Psychiatry in NZ

They may speak some form of English here, but pretty much everything else is different. That's certainly true of my profession. I'm in the same field, obviously, but the nature of what I do has changed dramatically. I spend about half of my time in downtown Wellington at the community mental health center where I do outpatient child psych, and I spend the rest of my time in nearby Porirua at the adolescent inpatient unit.

That sounds kind of boring when I describe it. Believe me when I say that it is not.

This country has about 4.2 million people in it. I think I've met about half of the country's child psychiatrists in the last few weeks, and there aren't very many of us. This means that patients wait over 5 months for an appointment at the outpatient clinic, and people are very ill by the time I lay eyes on them.

You would expect that with such a huge demand for psychiatrists that I might feel overwhelmed, overworked, and hence very stressed. Negative. My work day usually starts at 9am. I'd say 9am sharp but that's simply not how things work over here; think Caribbean time and you'll get the idea.

When I first arrived, I was still very much in my American mindset. After a few days of wondering when things were going to get busy, I asked my Scottish registrar (i.e. resident, a psychiatrist-in-training) how much time one normally blocked off to see a patient. He looked at me strangely. I explained: "Well, back home, we'd see a new patient for about an hour and a half and we'd see a medicine checkup patient for about a half hour. So how much time should I be blocking off?"

He replied, as if explaining to a child, "As much as you need."

This didn't compute. Here I am staring at a 5 month waiting list and nobody cares how much time I spend with patients? I persisted: "Look, I really don't want anyone to think I'm lazy. Normally I'll see about 6 or 7 patients before lunch. What's normal around here?"

He smiles a bit, and with his killer Scottish accent says, "Ah, Broose, I doon't think you'll haff any bach-to-bach clinics hair, mate." (As an aside: he's the second Scot I've met in the last two weeks. They love it here because of the balmy, dry weather).

Point is, expectations are different. It's easy to get used to, though. I actually caught myself looking at tomorrow's schedule and thinking that it will be a really busy day. I'm seeing 4 patients. Don't get the wrong impression, either- I see every single patient that anyone discusses with me and I'm even calling up people to see if they need to be seen. They just operate differently- they spend a lot of time on everyone that they work with, but they don't work with as many cases.

I'll say this, though- the cases that we do see are no joke.

Keep in mind that I'm fresh out of training in the States. The first patient I saw had had a serious suicide attempt two days prior and I was seeing them in the outpatient clinic. The next patient I saw arrived at the hospital dehydrated and catatonic. I saw maybe 4 cases of catatonia in 6 years of training back home. In less than two weeks I've seen cases of obsessive compulsive disorder, bipolar disorder, and catatonia that trump anything I've ever seen or even heard of.

The severity of cases makes it tough, but there is a silver lining here. In the States, I was often required to be more of a family therapist than a psychiatrist because the ratio of family dysfunction to mental illness was higher. Here, there is basically a guarantee that everyone I see has a major mental illness, and I never spend any time wondering if I'm being useful.

This is getting lengthy, so I'll close with this: it finally stopped raining. After 17 days, we've had over 24 hours of sunshine. Hopefully the patients at my hospital are enjoying it. After all, the door there is only locked when it needs to be.