. Not only that, but the team that I am with currently have become such regular people in my life. This is to the point that I cannot imagine life without them anymore.
I am so used to being that patient. What I am not used to, however, is being on the other side of the consultation. That is, being the ‘doctor’ (or, in my case, Medical Student) who is ‘leading’ the consultation.
We won’t be exposed to psychiatry until our 5th year. That doesn’t mean that we don’t get psychiatric patients come to other specialities, however. In particular, my time in A&E and AMU has exposed me to a number of patients presenting with mental health difficulties. It is in these situations where I am forced to become the person taking charge of the consultation.
What’s that like?
Seeing the patient in myself
In many cases, it is difficult for me not to create some sort of barrier between me and the patient. Whilst it is important to be empathetic towards our patients, it is also important for us to keep some distance from getting too heavily invested. I found this out very early on my placement – otherwise, it is difficult for us to keep our own morale and well being intact.
With mental health patients, however, I struggle not to see the patient in myself. After all, I too am in a very similar position to them (not that they or any other staff know it, of course). It is difficult for me NOT to fully appreciate just how terrible a person who is experiencing psychosis must be feeling when they present acutely to A&E. There are many times where I feel like saying to the patient: “I know exactly what you are going through” but I don’t.
Well, for starters, it’s not strictly true. Everyone experiences psychosis differently. Secondly, the patient could easily turn around and say to me: “No you don’t, you have to be going through it to know.” He or she has no way of knowing my own demons. I can’t reveal it either – I am scared of what the other doctors would end up thinking of me if I did. That is the brutal nature of the stigma.
Needing to take time to myself after seeing such patients
Sadly, many doctors seem to think it’s funny to send us to go and see mental health patients. Many of them have the preconceived idea that such patients are dangerous for whatever reason. Some doctors seem to get great delight in sending the naive, inexperienced Medical Student to go and see a patient in acute distress. They seem to revel when we students struggle.
This makes me feel very bad whenever I do go to see these patients. I can’t help but wonder what these doctors would think of me if they knew just how bad my mental health got to one stage. Would they also think that I was some sort of dangerous being? Would they even think that I’d be unworthy to be a Medical Student?
This ends up upsetting me more than anything else. As a result, there have been times where I’ve needed to go outside to shed a tear or two. Both because of how awful I feel for the patient, and because I myself feel as though I’ve been called those things by some doctors. Not that they realise it, of course.
But it can be helpful to some patients
As a Medical Student, I am in the fortunate position of not being pressed for time. Maybe things will change when I become a bit more senior but for now, I try to make full use of it.
If a patient mentions that they feel depressed, I try to make an active effort to talk to them about it. That’s only if it’s clear that they want to, of course. More often than not, however, they do want to talk about it – after all, it is difficult being on a hospital bed all day with no one to talk to for the most part. That was apparent on my own psychiatric admission.
For some patients, it is a case of just having them talk through their problems and listening. It isn’t difficult to make an empathetic statement like: “That sounds very tough for you” and to just nod and acknowledge what they’re saying. But it has to be genuine – it is very obvious when it’s faked. And it is genuine whenever I hear that stuff – as I’ve said, I too am on their side literally every week.
For other patients, it becomes a case of talking about other things, just to help them take their mind off their other difficulties. A patient with a type of cancer that metastasised to his brain is the best example I have of this. When I was asked to take a history, it was clear that the patient had low spirits due to their prognosis. “I just wish I could be at home and watch cricket,” they said to me. That was my opportunity – I started talking to them about the Ashes for the next half an hour or so. I got no information about their history, but they seemed to appreciate it afterwards.
Being a mental health patient in disguise whilst also training to become a doctor is a double-edged sword. On the one hand, it can end up reminding me of my own treatment or, at worst, remind me exactly of how horrible it feels. On the other, it does help me understand more aptly as to what the patient is going through. Often, I find it rather easy to develop a rapport with the patient as a result as the empathy appears to be more natural.
Only time will tell which side of the sword becomes sharper.