Real-life story - Dr Andrew Howe
Dr Andrew Howe is training to be a psychiatrist at the Maudsley Hospital, part of the South London and Maudsley NHS Foundation Trust.
How I got into the role
I decided I wanted to be a doctor when I was about 15. I’d done lots of voluntary work with people with disabilities and wanted a challenging career that would combine caring for people and science.
Before starting medical school I took a gap year and worked for a year as a care and activities assistant with elderly people. This provided a great experience of the daily challenges the care home residents were facing, and an appreciation of the demands of a caring role.
During my third year of medical school I spent six weeks working in a psychiatric intensive care unit with patients suffering from serious mental health problems including psychosis and mania. This was an eye-opening experience as I witnessed the extremes of mental illness. I found the work very rewarding as people often improved quickly before being transferred out.
My degree also included a clinical placement in psychiatry, half of which was spent in a general psychiatric ward and the remainder with a community mental health team. On the ward it was rewarding to see patients being able to return home. Within the community I enjoyed seeing how patients were supported to live their lives as independently as possible.
In my foundation training one of the rotations was in old age psychiatry, but I found that all specialties contained elements of psychiatry. For example in renal transplant surgery I observed that there are often psychiatric components to chronic conditions. Similarly during my paediatric placement children presented with medically unexplained symptoms, which often had psychiatric causes.
During my psychiatry rotation I found the senior doctors to be particularly supportive, providing weekly one to one supervision sessions where we could discuss our experiences of the job. During foundation training I successfully applied for core training back in South London.
What I do
I’m currently in the second year of the three year core training programme in psychiatry. You need to pass three examinations to achieve Membership of the Royal College of Psychiatrists (MRCPsych) before completing core training. I have currently passed the two written papers and will be sitting the clinical exam in my final year
Fitting in the study needed for examinations around a busy job can be a challenge. This can mean studying in the early mornings, evenings or weekends if necessary. Every Wednesday during the academic term we also have teaching to help us to prepare for the examinations.
Part of my training involves participation in a psychotherapy support group, which is led by a consultant medical psychotherapist. We discuss cases, and try to understand the emotional content of our patient interactions.
During core training I also see two patients for weekly individual psychotherapy. I have one patient who will be seen for a year of psychodynamic therapy, and the other for cognitive behaviour therapy which lasts for 12 weeks.
Core training in psychiatry involves six placements lasting six months each. During my first year I worked in community old age psychiatry. This was quite daunting to begin with as part of it involved visiting patients in their homes by myself as well as running my own clinics. Thankfully my consultant was always available for advice.
The next placement was on a general psychiatric ward which was very busy and fast-paced. I helped look after 14 patients on the ward, adjusting their medication and treatment plans where necessary and ensuring the right community support was in place before discharge.
My first placement in the second year was with the Child and Adolescent Mental Health Services (CAMHS) liaison service. I saw children and young people as inpatients or in A&E. This involved a variety of presentations including self harm, gender identity problems and ADHD.
Working with children also meant working with their families, schools and social workers. This allowed me to hone my multidisciplinary team (MDT) working skills.
I’m currently working on a female psychiatric intensive care ward, seeing patients with a range of serious mental health problems such as schizophrenia and bipolar affective disorder.
The best bits and challenges
Every patient is different and people present with psychiatric illnesses in different ways. No day is ever the same and I like the fact that you get to know your patients really well. Psychiatry is a very rewarding career, since you often see a complete change in your patients as they get better.
I also enjoy the teaching aspect of my job, and there are lots of opportunities to develop this. I’ve enjoyed teaching medical students in small groups, and having students shadow me on their attachments.
The work can be emotionally draining and dealing with patients’ very strong emotions can be difficult at times. It’s important to rely on the support of colleagues, friends and family. Within psychiatry we work in close supportive teams, and are encouraged to talk about the challenges we face in the job. It’s important not to bottle things up.
Life outside work
Psychiatry offers an excellent work life balance. I generally start work at 9 am and finish between 5 pm and 6 pm, apart from once a week when I’m on-call and work until 9 pm. I also work on-call three or four nights in a row once every two or three months.
These working hours leave plenty of time for my outside interests, which include visiting museums, gardening, walks in the countryside and playing the flute and guitar.
Career plans and top tips for others
The placements for my third and final year of core training are already organised. I’ll be spending six months in a brain injury outpatients’ department and my last six months in a day hospital psychotherapy service for patients with personality disorders.
At the end of core training in just over a year, I hope to start higher specialist training in psychiatry. I plan to apply for dual training in medical psychotherapy and general psychiatry, which is quite competitive. Dual training in psychiatry lasts for five years, after which I will be awarded my CCT and will be able to apply for consultant posts. I’d like to work in the psychiatric intensive care environment.
- get some experience in a psychiatry setting to see if it’s for you
- if you think you might be interested in psychiatry, look for psychiatry in everything you do, for example at medical school and during foundation school rotations
- get involved in audits and research that’s relevant to psychiatry and demonstrate your interest