Some Musings on Becoming a Psychiatrist

There was only a limited period for a psychiatric clerkship in medical school at that time. I took my clerkship with a Dr Sclare in a psychiatric inpatient ward. When the students arrived, he assigned them to individual patients to interview for about 30 minutes, then we would assemble in a group after the interviews, and he would ask each one to describe what we learned about the patients. He deliberately provided no clinical information about the patient beforehand, obtaining that was the task of the student reviewer. I was assigned a very quiet, reserved young woman who wouldn't respond to any of my queries. I didn't know what to do but being a rather garrulous young man (haven't changed much), I started telling her about myself and toward the end of the interview she began to join in, asking questions about me and beginning to talk a little about herself. The interview ended; I joined the group rather apprehensively knowing little about the diagnosis, etc. When my turn came however before I could start Dr Sclare announced to the audience something like “Hugh has to be congratulated. This young woman has been mute since she was admitted several weeks ago. This is the first time she has spoken since admission. Hugh you should consider a career in psychiatry.” This to my fellow students, when praise was something not often encountered in our medical school, and certainly not to me, needless to say was gratefully received. This did not directly lead me into a psychiatric career, but those words of praise remained at the back of my mind for some time.

After my internship thanks to the idiosyncrasies of the local draft board, I found myself left in September without a position (I had actually signed up for a residency in pathology, believe it or not). One of our local general practitioners, Dr Flanagan offered me a position in his practice which I gratefully accepted. Turned out to be wonderful opportunity. Dr Flanagan was very much a product of this community (as was I) and had a strong conviction that to provide appropriate care to patients, as well, of course, as good medical knowledge, it was important to understand the educational, socio-economic circumstances of the patients together with their personal histories and idiosyncrasies. This he did, not by lecturing but by example. At the end of the day, we would often meet in his house and he and I would talk about the patients of the day. He would tell me stories about patients like The Thief, Paddy Ma Heart, and many others. Paddy Ma Heart, by the way, was a very well-known patient in the area who floated from practice to practice because of his tendency to put in emergency calls in the evenings two or three times a week either by himself or through a passerby “Doctor I think this man is having a heart attack” So we talked about how to manage him. I met with Paddy and told him that I would pay a house call to him every month and examine his heart, in return for which he should try not put in any other emergency calls, call me instead. Both of us kept to our word.

This experience did not directly lead me to a career in psychiatry for reasons which I'll explain later but certainly served me in good stead when I did become one.

While I was enjoying my experience in general practice, I still wished for an opportunity to conduct some clinically based research in addition. Fortunately for me, during this time my father retired from being a school principal and decided he would like to become a school psychologist. During his psychology training at Glasgow University he met a distinguished psychologist, Dr Stott who was interested in various aspects of stress related research including the possible effects of prenatal stress on the health of the offspring. We were introduced and I began to collect data on his behalf from the pregnant women in our practice. I found this fascinating but quickly realized that it was going to be difficult to continue my clinical duties in my busy practice as well as to do justice to the research project. I reconsidered my career choices but rather oddly decided that public health might be a good fit to conduct research of this nature, perhaps with an epidemiological perspective. So, I left our practice and accepted a public health position in Flin Flon, a beautiful little town in Northern Manitoba. However very quickly realized that I missed very much the clinical experience and decided then that the best discipline that would allow me both to explore the mechanisms of stress and continue with a relevant clinical practice, and remembering the encouraging words of Dr Sclare, would be psychiatry. And thus, I became a psychiatrist and have never regretted this decision.

Incidentally, to finish in a rather sad note, all the questionnaire data I collected from the pregnant women in my practice was burnt in a fire that occurred in our offices in Manitoba.