Tips when starting Psychiatry

During clerkship or residency individuals new to psychiatry find it hard to accommodate. According to BeWell Medical Clinic, Psychiatry rotation is still not compelled for GP’s and emergency medicine while these are probably the first to encounter psychiatric patients in different forms of distress. For those starting a rotation of psychiatry being it clerkship or otherwise here are a few tips to get you started.

  • Treat the patients with dignity and respect at all times. You will never regret it.
  • Try not to be afraid of psychiatry or psychiatric patients, you cannot catch madness.
  • Mental health stigma and prejudice is real and widespread. Make sure you are not part of the problem.
  • Make sure you laugh. Psychiatry is emotionally demanding and without this release you will really struggle.
  • The psychiatric multidisciplinary team is less hierarchical than a standard medical team — respect this. Recognising the skills and knowledge of the multidisciplinary team will enhance your ability to care for your patients.
  • Become fluent in the performance and recording of the mental state examination, you’ll be doing a lot of it! Take a crib sheet with the headings on for the first few oncalls and clinics till it becomes second nature (as it will).
  • Direct confrontation and shouting at agitated patients rarely calms the situation or leads to a favourable result. Always try to de-escalate tense situations.
  • Always do a risk assessment. Always ask about suicidal ideation, thoughts of self-harm and thoughts of harm towards others. Other domains of risk include vulnerability from others, selfneglect and psychosis. Remember that not all risks are predictable.
  • Listen to the nurses! They spend much much longer with the patients than you do and have a wealth of knowledge and experience that they are usually happy to share.

Moreover, psychiatry is the place to learn about professionalism since psychiatrists are used to look critically at themselves and their team, teamwork since psychiatrists are used to work with other disciplines.

These tips are derived from an excellent publication on this subject with many more tips. The selection is based on the importance of the tips learned from 27 years of working in psychiatry.
Burkes, M., Hanna, L., & Woollard, J. (2011). Tips for GP trainees working in psychiatry British Journal of General Practice, 61 (583), 148-149 DOI: 10.3399/bjgp11X556407