How it actually began?

To all of my dear colleagues, especially those who are fond of Psychiatry, now I will write about my beginnings in Psychiatry.

I think that many of you watched the movie “One flies above the Cuckoo’s nest” even before attempting to study medicine. This movie would partially encompass at what kind of ward I was assigned to work as a total beginner in Psychiatry. But it was really worth it! The experiences that I gathered in less than a year period are priceless and were a good offset for upcoming opportunities. My tasks included working at the psychosis department for men and women and occasionally I worked at Social Psychiatry as a replacement for my colleagues who used to work there. Both of the wards for Psychosis were separated and both of them had secured part constructed for acute patients and open part for subacute patients.

As a GP I actually had a very modest amount of knowledge from Psychiatry and zero experience. So, this challenge was Psychiatry from a scratch. Most of my colleagues begin their training at the department for affective disorders or Psychosomatics until they gain the required experience to work with less supervision at the other departments that are a bit more demanding like acute psychiatry. My hopes were that I start my specialisation in this way….but as Murphy’s Law it turned out into something completely different! Ta-da! I got to work at a ward where are people with psychosis hospitalised…So….well. I thought in myself- who survives, survives! This was heavy multitasking because I was already considering learning German in terms of Psychiatry, attempting to understand dialectal German in Thüringen, learning a new working system…a killer machine! Keep in mind that in this type of ward most of the patients are acute and they are quite needy and one must be ready when a patient is in an acute phase of psychosis. For many of those who have never worked in this kind of psychiatry, I would like to make some things clear in order to avoid confusion and disinformation. Now let’s make a realistic list:

• Do not underestimate the importance of Aufnahmegespräch (Interview) with Patient, 80% of successful treatment lies in this, and please be very detailed in writing down about any changes that appeared in thinking, memorising, verbal expressing, the situation in the family, at work, socialisation, cultural beliefs, drug/alcohol intake, medicaments.
• For many of you who didn’t have the chance during studies or who never had the concrete working experience to administer i.v., I recommend that you ask your family doctor to gain some practice. It is never embarrassing to ask! 😉
• Choose a nice language for patients who find themselves in this kind of state.
• Be courteous and patient towards the patient’s parents or guardians.
• Careful about giving information via telephone, they are only given in person.
• Be realistic in giving a prognosis to parents or guardians, we would like to avoid empty promises that would often lead towards disappointments.
• Be persistent in getting more info from your mentor information about filling in certain documentation for patient’s admission and discharge. Juristic definitions in Psychiatry, as well as Social work definitions, tend to be complicated to us who are not in this field and it would be recommendable that these things are made clear from the beginning of specialisation. Be curious in asking: WHY, WHEN, IN WHICH CASE, ARE THE GUARDIANS FOR/AGAINST, PATIENT’S WORD.
• The previous element is one of the most complex as it is multidisciplinary, good teamwork has to exist in order to make these things clear.
• Prescribing certain medicine will be based on: – Bedarfsmedikation (sleeping pills, BZN) or if there are existing somatic issues or laboratory (vitamins, hormones, anemia, glucose, transaminases). Other medications are prescribed by Oberarzt or Chefarzt. Be sure to write into the documentation the name, dose and frequency of intake of certain medication.
• For the first approx 2 months the psychopathological report will be done by more experienced colleagues, so your duty will be somatic and neurological status at the point of patient’s admission.
• Don’t worry, I will send you the scheme how to write this, just send me an e-mail.

You have more questions? Would you like that write about more topics? Feel free to e-mail me via helenaopera@gmail.com

Good luck with everything!

Dr.Diva

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