Psychiatry Block

aaannnddd breath.

I was sort of looking forward to Psychiatry block, but not for the reasons most people would think. It is one of the blocks in final phase that is known for being “chill” and I needed chill. I had been in every day for the past 10 weeks bar about three days and was shattered. I had barely done any work outside of placement, and I just needed time to slow down and catch up.

I’ve decided to make my entire 5-week psych block into one post as there isn’t too much to talk about. It’s not a block I would give 5 stars to and that is not the speciality but the admin.

We were given a timetable that consisted of what we were doing every week, which was OK. I have to give a shout-out to our consultant’s secretary, who had emailed us to say hello before we even got the timetables. We also got another set of “timetables” from our community base. I put that in quotation marks, as it wasn’t a timetable, just a list of names. No locations, no timings. We also had in the email that we would need to message daily to find out what we could do as some clinics are online, some face to face (but restricted due to Covid) and some clinics may be cancelled all together.

I wanted to cry.

I literally had just done a presentation about timetables and how it’s important for students like me to have a decent plan, and then we get handed this.

I had mentioned it to my year’s admin who was lovely but, I decided to use this to my advantage.

K and I tried our best to arrange things before the secretary who had sent us that timetable, and who we were meant to “message daily to see what to so” went on holiday for two weeks out of the five-week block. We weren’t even being handed over to anyone before I put my foot down and asked for a list of consultant emails.

Thankfully, one of the consultants replied, and we had two clinics booked in for the next week. K and I were determined to try and get in as much as we could this block, as we had the EXACT same problems last year . We really wanted to give Psych a good go. It was being difficult and not letting us.

I also had tried to get into CAMHS as this was an area I was interested in. Promptly told this would be unlikely due to the clashing of second year timetables (breath Abbie, breath) and when we tried to get into the ECT clinics, was told no as again, fully booked.

I was ready to give up before the block had even started.

One saving grace was that the first week of the block was all online. So, it meant I could spend time at home. Which I needed. Pets, and meals cooked for me.

I also got to attend a wedding for the first time which was of my friends. Well, sort of attended, I sat on my bed and livestreamed an event that was happening … back in Coventry. The ONE week I am not there !

We also got to see my uncle and (attempt) to take him home for the first time since before the whole pandemic started. This was back in February 2020 BEFORE the national lockdown. My uncle’s care home decided to lockdown early, which we all supported, but I know it’s been hard on him. He’s been wanting to come out since Feb this year so I know he’s had enough.

Well, we thought so. One Covid test later, and he’s refusing to come out of the care home full stop.

I think we are going to have a uphill battle on our hands. At least I got to see the home’s new BEAUTIFUL cat. Look at this lion:

I did have to break this spell of bliss though as head back to Coventry as I did have to do my degree still. On the Monday we had managed to arrange an online clinic. Except, nothing happens online without tech issues nowadays.

The consultant was really trying to get us both in but the first patient was only seen by K as I wasn’t able to be added to the meeting. In the afternoon we had some better luck with some three way MS teams/ attend anywhere/ consultant mobile on loud (patient consented). You can’t say we don’t try.

On the Tuesday we had a free day bar our teaching with our consultant. I was looking forward to this as we badly needed some good psych teaching. I get the uni wanted to standardize the teaching given out. However, when this means your teacher reads off a document word for word you can also access on moodle for an hour and a half and doesn’t answer questions till the end. It’s draining and I am really starting to struggle paying attention on Microsoft Teams as it is.

We then had a in person Simulation session the day after which was BRILLIANT. We each got to have a turn interacting with a SIM patient (an actor trained to deliver sessions for healthcare students). Psych patients can be vulnerable, so it isn’t appropriate just to go up to people and practise history taking here, so SIM patients are our best bet.

My SIM patient was struggling with bulimia. We don’t really get taught about eating disorders, so it was a total new territory for me. I ended up stumbling through, but I think I did an OK job. It’s just another thing I need to read up on.

I also had my long awaited ENT appointment. Well, the less said about that the better. in and out in under 5 minutes, looked in my ears and said they were clear (this will be important) and had the audacity to say they treat their students well. I can confirm we tried to get into their clinic once and they never showed up. They barely let me speak all through the consultation, and it was clear they wanted to get back to their conference, which was playing out loud on a tablet behind them. Oh, well, better make a bag for A&E as that is where I will end up every single time I get an infection.

Luckily, the week after I barely had anything on bar my twilight shift. It was our old age week, so I attended a ward round with a brilliant consultant. I find Psych ward rounds really weird. Instead of going to see patients, patients come to you. We were all sat in this room with the Fy2 and nurses with the consultant. If I were a patient, I would be unnerved with the amount of people in the room but they all seemed comfortable. What was amazing is that the consultant actually gave me a brief summary of each patient so I could get something out of the week and not just be sitting there looking lost.

It was only a half day but I got home feeling like I had done something, which was good.

The next day I was meant to go with the consultant to see some patients in a care home near Birmingham. However, I had been awake half the night with yet another double ear infection (three days after the ENT consultant said I was in the all clear) so I was busy trying to get the pain under control. Cue Wednesday morning when I was sent up to UHCW as both of them had fully closed up and I now needed ear wicks to let the antibiotics do their job.

I got a bit annoyed as I kept saying to the doctor that I coudn’t hear them due to both my canals being swollen shut but instead of doing anything about it, they took a step back and spoke only marginally louder. Thankfully, I had a lovely HCA who supported me through the painful insertion of the wicks and swabs from both the ears. I also got some stronger pain relief from the doc so I guess they redeemed themselves.

I had to miss the following academic day as I still could not physically hear anything that was going on. Second missed one in a row – gulp.

However, I dragged myself up to do our mock PSA test, which is the prescribing exam we have to take to be able to give drugs when we graduate. And I passed it! The average passmark is round about 60%, so I did well with my 64%. Slightly more confident about the future now.

The next week we had our acute week. This meant we were based in a hospital. I was looking forward to this as we had heard stories from our friends about it being a good opportunity to practise our history taking skills.

Thankfully, this week was saved by a doctor who I knew off twitter, otherwise we would have been in for one day, and one day only. On the Monday, we were not collected from the mess so we were taken to our ward by the amazing F2 doctor who I am forever grateful for .

We attended a ward round, again, really hard to get use to these formats and I practised my mental state examinations on each patient that came through. It was very hectic with one patient coming to the door every 10 minutes to the point where the staff had to lock the door and I had to go halfway through to have my check-up after my SAU admission on Wednesday last week.

However, we did get to see a large range of presentations, including a patient who I believed every word they said up till the final moment when they said something that was obviously not true.

It was interesting, but there was not much else to do that afternoon. We ended up going home early, but I arranged to sit with the F2 covering the acute ward, which is where patients go when they are first brought to the hospital.

We were warned it could be a very quiet day, so brought things to do such as work, but ended up just watching everyone play (very competitive) games of poll. I also got to chat to an ASD doctor that day (I had been persistent with getting into CAHMS). It was interesting as we were talking about diagnosing both ASD and ADHD at the same time as a lot of the traits from both of the diagnoses can overlap.

We then got to sit in on a review of a newly admitted patient before heading back home for the day. We agreed to go in for one more ward round as it was now clear that wasn’t an awful lot we could do, and I needed a sign-off.

We attended the ward round and saw new patients, all with different diagnoses. I did a mental state exam on the first one, presented back to my consultant and filled out the ticket myself before presenting them my tablet to get them to sign my ticket off there and then. Sometimes, you just get the feeling that your tickets will never be signed off, and I got that feeling that morning. They seemed surprised that I was handing them a tablet, mumbling that they normally get an email but thankfully, signed it.

And that was it. Our Psych block largely over. We had one more clinic to attend, which was another CAHMS clinic I had managed to wiggle into. The consultant was lovely, and we were offered coffee before we started. It was a good end to psych block. I actually really enjoyed the morning and liked seeing all the patients. The last patient at the end broke my heart with how much they were suffering, but I know they will get better, they just need time and expert help, both of which they were getting.

And that was it. Our entire Psych block done. No more psych teaching before we became doctors. I must have picked something up during the 5 weeks, as I easily passed the formative, but I don’t know. I just feel it could have been made better.

However, I appreciated the slowing of pace, I really needed to catch up on sleep which I did and just have a general reset before…… acute block!