I have now started my psychiatric observational placement and I have been fortunate to secure a place at an NHS Mental Health Trust where medical students are also on placement. I have been sitting in on clinic sessions at a university hospital with consultant psychiatrists covering new assessments, outpatient follow up appointments as well as team meetings discussing the management of care. In general, the 1-1 session between psychiatrist and patient is essentially a business like arrangement where discussion centres on how to provide a treatment plan in consultation with the patient. The session is time restricted, usually 15 minutes, and invariably involves the psychiatrist typing on a keyboard in front of the patient throughout the course of the session. This, of course, is all very different to the psychotherapy session when the length of the interaction is usually for 50 minutes and the writing up of the notes takes place after the client has left the room. The issue of electronic note-taking within the NHS setting is a consistent theme for debate amongst psychotherapists. This newsletter from the Royal College of Psychiatrists discusses some of the issues involved.
The psychiatric 1-1 session is also concerned with the management of prescribed medication as patients present with personality disorders and mental illnesses. Spotting the symptoms of these illnesses will be a critical part of the placement for me.