Treating rural patients with both medical and psychiatric diagnoses

Ever wondered what it's like to be a psychiatrist? This series explores a day in the life of psychiatrists who work in different areas of psychiatry.

In this article, we hear from Dr Sarah Hutton who is Consultation–Liaison psychiatrist working in rural Western Australia (WA).

A Day in the Life of a Rural C–L Psychiatrist

I didn’t set out in my psychiatry career to work in rural WA – I stumbled across this position almost by accident after a very brief locum stint before starting a position in a metro centre. I fell in love with the town, the region and the lifestyle almost immediately.

The positive impact working rurally has had, not just on my work–life balance but also on my family, has been immense and I would recommend a career in rural medicine, and psychiatry in particular, to anyone who stands still for five seconds!

Working in psychiatry in rural WA is never dull!

No two days are the same. Being a small rural service often means as psychiatrists we take on a couple of roles (or more!) within the team.

I’m a Consultation–Liaison (C–L) psychiatrist and spend half of my time looking after the C–L service and the other half being the clinical lead for the Community Mental Health (CMH) Team. The roles aren’t divided as clearly as they sound, with me often doing both roles simultaneously.

One thing I love about my role is that I can structure my time to suit service needs and keep my time flexible. I also get to indulge my area of particular interest in perinatal psychiatry and have made myself known to the team, and GPs in the wider community, as the local expert in the area.

So, what is C–L psychiatry?

The short answer is probably to say the interface between general medicine and psychiatry, but the long answer is far more complicated.

We assess and help manage those patients who have both medical and psychiatric problems, where their mental health may be negatively impacting on their physical health.  This is usually done in the general hospital setting but we do see a lot of patients in outpatient settings as well.

Let me take you through a typical day, if there is such a thing.

After a morning coffee at home and kissing the kids goodbye for the day, I make my 10 minute commute to the hospital. 

The first order of business is always to check my emails as anything curly that’s happened on the medical wards the evening before is flagged by our Liaison Nurses. I then check my appointments for the day and do any preparation that’s needed for those. We have a team meeting first thing before either diving into appointments or C–L work.

What types of patients do I see?

At present, and in the recent past, we have been involved with the care of young people with eating disorders requiring refeeding due to medical issues, older adults with dementia and associated behavioural disturbances, patients with delirium and alcohol withdrawal, amongst other things.

Whilst I may not spend as much time on the wards as the registrar I supervise, I spend a lot of time discussing with my registrar each of our patients and their management. I will also liaise with the medical teams as needed.

What else does my role involve?

I make myself available for my CMH case managers to discuss any issues with community clients throughout the day, and more often than not I have to fit in a meeting or two.

Most weeks I will also have to prepare a report for the Mental Health (MH) Tribunal for clients under the MH Act and attend the hearing.

It’s important to note I prioritise breaks and lunch and I’m very fortunate that that’s relatively easy to do in my role as I structure my own time – you can’t run on empty!

The end of the day is reserved for admin/documentation time before a final email check and heading home, on time, to the family.

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Disclaimer: Any patients mentioned in this article have been deidentified and created for the purposes of this article. This article may represent the views of the author and not necessarily the views of The Royal Australian and New Zealand College of Psychiatrists ('RANZCP'). By accessing the article you also agree to the RANZCP Website Terms of Use Agreement.


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