I do not drink coffee and I never have so I frequently rejected offers for a cup of coffee as a medical student. More experienced colleagues often said “… aha, you’ll surely start drinking coffee when you begin working at the psychiatric ward”. So, I expected that the path in psychiatry would be long and winding and that coffee could become my principal mean of staying awake and surviving.
Starting in psychiatry after the 4th year was quite a challenge. After having mainly used blood samples, X-rays and algorithms, I soon realized that these things would usually not prevail when diagnosing and treating psychiatric patients. It was inspiring watching different specialists using diverse approaches, where every single patient had to be approached on the grounds of their own mental status. Every interview was like a puzzle that needed to be solved, no stone would be left unturned in order to find a diagnosis and to determine the best method of treatment. Additionally, the morale, good teamwork, humour and mutual respect between different professions within the ward made my experience very memorable.
After graduation, I wanted to obtain more experience in internal medicine and I worked at such wards for one year. This experience has served me well, as I feel it is important to approach the patient holistically when it comes to treating mental illness. Every case is unique, but their common denominator is how a good treatment combination can be a lifesaver for the patient. Usually psychiatric disorders are detected at an early age, hence it is a positive challenge to have the opportunity to improve the life of the relevant person and thus make treatment in the coming decades easier. Upon admittance into the ward, the patient is often physically healthy whereas mental illness may leave him unable to take care of his basic needs. The mental suffering can be so painful at times that if such suffering were physical the patient would have to be admitted into the ICU.
Working in psychiatry is far from being a walk in the park. It is easy to feel helpless, in the face of the long waiting lists or when a patient has tried all possible treatment options without recovery. It is also demanding when a patient lacks insight and denies necessary treatment, and therefore has to stay against their will at the hospital. To deal with these factors I look at it as a long-term project to develop the resilience and patience it takes to become a good psychiatrist. To start with, my main tools are respect and curiosity towards the patient.
The training programme in Iceland is well established and produces very competent psychiatrists. The lecture days are well organized and it is ensured that we get time off from work for them. Every resident meets their mentor weekly to discuss what is on their mind at any given time, be it complex cases or more personal issues. There is an abundance of learning opportunities and I have experienced a good attitude and support from the psychiatrists. Also, it must not be forgotten how inspiring it is to have the support and friendship of my fellow residents.
To summarize, I have still not started to drink coffee. □