A guide to medical etiquette: psychiatry

Psychiatrists are not like other doctors. You can tell this straight away when they talk about postmodernism. If an orthopaedic surgeon even said postmodernism, none of their colleagues would trust them again. You as a medical student have to learn to cope with this altogether different world within a short time. Here are some guidelines to help you adjust.

1 Avoid guidelines. Psychiatrists don't like guidelines (too modernist). Whenever you use a guideline, make the following disclaimer: "Of course, at the heart of guidelines there is a conflict between the idealised circumstance embodied in the list and real world complexity." As you are saying this stroke your fledgling beard and clench your fists emphatically when you say "heart."

2 Attire. White coats are out. They might even prompt ridicule: "Why have you brought that instrument of oppression with you?" A nice woolly jumper or some tie-dyed clothes, rings on your fingers and bells on your toes are even better. Try growing a beard (whatever your gender).

3 Taking blood. If there is a lithium level that needs doing, the task of taking blood may well fall to you. Many psychiatrists proudly declare that they haven't been near a needle for years. Therefore, make sure your venepuncture is of a high standard before beginning.

4 The problem of believing one has the disease one is studying occurs throughout medicine. Medical student hypochondriasis is worst in psychiatry. What you previously saw as amusing idiosyncrasies in yourself and others become full blown neuroses or obsessions under the DSMIV classification. Stay calm; it will soon be over.

5 Do not call the individuals in psychiatric care mad or insane. It is not difficult to empathise with them if you consider how you would react if you believed everyone on the bus wanted to kill you.

6 Many psychiatrists have idiosyncrasies, perhaps through long study of mental illness. Allowances have to be made. Don't bring up their peculiarity or they'll pick up on yours. Be careful of applying this advice in other rotations. When physicians, ask what an endoscopy means, they don't want to hear you ruminating about the loss of the secret inner sanctum of the body's insides.

David McAllister, intercalated medical student Glasgow University
Email: 960715m@student.gla.ac.uk


studentBMJ 2000;08:259-302 August ISSN 0966-6494