As someone who spends her life wrapped up in hospital dramas I was incredibly excited to write up this ‘24 Hours In The Life Of‘ piece, as this month we’re talking to Emily* about what it’s really like to work as a doctor – and specifically as a psychiatrist.
Emily* is 30 and has been a doctor for seven years, although only started in her current role last month. She completed five years at medical school, two years foundation training and a further three years core training where you work full-time, do on-call shifts and have to pass membership exams to the Royal College of Psychiatrists (which, just FYI, cost £2,000 – more if you have to resit).
She currently works 9-5 Monday to Friday, and does one 24-hour on-call shift a week, as well as a full weekend shift every other month.
This is what a day in the life of Emily* looks like…
7am: “I’m definitely a morning person and like having a bit of time to start the day, rather than rushing out the door. I don’t tend to eat breakfast (I know…), but I always start my day with a cup of tea, then make another one for the drive into work.”
9am: “Since Covid we have morning meetings every day at 9am (I work in a community mental health team) via Microsoft Teams to check in on any issues, any clients of concern or things that need doing that day. It’s been hard starting a job in the middle of a pandemic but these meetings have been helpful to try and get to know how everything works and who I’m working with. I’m generally based in an office but will leave to see patients on the inpatient wards, to do assessments in A&E or to head to the Section 136 suite (this is where people are brought by the police under a Section 136 of the Mental Health Act when there is a concern about their mental health).”
10am: “My first appointment of the day is a 42-year-old woman with bipolar disorder who had been started on a new medication a few months ago. Since starting it, she had noticed an improvement in her mood and we agreed to increase her medication slightly to make sure that she was receiving a therapeutic dose, and that her mood is as stable as possible.”
11am: “Next up is a new assessment of a 51-year-old man with low mood and suicidal thoughts. He has a background of recurrent episodes of depression throughout his life, but over the past few weeks his illness has returned as a result of struggling to cope with the effects of long Covid. Thankfully he is no longer feeling suicidal, but his low mood remains. I start him on an antidepressant medication and refer him for talking therapy. I also give him the details of some organisations that can help in a crisis.”
“I think that we are only beginning to see the effects of the pandemic in mental health services. The past year has been really damaging for many people’s mental health and has worsened symptoms for those already unwell. It is also likely that we are going to see the consequences of those suffering with long Covid; evidence suggests that psychiatric disorders are common in people diagnosed with Covid and, at this point, we don’t fully understand the long term effects.”
1pm: “I spend the afternoon writing up the assessments – we have to document on an electronic system and then write a letter to the GP. I will often have to email GPs as well if something needs doing sooner.”
3pm: “I have to go and see one of our patients who is admitted on the ward. She has a diagnosis of schizophrenia and is currently very unwell. Unfortunately she was admitted into hospital after stopping her medication, which can happen quite frequently as people think that they don’t need it anymore when they get better. She has been quite agitated on the ward so I have a discussion with the nurses about how we can best support her. Often when people with psychosis are unwell they experience delusions which can be very frightening and this can cause them to act out. We always try and be as least restrictive as possible, but sometimes we need to use sedative medication or occasionally restraint when they are at risk of hurting themselves or other people. It can be distressing, but it is always done as a last resort and in as safe a way as possible.”
“It can be extremely emotionally draining and, working in mental health, you definitely experience vicarious trauma. I often have to make high risk decisions and you are often left wondering if you’ve done the right thing.”
“I also find it extremely difficult working in such a stretched, understaffed, under-resourced system, and I hate having to explain to people that there will be a wait to be seen or start therapy. You often see people get worse while they’re waiting for treatment that could have helped them if we’d be able to see them earlier.”
5pm: “In the evening I go to A&E to do a Mental Health Act assessment for a 20-year-old woman with personality disorder who has taken an overdose. This is a complex diagnosis that is often not well understood. There is a misconception that it is not treatable and, although that’s not true, it is difficult to treat and usually needs long term psychotherapy. As is true for all mental illnesses, the cause of personality disorders is not just one factor, but there is commonly a history of traumatic experiences, particularly in childhood. It can be heartbreaking to hear of the abuse and horrific experiences that some of my patients have gone through.”
“We have evidence that admitting people with a personality disorder into hospital is usually not the right thing to do, as it can paradoxically increase the risk of self harm behaviours and can lead to unhelpful coping mechanisms. It is felt that admission in this case is not indicated and we come up with a plan which involves support from the home treatment team, and follow up by her usual community team.”
6pm: “I sometimes I finish a bit late but rarely more than 30 minutes and I am home usually by 6pm. At the moment I’m being sent to different areas of the country for placement. I’m currently two hours from home so staying somewhere temporarily. I tend to try and relax in the evenings by reading or watching TV. I’m looking forward to exploring the local area more now that lockdown restrictions are easing and the evenings are getting lighter. I’ve become pretty lazy so I tend to make myself a ready meal for dinner.”
“I try and drive back home once a week. I try to make the most of it by spending time with my husband – we enjoy mountain biking together.”
10pm: “I’ve been trying to read more so try to have a bit of time before bed to get a couple of chapters done. My bedtime is around 11pm.”