I personally chose psychiatry as my first clerkship posting as
I am aware of my weaknesses in communication and interviewing skills. I am
always anxious, stutter, and sometimes went blank during history taking
sessions conducted in Clinical Foundation of Medicine. What better way to start
my first clinical experience other than by going head to head with my weakest
(among many) area so that I can improve on it before entering other clerkship
postings? I believe, psychiatry clerkship is the way to go if you want to
improve on your communication and interaction with patients, and not
forgetting, the teaching clinicians.
I still remember vividly on my first day in the psychiatric
wards where during the introduction to the female ward by the consultant, a
patient came forth and she uttered something in a language that I could not
understand. Then she suddenly grab my butt and walk away as if nothing
happened. I was stunned. None of the people around me realized of the event
that just happened. “Oh my god, I'm in for a nightmare here!” I said to myself.
The first patient that I approached was a 45 year old
Chinese gentleman with history of heroine abuse. He developed schizophrenia and
was brought in by the family because of abnormal behaviour. He was very
forthcoming and cooperative. As I was talking to him, he admitted to hearing
voices telling him to do good and be kind to others and as a result, he went
around the city handing money to people. He is a taxi driver and would drive
people to their destination without receiving any money but in fact, giving
them money. Oh how I wish I was one of the lucky person who was on the
receiving end of his kindness. Especially now, when the last scholarship money
received by me was more than six months ago. But I know, it is unethical to
manipulate my patient for money even though it is mutual between us. Even in
the ward, he was moving around, saying good things to other people and
spreading positive vibe to everyone near him.The interview with him went well,
and it gives me confidence to push on since then. In addition, it restore my
faith in humanity because even a person with mental illness can also do good,
what more a healthy person like us?
I move on and interviewed quite a number of patient since
then to sharpen my interviewing and communication skills. My interest in
psychiatry also develop as a result. It developed so much as when I was
listening to the radio during my drive back home, an advertisement was aired
and I could somehow relate it to psychiatric illness. It was an energy drink
advert. A story about a couple who was on their way back to their home town from
the city. The wife asked “you didn't have enough sleep yesterday, and now you
have been driving for 12 hours straight, don’t you feel tired?”. The husband
answered, “no, I actually feel GREAT! I feel strong and I could drive plus do
many other things if I want to” he replied with an emphasized on the word
‘great’ and increase tone throughout. Well, that is a classic description of
person in manic episode if you ask me. He have some classic symptoms such as
elated mood, decrease need for sleep, increase energy, flight of ideas and
pressured speech.
However, not all about psychiatry is a good thing. When
studying about personality disorder, I became more judgemental and started to categorized people based on
their behaviour. But after a few days, I realized that what I did was wrong, and
I just stop doing so after that. But that few days of being judgemental have helped
me understand about personality disorder more than any amount of reading could.
A golden sky at the end of a storm I suppose.
In the end, as I reflect on my experience in this clerkship,
I finally realized that the event in the female ward was just an anomaly, never
a usual thing to happen. Experience obtained during this clerkship is never a
nightmare and my overall impression on psychiatry has improved a lot to the
extent that I might consider doing this again in the future.
