The Daily Schedule Of A Psychiatrist

Psychiatry involves the diagnosis, prevention and treatment of mental health conditions such as mood disorders, psychotic conditions and anxiety related illnesses. Psychiatry shouldn't be confused with psychology as the former is a medical doctor who specialises further, and the latter completes an undergraduate degree in psychology and can then decide to do a honours and masters degree thereafter. Psychiatrists prescribe medication to patient whereas psychologists manage them with psychotherapy.

As an important concept to remember, psychiatric illnesses are just like any other illnesses, such as infections, for example. Mental health conditions are not just issues that need a "strong personality" to keep them under control and do not affect "weak-willed" individuals, they are conditions that need to be treated and the best way to do this is with a combination of medication and psychotherapy.

Training

A doctor wanting to specialise in psychiatry must first obtain their undergraduate medical degree in order to become a qualified doctor. This is then followed by a mandatory 1-2 year internship phase where the doctor is exposed to the different medical and surgical disciplines. When a doctor has applied for a position in psychiatry and their application has been successful, they will then join the psychiatric residency programme which takes 4-5 years to complete.

Psychiatry has numerous sub-specialties available for a specialist to train further in. This requires participation in a fellowship training programme that can take 1-2 years to complete. These sub-specialties include the following:

• Emergency psychiatry.
• Psychosomatic medicine.
• Clinical neuropsychiatry - branch of medicine dealing with mental disorders caused by diseases of the nervous system.
• Child and adolescent psychiatry.
• Geriatric psychiatry.
• Hospice and palliative medicine.
• Pain management.
• Sleep medicine.
• Forensic psychiatry - the psychiatrist is involved in seeing patients to determine whether they can be held accountable for committing a crime or not.
• Addiction psychiatry - this discipline focuses on the evaluation and treatment of patients with alcohol, drug or other substance-related disorders, and of patients who are diagnosed with both psychiatric and substance-related disorders.

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The Clinical Application in Psychiatry

The diagnosis of psychiatric conditions are performed by incorporating the following important aspects:

• Appropriate history taking, including family history and history of medication use. It's also important that psychosocial, pathological and psychopathological histories be obtained.
• Performing a mental status examination to list differential diagnoses.
• Determining a diagnosis by looking at criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 
• A physical examination is done to exclude any obvious illnesses or conditions that can cause mental health disorder signs and symptoms.
• Further investigations such as blood tests (full blood count, kidney functions, thyroid functions, HIV, etc.) and neuroimaging procedures (CT scans, PET scans and MRI) are done to exclude other physical conditions. 
• Performing personality and cognitive tests. These are important as they help to exclude issues such as personality disorders and dementia, respectively.
• Some psychiatrists are starting to use genetic testing during the diagnostic process, but at this time this subject remains a research topic.

The Daily Schedule Of A Psychiatrist

Psychiatrists consult with their hospital patients once a day. These patients can include those who are voluntarily admitted at psychiatric hospitals (major depression, generalized anxiety disorder), patients who are involuntarily admitted or sectioned by law (acute psychosis) and patients admitted long-term for chronic psychiatric conditions (catatonic schizophrenia).

Psychiatrists in private practice work in their own offices where they see their out-patients. The will travel to the hospital where they provide services for to consult with in-patients that have been admitted for them. 

Psychiatrists have to provide on call services after hours and on weekends for the acute and psychiatric hospitals. Primary healthcare workers may discuss patients with the specialists as they may need an opinion or may want to refer the patient for admission. Casualty doctors working at emergency centres may contact psychiatrists if they are faced with an aggressive patient showing signs or a psychiatric condition. These patients are usually administered with a sedative drug and further investigations are performed on them to exclude non-psychiatric causes for their behaviour if the psychiatric cause isn't obvious.

Monday

The week usually starts by the psychiatrist consulting with patients who are admitted the previous day at the psychiatric hospital they work at. These are patients who have been discussed with the psychiatrist by primary healthcare workers. These patients are usually those whose psychiatric condition has caused issues such as having suicidal thoughts or attempting suicide, no motivation to work, becoming hostile or withdrawn from friends and family, experiencing odd sensations and performing socially unacceptable behaviours.

In the afternoon, the psychiatrist will consult with patients at their offices who have made appointments or where referred by other physicians. These patients suffer from possible psychiatric issues such as major depression, obsessive-compulsive disorders, generalized anxiety disorders, bipolar mood disorder and panic attacks.

The psychiatrist can manage these patients conservatively, by prescribing medication and referring them to a psychologist for psychotherapy, or they may be admitted to a psychiatric hospital so that they can be managed further. At a psychiatric hospital, patients can be managed in a safe environment where the psychiatrist will consult with them, they will be seen by a psychologist and they can also be referred to allied healthcare professionals such as physiotherapists, occupational therapists and dieticians for their services. This approach encompasses the idea of treating a patient holistically.

Tuesday and Wednesday

The psychiatrist will continue to see their hospital patients in the morning and their out-patients at their office in the afternoon. One of these days will also be used to perform non-clinical administrative tasks such as having meetings with hospital staff and management as well as medical representatives.

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Thursday

Hospital patients will be seen in the morning. The afternoon will be used for either teaching undergraduate students and postgraduate clinical assistants, or the specialist will be filling out chronic prescriptions, performing further research for their own educational needs or filling out motivation letters and forms for medical insurance companies .

Friday

Once the hospital patients have been seen, the specialist will finalise the day by sorting out any unfinished administrative tasks.

The doctor that is on call for the weekend will be in charge of the medical care of their own patients and the patients who were discussed with them by their colleagues.