Friday, February 13, 2009

Learning to Listen

I've spent the last three weeks at Toowong Private Hospital (TPH) where I've been introduced to the wonderful world of private health care and mental health. It's a small, 54-bed facility devoted entirely to dealing with mental health issues. Most students at my clinical school are based out of the Mental Health Centre at the Royal Brisbane hospital and I would count myself fortunate to be able to experience acute mental health care in a private hospital setting.

Pros of being at TPH:

It's listed first because it's the most important. As a student, free food is a big deal - scones/muffins/fruit/etc for morning tea and a choice of cafeteria-style lunch (usually some sort of chicken/steak/pork/lamb with rice/potatoes and veggies). It's definitely not gourmet but it's free and edible. So far, I don't think any other hospital offers free food to this extent for the students. My consultant also has a nice espresso machine and he made us all flat whites following ward rounds this past week.

2. Close to home.
It takes me less than 10 minutes to get to and from the hospital. Out of all the options for hospitals placements this is by far the most convenient to reach for me.

3. Free Parking.
Parking is always an issue and I'm cheap so I'll usually park pretty far away from RBH that requires a 5-10 minute walk. At TPH, I can park on the street right outside the hospital all day for free.

4. Registrars and consultants keen on teaching.
I figure I should throw in some medically-positive reasons for being at TPH. I have been satisfied with the teaching offered to us by the staff. They're available for questions, easy-going, and even take time during rounds to specifically teach us.

Cons of TPH:

1. More contact hours
You'd think this would be a good thing but when you're spending your free time studying for an 8 hour exam covering everything you've learned in the last two years of medicine (or in my case, should have learned), the last thing you'd want is more hospital contact hours. People told me that mental health is pretty slack and that some registrars only want to see their students once a week. My registrar, on the other hand, seems pretty intent on us being there all the time unless we have workshops or lectures to attend. Great for learning mental health but brutal for USMLE studying!

That's actually the only bad thing I can think of. Being at Toowong has been great.

Probably the biggest thing I've been taking home each day is how to be a good listener. On one hand I'm sitting there thinking about specific questions I need to ask based on what they tell me. They just mentioned thinking about killing themselves...okay, gotta make sure I assess their suicide risk, means, plans, intent, etc. Or they just mentioned that they've been drinking a bit more in the last few months...okay, gotta ask them about their alcohol consumption, and then probably double that amount because people tend to lie about how much they drink. It's hard not to turn into a robot that takes down info and spits out questions based on what keywords pop up. I mean, if that's all I'm doing then why don't we just have robot counseling?

On the other hand, being a good listener means showing that you care and taking interest in what they're saying. I have a long way to go in learning how to appropriate respond to what people say or do in front of me. What do you do when a grown man breaks down in tears in front of you? Probably involves some varied combination of: handing him a tissue, offering words of comfort, being annoyed, crying myself, feeling awkward, being silent, being awkwardly silent, asking them to tell me more about it, regretting it after 10 minutes of hearing more + more tears, awkwardly changing the subject after a while for time's sake. I'd like to think I genuinely care about the people I meet. I still get angry when staff so openly disrespect and slander patients behind their backs. I guess humorous trivializations of people's lives and struggles at their expense is one way of dealing with it.

When I think about the gravity of what they're disclosing to me - being sexually abused by their father and uncle at the age of 7, being so badly beaten by their drunken father that they couldn't go to school the next day, or being raped by multiple men and having nobody believe your story (not even your family) because a of a history of psychosis - I feel overwhelmed with emotions. Sometimes I want to charge in on my white horse and save them from their awful situations. That could involve being a friend to someone who has nobody for social support. Or maybe it could involve hunting down and castrating a serial child rapist, locking them up, throwing away the key and leaving them there to rot (I'd be super tempted to physically pummel a person like that within an inch of their life prior to cutting off their balls). Sometimes I feel depressed myself. I can't believe that I complained about my parents growing up. I know comparisons are bad but you just can't help it sometimes - we all do it subconsciously to some degree. Sometimes I feel frustrated and angry with them because I find out afterwards that they lied to me about a ton of things. I'm learning to develop my internal lie detector. Gregory House is right - everybody lies.

What's interesting is that mental health is the only area where we ask patients about religion. 99% of the time it's of no relevance to their management but here it is vital when exploring things like religious delusions or coping strategies. I usually word it like, "Do you consider yourself spiritual?" and then ask them to elaborate if they say "yes". I know it would be inappropriate for me to turn the interview into a prosthelytizing session and I know that for most, religion is felt to be a private matter, not to be imposed on others. I've been thinking a lot about this issue and how I should live and act in the workplace. I sort of feel that I am prepared to give a truthful, honest answer when asked...but should I say anything if not asked specifically? I know I can definitely pray for them...

Week 4 begins tomorrow with observing some electroconvulsive therapy (ECT) sessions first thing in the morning and then in the evening, helping out in the psychiatric emergency centre (PEC) at the Royal Brisbane Hospital. Yay.

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Blogger billy said...

wow, nice. definitely a dilemma there.

btw, do canadians not know what a flat white is? is it an aussie thing?

2:29 AM  

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