Being a psychiatrist – any regrets?

Becoming a psychiatrist was very important to me as a young doctor. As a patient, who had been in and out of a psychiatric hospital, it felt like a lost dream, something I could never hope to achieve. It is true that I had wanted to train as a psychiatrist before I became ill, but I can’t really say why, looking back. I’m not even sure that it was based on sound reasoning, as my only experience had been two brief and unsatisfactory attachments as a medical student.

If I am honest, I wonder sometimes whether I wanted so much to be a psychiatrist because this path seemed closed to me, and people said I couldn’t. This wouldn’t be entirely out of character. Some people suggested that I wanted to do it to understand my own problems, and, while acknowledging that it’s not an unreasonable question, I don’t think this was the case. I had always found psychiatry interesting – I still do – but it was only when it became harder for me to do it that I determined I would. There were other reasons, but I must admit my own obstinacy.

Training was extremely difficult. At each stage – each exam, each post – I thought I might not get any further, and I worked terribly hard, and definitely have some regrets about this. I remember long miserable commutes, on-call, studying, and barely seeing my little girls. My appearances in the playground at pick-up time were rare, and you never get that back. I was lucky to later go less than full time, and this made a big difference. As a consultant, I stopped doing on-call after three years, following yet another episode of illness, and this was transformative. Looking back, it had been very bad for my health, but I never thought it possible to stop it earlier, and no-one suggested it.

I have always believed that I was lucky to work with psychiatrists, and wondered whether they were more sympathetic and understanding about my mental illness, as you might hope. But maybe it has just been luck, and I know that there are psychiatrists who are less thoughtful of their colleagues. Unusually, I also work with anaesthetists (pain clinic), and they are just as supportive. Perhaps some specialties would be different, but I’m not sure personality always maps well to career choice.

From the perspective of what I’ve achieved in my career, I’m happy, I would even say proud. But I regret that I’ve never had good separation between work and life, and, if I’m honest, work has always spilled over. Maybe I enjoy it? But sometimes I think it’s more a fear of not doing it properly, or even of losing it. Something that cost me so much toil could not be worn casually.

But the real question is – do I regret being a psychiatrist? It’s so much part of who I am that it’s hard to step back and ask the question. I like my job, on a day to day basis; it’s almost all clinical (management nearly finished me) and I like my colleagues, trainees and patients. But, if I’m honest, the tragedy of the patients’ lives does get to me, and it can become hard to cope with this. Of course it’s far harder for them, but it’s difficult sometimes to hear their terrible stories, and only be able to help in a limited way. It intrudes on my own life; and maybe it is good to be reminded of all the deprivation and sorrow that exists, but I still find it hard.

What does a psychiatrist do? In some ways, I think I’ve managed to avoid many of the aspects that I’m uncomfortable with by working in addictions. I rarely use the Mental Health Act, and although I fully acknowledge that it is needed, I don’t want to be that person. I do prescribe psychotropic medication, but much less so than a general psychiatrist, and again, I prefer this. Much of my out-patient work, in the pain clinic, is about rationalising medication or even deprescribing. I am always careful to follow guidelines, and consult with peers, as I don’t want my own personal experiences to dominate, but they do make me question.

Ultimately, I have no regrets about not being a general psychiatrist, but I sometimes wonder if that’s a bit of a cop-out. I am a general psychiatry patient, after all. But perhaps that is the reason – I have always been ambivalent about my own diagnosis and treatment, and I couldn’t afford to let that affect the patients I treat. As a patient, I can admit that I am often dubious about diagnoses, even more so about treatment. I hear the experiences that others have, the impossibility of accessing good treatment, feeling abandoned at times of crisis, and it makes me feel deeply troubled.

I know that there are insufficient doctors and nurses in psychiatry, but this doesn’t make any difference to those who are turned away, because their problems aren’t bad enough. I know our medications can only do so much, and can have debilitating side effects, but I think many understand this if it’s explained. What we need are people to listen and care for us, and to provide succour at difficult times. What we don’t need are answer machines, and redirections and incomprehensible messages, especially at times when lifting a phone requires courage.

Being a psychiatrist requires honesty, about what we can, and cannot, do. It requires humility, and it requires perseverance. We don’t have quick and easy interventions to offer, but what we can do, we must do well. Ultimately I have no regrets about being a psychiatrist. I’m just not sure that I’d do it again.