Volume 11 Issues 10 October, 2021
Young Psychiatrists, all is not written in Kaplan, Maudsley and NICE, but your seniors know a lot of field experience.
Finishing my post-graduation in 2007 and started my career as an assistant professor in psychiatry at Kurnool Medical College. Initially, my mind was filled with the evidence-based treatment from NICE (National Institute for Health & Care Excellence) expressed arrogancy and funny remarks on treatments my seniors gave. For which I often feel guilty and meet them in seminars to apologise. I learned that real-time treatment differs from guidelines constantly needing tweaking or devising a new strategy. Of course, I want to admit that no books can be written on the actual clinical experience, and they can be learned from professors & colleagues through humble discussion. Everyone in your practice day life, from nursing orderly, patient attendant, patient, and seniors, are all your teachers.
One of my experiences was with a Husband who came to me to ask for advice on divorcing his wife. He was vexed up with his wife not responding to treatments. I asked them to come to me with all the detailed reports. The wife and her parents and husband and their parents came to Outpatients. The wife parents started blaming her husband and his parents for her wife illness, and the husband parents complained they were cheated by hiding illness. The room was filled with anger, despair and mistrust. Listening to wife and husband, it was difficult for me to understand who had the illness. After 2 hours of listening, only one point helped me, “my husband infected me with diseases and all her physical symptoms because of his sexual talk on the phone.” I was convinced it was a delusional perception, and reviewing treatment history, she was treated on multiple antipsychotics for a more extended period with good compliance. The only antipsychotic I did not find was clozapine. So I started clozapine with tremors in my hand; what if neutropenia occurs, what cardiac problems and how shall I convince to travel 200 km for a blood test. I ringed my senior what to do about weekly blood tests,” hey doc, ask them to get it done in the local lab, the ring you and report blood test report”. At the end of 6 months of treatment, all was well, and they withdrew the petition of divorce. For my success, in this case, was I made schizophrenia a disease equal to other conditions like hypertension and diabetes mellitus, where treatment is drugs and not divorce.
Success in Psychiatry is improving your listening skills. A rat race to see 50 patients or more per day will be of more harm to patients. Psychiatry is all about listening and empathy. Clozapine is too feared drug due to side effects, careful monitoring of side-effects would save lives and families.
