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I suspect that I'm having a depressive relapse after a month or two of genuine euthymia. No surprise that coincides with a return to work and exam grind. My workload is probably 3-10 times what it was on my first rotation. I used to get bored during my shifts. Now I barely have a moment to park my ass, and the other doctors and I have to draw straws to decide who gets to have lunch first. I used to have the time to (at least in theory) revise my notes during working hours or browse the internet. Right now my phone is helpfully noting that I've reduced my screen time by a remarkable margin.
Is this going to get better? Hah. Haha. Hahahaha. This is going to be my life for the next 5 months, no relief from the pain. I am under-medicated for my ADHD. I have worsening migraines. I leave work wanting nothing more than to crawl into bed and stay there.
What clinched the self-diagnosis was sighing. Literal, audible sighing. The last time I was properly depressed, a junior colleague clocked this tell before I did, which surprised me, since I thought I was hiding things well. The literature, predictably, confirms a correlation. (The body keeps the score and occasionally narrates it out loud.) I caught myself doing it yesterday. Then an intern asked me why I was sighing.
@ToaKraka was kind enough to link to the PHQ-9 screening questionnaire lower in the thread. One glance at it made me wince, I didn't have to add up the numbers to know it didn't look good for me.
The good news is that Paper B pressure lifts next week, possibly forever if I pass. I have never failed an exam in my life. That fact is a load-bearing pillar of my self-esteem, and I am aware of how that sentence sounds coming from a psychiatry resident. I'm willing to risk the burnout. The exam has to be cleared eventually, deferring wouldn't buy me study time anyway, and a pass earns me twelve to eighteen months of academic reprieve. The workload stays the same. This is the only consideration keeping me from filing the current monomaniacal focus under "obviously irrational."
Apparently, around 20% of psychiatry residents experience burnout or depression. Lovely. Glad to have good company. I know the pharmacological management of depression like the back of my hand.
Before anyone panics, I'm going to talk to my GP, and warn her that I might need to see a psychiatrist. The last time I did this was slightly awkward, given that I knew precisely what she would suggest before she said it, and she was kind enough to treat me like a fellow professional and go off my self-assessment. I know precisely what to do if it gets too bad to bear.
Let's hope it's just exam stress. Being fully honest, that's not likely to be the case. But it'll help, on the margin. But tripling my stimulant dose?* Proper migraine prophylaxis? More optimism on that front. And I know the NICE referral pathways well enough to demand that I get something more immediate and robust than another course of Standard Antidepressant.
*What a fucking joke. The ADHD assessment and treatment pathway is designed to weed out 90% of people with ADHD before they see an actual psychiatrist. At least if you don't spend a third of a month's wages on a private assessment and consultation. I fell off that wagon because of... depression and ADHD. Getting back on it will be either time consuming or expensive, and I'll take the latter any day of the week.
Oh well. At least I'm not a gynecologist. Gotta look at the bright side of things.
Rotations get better. By the end you'll look back at your level of knowledge and efficiency and be horrified. Remember this part.
Also - I think you said you are on consults, consults in any specialty are highly variable. Some seasons, weeks, months are harder than others. Sometimes jack shit will happen because the hospital is stuffed and another specialty is suffering. The tide goes in an and out, but it does GO.
When I was in residency I had a senior who made the claim that people are fast or slow, and that that never changes. I've learned that's true, but only for some personalities. You do not have that personality.
You can get faster and more efficient if you want to. So want to. And figure out how to do that.
Thank you. But I don't think this rotation is likely to get much better, and I say this while fully acknowledging the possibility that depression and fatigue is coloring my judgement.
You have to understand that I'm surrounded by other, competent doctors. Some of them scarily so. They don't get the breaks very often either, barring the "mandatory" lunch break half of them eat at their desk.
I hope I get faster and more efficient. I'm touched by your faith in me. The workload still seems daunting. Oh well, it's 5 months. I've done a full year of about-as-bad, and that only made me so depressed I seriously contemplated quitting medicine. Right now, I'm older, wiser, and better acquainted with antidepressant guidelines. Getting better medicated is my best bet for making this bearable. I am pursuing it like my career depends on it, which it may well do.
It's impossible to have a good version of this talk in this setting, but I will try - usually (but not always, I'm not there, I don't know what you are struggling with) the problem for early phase trainees is excess cognitive load associated with stuff that should be "free." Writing notes shouldn't usually require thinking, it should only require time. Basic interviews will be effortless. Physical exam (oh wait psych lol)...
Later the difficulty will be true medical decision making in complicated cases, advanced level exam and interview, and leadership and administrative tasks. These have higher ceilings.
For now you are probably finding it painful to do basic things. I mean yeah, that is what training is for. Most of the work is those basic things though, and as you do them more often you will find them easier, they will be automatic. Even sitting at your desk working is less exhausting if dictating or typing your note is automatic and not an onerous process as you remember how to accurately describe such and such thing.
Example - as you start getting more experience you'll notice how remembering everything for the patient encounter gets easier. This is not because you are gaining memory kung-fu, it is because your brain is automatically knowing what is important and pertinent and what is default.
This process will happen as time goes on, but with some mindfulness you can accelerate it - or if that's hard you can just ride the wave and know it will happen.
It's happened before for every trainee and it will happen to you.
One of my favorite processes in medical education is watching textbook driven people go "you aren't teaching me" and then gradually realizing that the work is the teaching and that they learned the textbook without needing to sit down and do that bullshit.
It comes. It's hard and you have to do it, but the knowledge and skills come.
Then things get easier.
*Above advice not valid for procedural skills.
Thank you. There is a lot of context I haven't shared, and probably won't share, even in private (with anyone, not you, you'd be more likely to know than most).
That's not the biggest problem I have. I'm happy to write proper psychiatric notes. I write essays on the internet for fun, and that's more intellectually taxing.
You'd be unpleasantly surprised. I definitely was. Psychiatry works very differently here. As a trainee at my level, I do a lot of medical management of physical illness, and I don't like it one bit. This will only change when I become a registrar. I'm not sure what the threshold for "call medicine and ask them to manage this" is in the US, but it's much higher here. That's what's really killed me in the past. [More highly relevant information that I am studiously omitting.]
An early trainee is a glorified ward donkey. All I can do is bray and scratch my ass.
I agree that things will get better later, with time and experience. You know why my last placement sucked. This one sucks for entirely different reasons. Mostly the drastically higher workload. It should get better, once I push through the next 5 months, which I intend to. I worked very hard to get here, I have nowhere better to go, and I do sincerely believe things will get better eventually. I still appreciate the support.
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