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Guest Olivia_Will

Psychiatric Anti-Heroes; or How to be Good

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I've just started as an SHO in psychiatry, and I'm curious to know what other people think are qualities needed to make a good psychiatrist. I remember as a medical student (I trained in South Africa), I was taught by one psychiatrist who insisted patients drew 'a picture of a house' for her. Inevitably, a square topped by a triangle would be produced, as the patients came from rural areas, where they lived in huts - and without pencils. She'd show this to us and say: See? Good evidence of an extremely low IQ...

I have this and many other odd memories of my first exposure to psych - the anti-heroes who taught a lot about what not to be. Anyone else got some good examples? ::)

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Giving a damn about your patients matters more than in any other speciality because everything else will flow from this.

Studying phenomenology is absolutely important because this is the basis from which all your diagnoses/decisions will ultimately flow. [Remember empathy is different from sympathy]. Sims is good, Fish is apparently better.

Knowing the symptoms from ICD-10 for each major disease entity will put you in good stead. Also be familiar with the axes in DSM-IV and think about it in each patient.

Making a note of the phenomenology in each patient and then using this to think of a provisional diagnosis will be of immense benefit. Your working knowledge will quickly accumulate.

Try and use the full MMSE as soon as possible, as then you will be able to compare it across patient populations [some SHO's got 26-27 after a night on call]

Get familiar with the basic terminology in psychotherapy especially psychodynamic and CBT models as these usually take a bit of time to sink in i.e the earlier you look at it the better. Try and get in some psychotherapy as soon as possible.

Know the major side effects of the main medications you use. Familiarise yourself with the Maudsley guidelines for management if you want guidelines.

Listen to all members of the team as their experience is invaluable

Do not forget to be critical of others (not aloud), yourself, diagnoses that have already been given, and of the evidence you use to make your diagnoses.

Good luck and enjoy

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Polly,

Once in a clinic as a medical student I sat and watched. The young man who came in had been studying Law a year ago. Now he had schizophrenia and was reading large print books from the library. A very different future. This was the second time I decided not to become a psych. Too tragic to bear.

As for the qualities that make a good Psychiatrist, one way of looking at it would be to in terms of the MSE...

1. Well Groomed.

2. Appropriate Comportment.

3. Of temperate mood.

4. Lacking in obsessions, delusions and any form of thought disorder.

5. Unable to halucinate without psychedelic 'encouragement'.

6. Oriented to person, place, time and ok with the three 'R's.

7. Insight.

And if lacking in the above..

8. A rather morbidly fatalistic sense of humour.

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hey!

there is no stereotypical good psychiatrist and bad psychiatrist.its what you evolve as.believe in yourself and be friendly,you will be a good person and that will make you a better doctor.

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Polly,

. This was the second time I decided not to become a psych. Too tragic to bear.

...wonder what was your first time and what are you doing here!! ;)

and justin,i really wonder how one can empathise and still give a damn about the patients!!

needs a humane approach than any other disipline i think apart from everything mentioned above

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I would add in having respect for your patients - all of them - and try always to engage them in the management plan including encouraging advance statements and joint decision making. Maximise your communication skills too. The worst psychs I have worked for have had little interest in the patients' wishes and have been appalling communicators. People with mental illlness have enough crap to deal with considering the huge stigma still around - our responsibility is to care in a non-patronising  way and not forget to always try to foster positive life changes (don't forget, as so many do, that some with SMI could get very successful jobs with the right support).

Most of all enjoy.

Elvis 8)

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Here's an anit-hero for ya:

In the middle of a ward round, with a very distressed patient, the Consultant Psychiatrist hocked up a big nasty load of phlegm and spat it out into a tissue. No 'excuse me' or any attempt to conceal it. Just SPIT! Naturally enough we were all a bit shocked. Although not as shocked as when he did it a second time with a different patient!

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