I’ve said it on my blog many times before but I will say it again – we learn the most from our patients. If we ourselves are the patients, it does great wonders to what we learn. It is one thing learning from a textbook or lecturer the pathophysiological basis of depression. To actually have to go through it yourself and experience it, however, is a completely different matter. Only by being able to fully appreciate the extent to which diseases affect patients are we able to, in my opinion, offer the greatest empathy and care towards patients in a similar condition.
It is no secret that, at the most basic level, we go into Medicine hoping to help people. We all think of many weird and wonderful ways to tell that to the person interviewing us when we apply for a place at Medical School, but that’s what it ultimately comes down to. So when we ourselves experience being a patient firsthand, the battle to help a patient becomes almost personal. For once, we know the true way in which an illness becomes crippling towards the patient. We don’t want the patient to have to go through the same thing that we went through. Our desire to help the patient in this case somehow manages to improve over our already immense desire.
For me therefore, what have I learnt about being a patient admit in a psychiatric ward? Here are my lessons. (For the sake of those who have not read any of my blog posts before, I was admit into a psychiatric ward with severe depression and mild psychosis).
Making the patient feel human does wonders
It may sound obvious, but the best healthcare providers were those who actually treated me as a person rather than as just something on their timetable that they had to go through. It is often the negative experiences that teach us things and, sadly, this is no exception.
I was awaiting a follow up GP appointment about my medications. My medications were about to run out and I wanted to ask for more. I also planned, however, on talking about some more severe psychotic symptoms that I had been experiencing lately. I had ten minutes in the appointment, so I was sure that I had enough time to raise my concerns. When I was finally called into my appointment, the conversation went a bit as follows:
GP: “How can I help you?” (Without even a “Hello” – that in itself seemed rude to say the least!)
Me: “Well, my citalopram is about to run out and I was also hearing some voices lately that…”
GP: “What dose are you on?”
Me: “40mg. The thing is though…”
GP: “The voices could just be a side effect of the medication to be honest. How long have they been going on for?”
Me: “I’d say only a few days, but it was the anniversary of a close one’s death so I was wondering if…”
GP: “OK, start the medication and if the voices come back, book an appointment and we’ll think about how things go from there. Any thoughts of harming yourself or others?”
Me: (Feeling a bit disgruntled) “No.”
GP: “OK, I’ll print your prescription out.”
And that was it. The appointment lasted literally about three minutes. Don’t get me wrong, I do appreciate the immense amount of pressure that GPs are put under to see a large number of patients. But a three minute appointment seemed to be very dismissive to say the least. Not only that, but I felt as though my concerns weren’t being listened to at all, given how much I was being interrupted. It just seemed more as if the GP was more adamant on himself being right rather than to want to listen to what I had to say about my condition.
As Medical Students, we are often taught to take a patient centred approach to things. What this means, essentially, is to work with patients rather than to tell them what to do. It is a topic that often rolls eyes amongst Medical Students when it is being taught because of how obvious it seems, but it doesn’t change how vital this approach is. In my own case, it actually put me off from going to the GP for a bit too. Of course, this was no good for my Mental Health!
As I said, I do appreciate the fact that many GPs are under pressure. What I have noticed, however, is that the majority of GPs who I have spoken to seemed to have much more time to talk to me. It begged the question – if these GPs could do it, why couldn’t some others?
Nurses are AMAZING
“Why Medicine – why not nursing?”
In the UK, that is a potential question that Medical Applicants can be asked on interview. We were all taught to talk about the role of the nurse, and how it differs to the role of the doctor and how we feel as though we are somehow better suited to the role of the doctor but appreciate the role of the nurse. Simple. Job done.
But I fear that this ‘rote learning” technique of answering this question is only that – rote learning. In my eyes, many medical applicants (myself included at the time) don’t really fully appreciate the role of the nurse, despite just being told that they are vitally important in healthcare. How they are important, however, is not really something that many of us think about in too much detail. The only way to see how they are important is to actually be treated by one, or to work closely alongside one.
Throughout my many trips in hospital, I noticed that it was the nurses who were spending much more time with me compared to the doctors. This, of course, is not meant to put down doctors at all – training to be one has shown me just how difficult the role is. Rather, what I am trying to do is to hammer the message in that without nurses, healthcare would fail dramatically. They did all the small, difficult but necessary jobs that we as medical students don’t have to worry about much. For example, having to clear urine of the floor, clean a patient who has defecated themselves and so on. Not only this, but it was them who had to deal with most of the abuse from patients. In most cases, the patients had let out their frustrations on the nurse so that they were more calm when seeing the doctor. Not fair on the nurse, but there we go. Did this stop the nurses from doing their jobs, however? Not at all.
Nurses are perhaps one of the most underappreciated members of society. It truly makes my blood boil when I see things like grants being scrapped for nurses, or seeing them being treated very badly despite all the amazing work they put in.
So, thedepressedmedicalstudent, if you love nurses so much, why are you doing Medicine and not Nursing? The honest, non-interview answer? Because I simply don’t feel like I have the energy or strength to work so hard without being appreciated much. I’m not strong enough for that. Selfish, perhaps, but there we go.
Illness is frustrating – things said in frustration aren’t necessarily personal 🙂
This is something that I regret. Many times in my psychotic episodes or depression, I ended up saying angry things to the healthcare professionals looking after me. These healthcare professionals did not deserve any of my frustrations, given how most did such a brilliant job, but it is important to realise that when people are ill, they will be frustrated and grumpy. This is not me trying to defend my actions at all. Rather, it is me trying to say that I’ve hopefully learnt not to necessarily take negative things said to me by patients personally.
The patient is someone who is going through a very difficult time, and different people will react differently to difficult times. In the case of mental health especially, where it seems like very few people understand, the feeling of being trapped can be very isolating. The frustration of this isolation can be taken out on the healthcare professional. Note – it is the frustration of THIS ISOLATION. Not frustration at the healthcare professional.
Mental Health Issues need more attention
Regrettably, there seems to be some sort of ‘joke’ that psychiatry is not ‘real’ Medicine. It’s always been a joke that we Medical Students have laughed at but, of course, not really meant seriously. Nonetheless however, I do find myself wondering about the origin of this ‘joke.’
In my time as a mentally ill patient, what I realised was that psychiatrists, psychiatric nurses and many other mental health professionals were very much understaffed. Each mental health professional I met was very well trained and was extremely helpful in aiding me. What was an issue, however, was that in many cases due to staff shortages, my care was managed by several different healthcare professionals. This was something that I found unhelpful in that it didn’t ensure continuity of care. It resulted in a less personal relationship with the physician and other professionals. Thus, the more personal a relationship between doctor and patient (within limits, of course), the better the care.
Patients can be frustrating…but it’s not their fault
This point relates quite a lot to my third point actually, now that I think about it.
As Medical Students, and undoubtedly when we become doctors, we will encounter many patients who will end up being difficult to deal with. Inevitable, this will end up frustrating us – but it is important to realise that this isn’t the patient’s fault. It is important to remember that being a doctor is more than just a job. It is a lifestyle where other people’s lives will be in our hands. Where people where trust us to carry out the most difficult procedures on them. Where people will trust us with their deepest darkest secrets.
“I think you may have psychosis,” my psychiatrist was saying to me once. This was the first time that I had been given a diagnosis for my condition. “Now, what we will do next is…”
But I can’t remember what the psychiatrist said to me. In my mind, all I had heard was the word “psychosis” and bam, there had been an internal explosion of panic within my brain. Anything else that was being said to me the whole day was just a blur. In my head, all I was hearing was: “I think you may have psychosis.”
I can’t imagine how frustrating I must have been to the receptionists, who I was meant to book a follow up appointment with for something but couldn’t recall what for! Nevertheless, they didn’t seem to mind. Rather, it seemed like it was a situation that they had experienced many times. And this did wonders to help me trust them, as well as the healthcare profession as a whole.
I wrote this blog post as a way to remind myself in the future of why I went into Medicine in the first place. I am sure that at many times, I will end up feeling frustrated, tired, underappreciated and so on. However, by reading this, I hope to also constantly remind myself how grateful I was for the support from my medical team when I most needed it. Without them, I doubt I would have been in a better position like I am today. Whenever I, or many others, end up feeling frustrated, I beg them to remember that they really are making a huge, positive difference to people’s lives every single day. And that is the biggest lesson I have learnt.