A placement in psychiatry can help trainees in all specialties

A trainee doctor recently published an article in the British Medical Journal, documenting her experience during a placement in liaison psychiatry at St Mary’s Hospital, praising the service and highlighting why a placement in psychiatry can help junior doctors in all specialties.

Emily Duncan said:

I recently completed a four month placement in liaison psychiatry at St Mary’s Hospital, a major trauma centre, run by Central and North West London NHS Foundation Trust.

One of the striking aspects of a post in liaison psychiatry is the variety of problems with which doctors are faced. There is a considerable demand for psychiatric assessments for people admitted after deliberate self-harm, including jumping from heights and self-mutilation. St Mary’s also see people with the psychological consequences of traumatic injuries.

The liaison psychiatry team will often be faced with the first presentation of someone’s mental health problems, so as a junior doctor in liaison psychiatry I have been concerned with the initial assessment, diagnosis, and management of what may turn out to be a severe and enduring mental illness. That was not what I had expected. As a medical and surgical house officer my only contact with the liaison psychiatry team had been to ask for help with patients who were either tearful or presenting with challenging behaviour. It turns out that there is much more to psychiatry.

During my placement I spent my time reviewing patients on the medical and surgical wards, as well as in the emergency department. Instead of traditional ward rounds, we had twice daily meetings where all the patients were presented and discussed by the team. Most of my day was spent assessing patients, either independently or with supervision. The regular meetings provided an invaluable cushion for a trainee: I assessed a patient in the morning and formulated a diagnosis and plan, which were discussed in the afternoon before implementation. This structure meant that I worked independently but was also fully supported by the team at St Mary’s.

Working in liaison psychiatry can be emotionally taxing, but the knowledge I have gained from this placement will certainly inform my clinical work. Moreover, the non-technical skills I have developed in complex decision making, communication, and teamwork will be transferrable to other posts. This experience has made me much more likely to pursue psychiatry as a career, but even if I follow another path I am confident that it has made me a better doctor.
I thank Steven Reid, consultant psychiatrist at St Mary’s Hospital, for his invaluable help and advice in writing this article.

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