531461 research-article2014
APY0010.1177/1039856214531461Australasian PsychiatryKumar
Australasian
Psychiatry
Teaching and Training
Why a career in psychiatry? Varun Kumar Psychiatry Registrar, Department of Psychiatry, Westmead Hospital,
Australasian Psychiatry 2014, Vol 22(3) 296–298 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214531461 apy.sagepub.com
Westmead, NSW, Australia
Abstract Objectives: To reflect upon the factors that might motivate one to undertake a career in psychiatry from the personal perspective of a current registrar in training. Conclusions: The reasons for choosing a career path in psychiatry are complex, and relate to an individual doctor’s life experience, training experiences and own value system. Dissatisfaction with the traditional “medical model” of illness may be a contributing factor, with a perception that psychiatry may embrace the biopsychosocial model of illness more fully. Beyond this, a particular interest in the poetry inherent to an individual’s story and appreciation of the artistic underpinnings of medicine may also contribute. Keywords: career, psychiatry, biopsychosocial model, poetry
To his patients he gave three-quarters of an hour; and if in this exacting science which has to do with what, after all, we know nothing about - the nervous system, the human brain - a doctor loses his sense of proportion, as a doctor he fails. Virginia Woolf, Mrs Dalloway1. During my consultation-liaison attachment, not a week would pass without some intern or resident curiously enquiring why I had chosen a path in psychiatry. What perhaps surprised me the most was that I found it difficult to convey to them, or perhaps even understand myself, why I had. It seemed a simple enough question, an important question, and yet the answer seemed complex and bordering upon ineffable. Psychiatry had interested me since early on in medical school. In my first rotation I enjoyed the relaxed composure of the psychiatric nurses that acted as a counterpoint to the sometimes chaotic ward environment. The rigid hierarchy of the medical wards did not seem present, and, even as a medical student, I felt a sense of belonging. As for the psychiatrists themselves, they seemed to me to be the holders of some secret knowledge. Their knowing smiles somehow transcended the suffering of the patient in front of them and merged into something more mystical. Even as early on as this the psychiatry registrars on the ward had warned me of the stigma that they, at times, encountered when interacting with their medical
colleagues. It was years later that a wise doctor working on an acute adult ward suggested to me that the feeling associated with this stigma should be worn as a badge of honour, as it brings us closer to understanding our patients. As a medical student, poetry was an important way for me to reflect upon difficult moments that were inevitably a part of training. My beginner’s mind found it difficult to grapple with why some doctors would aggressively treat an individual’s physical pain but at times not prioritise, or perhaps not recognise, their depression. I wrote the following poem as a student during a cardiology term. It conveys a sadness that is, I think, well understood by many mental health clinicians and their patients. Line in the Sand Ward rounds, The bane Of every med student. One patient, Then another, And another.
Corresponding author: Dr Varun Kumar, Department of Psychiatry, Westmead Hospital, Westmead, NSW 2145, Australia. Email: [email protected]
296 Downloaded from apy.sagepub.com at EMORY UNIV on April 19, 2015
Kumar
The inferior infarct,
I promised myself,
That was bed ten.
That if the senior doctor
Or was it fifteen?
Couldn’t be bothered
I could be thinking
To see me,
Of the man
I would get a new one.
With an arrhythmia.
If he doesn’t care about me,
I must pay attention.
Why should I see him?”
I hope
A hint of anger,
They don’t ask me anything.
But I sense more to it
The registrar
Than that.
Smiles at me.
He glances
I think
At me,
She remembers the feeling.
Again.
“Come.
“And who is that?”
Let’s go
The registrar,
To the outpatient’s clinic”.
Is unhappy.
She looks through This man’s chart. “This patient Has had two heart attacks. We put a stent In one site, But failed in another”.
“Mr Rogers, This is a public hospital. That means, There are medical students. It also means That you see a registrar, And then I report to the consultant.
“He is only forty-five.
He has hundreds of patients,
Smokes,
No time
High blood pressure,
For them all”.
High cholesterol, No wonder”. The registrar Turns on the loud speaker. “Mr Rogers To room B15”. A knock on the door, A young man enters. He shakes the registrar’s hand, Glances at me. The registrar Introduces herself, But not me (I hate it When that happens).
The patient, Is silent. “Now, I do want to help you. I know it’s frustrating. Tell me your problems”. He explains them, She extracts from them. He is tired, All the time. He gets Short of breathe And has These chest pains.
They sit down,
The registrar gets up,
And he launches:
And leaves
“Look,
To see the consultant.
Before I came here today,
I look at him,
I drew a line in the sand.
Feeling slightly anxious 297 Downloaded from apy.sagepub.com at EMORY UNIV on April 19, 2015
Australasian Psychiatry 22(3)
With the need to say something:
Doctor”.
“It’s a lot to take in,
She smiles.
How are you feeling
He shakes my hand,
About everything?”
And leaves.
Straight
I can’t help
From his injured heart,
But think.
It rushes.
That we,
“I’m tired all the time.
Should be sorry.
It’s so hard,
We drew a line
To do anything.
In the sand,
I can’t concentrate”
Long before you.
“I don’t have
Here is your body,
A partner,
Here is your mind.
Very few friends. My family, Are all in Perth. I just Don’t have anyone…” He pauses. “To talk to?” He nods, And looks me In the eye. “I’m only forty-five And I’ve started To think About my mortality. I’m too young For this. If you’re older, You can accept it. But me…” The registrar Returns. She explains How she will change his drugs. His symptoms Should lessen. He should return
Strange. Some people, We never forget. Perhaps then Virginia Woolf pre-empted the biopsychosocial model. The “loss of proportion” she described may very well be a sadness that is at risk of pervading modern medicine. This is a sadness that I felt when seeing this patient as a student, and it has been replicated many times since. As professionals working in psychiatry we are, perhaps, uniquely placed. We are privileged to have access to the inner lives of our patients: their hopes, dreams and often deepest torments that they would tell no one else. With privilege we listen to the poetry that is inherent to their lives. Psychiatry is far from reproach, but may, therefore, have a unique perspective to offer. One of these may be an appreciation of the “poetic proportion” that is an inherent part of being human. Going where our patients lead us not only allows us to help them in a medical sense, but it also opens up possibilities that go beyond therapeutics, and extends into something indefinably unique. I think that quality is why I chose a career in psychiatry. Acknowledgement I would like to gratefully acknowledge Dr Chris Ryan for his support during the development of this article.
Confidentiality All identifying data pertaining to the patient mentioned in the poem has been altered. This includes name, places and particulars relating to his medical condition. Given that this patient was seen over eight years ago in a short clinic setting written consent could not be obtained.
In three months
Disclosure
For a new angiogram.
The author reports no conflict of interest. The author alone is responsible for the content and writing of the paper.
He stands up. “I’m sorry,
Reference
For how I acted before,
1. Woolf V. Mrs Dalloway. London: Vintage, 2004.
298 Downloaded from apy.sagepub.com at EMORY UNIV on April 19, 2015
APY0010.1177/1039856214531461Australasian PsychiatryKumar
Australasian
Psychiatry
Teaching and Training
Why a career in psychiatry? Varun Kumar Psychiatry Registrar, Department of Psychiatry, Westmead Hospital,
Australasian Psychiatry 2014, Vol 22(3) 296–298 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214531461 apy.sagepub.com
Westmead, NSW, Australia
Abstract Objectives: To reflect upon the factors that might motivate one to undertake a career in psychiatry from the personal perspective of a current registrar in training. Conclusions: The reasons for choosing a career path in psychiatry are complex, and relate to an individual doctor’s life experience, training experiences and own value system. Dissatisfaction with the traditional “medical model” of illness may be a contributing factor, with a perception that psychiatry may embrace the biopsychosocial model of illness more fully. Beyond this, a particular interest in the poetry inherent to an individual’s story and appreciation of the artistic underpinnings of medicine may also contribute. Keywords: career, psychiatry, biopsychosocial model, poetry
To his patients he gave three-quarters of an hour; and if in this exacting science which has to do with what, after all, we know nothing about - the nervous system, the human brain - a doctor loses his sense of proportion, as a doctor he fails. Virginia Woolf, Mrs Dalloway1. During my consultation-liaison attachment, not a week would pass without some intern or resident curiously enquiring why I had chosen a path in psychiatry. What perhaps surprised me the most was that I found it difficult to convey to them, or perhaps even understand myself, why I had. It seemed a simple enough question, an important question, and yet the answer seemed complex and bordering upon ineffable. Psychiatry had interested me since early on in medical school. In my first rotation I enjoyed the relaxed composure of the psychiatric nurses that acted as a counterpoint to the sometimes chaotic ward environment. The rigid hierarchy of the medical wards did not seem present, and, even as a medical student, I felt a sense of belonging. As for the psychiatrists themselves, they seemed to me to be the holders of some secret knowledge. Their knowing smiles somehow transcended the suffering of the patient in front of them and merged into something more mystical. Even as early on as this the psychiatry registrars on the ward had warned me of the stigma that they, at times, encountered when interacting with their medical
colleagues. It was years later that a wise doctor working on an acute adult ward suggested to me that the feeling associated with this stigma should be worn as a badge of honour, as it brings us closer to understanding our patients. As a medical student, poetry was an important way for me to reflect upon difficult moments that were inevitably a part of training. My beginner’s mind found it difficult to grapple with why some doctors would aggressively treat an individual’s physical pain but at times not prioritise, or perhaps not recognise, their depression. I wrote the following poem as a student during a cardiology term. It conveys a sadness that is, I think, well understood by many mental health clinicians and their patients. Line in the Sand Ward rounds, The bane Of every med student. One patient, Then another, And another.
Corresponding author: Dr Varun Kumar, Department of Psychiatry, Westmead Hospital, Westmead, NSW 2145, Australia. Email: [email protected]
296 Downloaded from apy.sagepub.com at EMORY UNIV on April 19, 2015
Kumar
The inferior infarct,
I promised myself,
That was bed ten.
That if the senior doctor
Or was it fifteen?
Couldn’t be bothered
I could be thinking
To see me,
Of the man
I would get a new one.
With an arrhythmia.
If he doesn’t care about me,
I must pay attention.
Why should I see him?”
I hope
A hint of anger,
They don’t ask me anything.
But I sense more to it
The registrar
Than that.
Smiles at me.
He glances
I think
At me,
She remembers the feeling.
Again.
“Come.
“And who is that?”
Let’s go
The registrar,
To the outpatient’s clinic”.
Is unhappy.
She looks through This man’s chart. “This patient Has had two heart attacks. We put a stent In one site, But failed in another”.
“Mr Rogers, This is a public hospital. That means, There are medical students. It also means That you see a registrar, And then I report to the consultant.
“He is only forty-five.
He has hundreds of patients,
Smokes,
No time
High blood pressure,
For them all”.
High cholesterol, No wonder”. The registrar Turns on the loud speaker. “Mr Rogers To room B15”. A knock on the door, A young man enters. He shakes the registrar’s hand, Glances at me. The registrar Introduces herself, But not me (I hate it When that happens).
The patient, Is silent. “Now, I do want to help you. I know it’s frustrating. Tell me your problems”. He explains them, She extracts from them. He is tired, All the time. He gets Short of breathe And has These chest pains.
They sit down,
The registrar gets up,
And he launches:
And leaves
“Look,
To see the consultant.
Before I came here today,
I look at him,
I drew a line in the sand.
Feeling slightly anxious 297 Downloaded from apy.sagepub.com at EMORY UNIV on April 19, 2015
Australasian Psychiatry 22(3)
With the need to say something:
Doctor”.
“It’s a lot to take in,
She smiles.
How are you feeling
He shakes my hand,
About everything?”
And leaves.
Straight
I can’t help
From his injured heart,
But think.
It rushes.
That we,
“I’m tired all the time.
Should be sorry.
It’s so hard,
We drew a line
To do anything.
In the sand,
I can’t concentrate”
Long before you.
“I don’t have
Here is your body,
A partner,
Here is your mind.
Very few friends. My family, Are all in Perth. I just Don’t have anyone…” He pauses. “To talk to?” He nods, And looks me In the eye. “I’m only forty-five And I’ve started To think About my mortality. I’m too young For this. If you’re older, You can accept it. But me…” The registrar Returns. She explains How she will change his drugs. His symptoms Should lessen. He should return
Strange. Some people, We never forget. Perhaps then Virginia Woolf pre-empted the biopsychosocial model. The “loss of proportion” she described may very well be a sadness that is at risk of pervading modern medicine. This is a sadness that I felt when seeing this patient as a student, and it has been replicated many times since. As professionals working in psychiatry we are, perhaps, uniquely placed. We are privileged to have access to the inner lives of our patients: their hopes, dreams and often deepest torments that they would tell no one else. With privilege we listen to the poetry that is inherent to their lives. Psychiatry is far from reproach, but may, therefore, have a unique perspective to offer. One of these may be an appreciation of the “poetic proportion” that is an inherent part of being human. Going where our patients lead us not only allows us to help them in a medical sense, but it also opens up possibilities that go beyond therapeutics, and extends into something indefinably unique. I think that quality is why I chose a career in psychiatry. Acknowledgement I would like to gratefully acknowledge Dr Chris Ryan for his support during the development of this article.
Confidentiality All identifying data pertaining to the patient mentioned in the poem has been altered. This includes name, places and particulars relating to his medical condition. Given that this patient was seen over eight years ago in a short clinic setting written consent could not be obtained.
In three months
Disclosure
For a new angiogram.
The author reports no conflict of interest. The author alone is responsible for the content and writing of the paper.
He stands up. “I’m sorry,
Reference
For how I acted before,
1. Woolf V. Mrs Dalloway. London: Vintage, 2004.
298 Downloaded from apy.sagepub.com at EMORY UNIV on April 19, 2015
