DOWN THE MEMORY LANE

Volume 11 Issues 4 April, 2021

Case conference presentation – A learning experience

During our post-graduation days, we all had to present certain number of cases in our weekly academic teaching programme. When my turn came, I was given a diagnosed case of Bipolar Affective Disorder who was in depressive episode at that time. In teaching apart from presenting case history, physical examination and investigation findings; we also had to do mental status examination in front of all to show our interviewing skills which were critically examined by senior teachers. Being a second-year junior resident, I had worked hard on that case supervised by my mentor. Now the day came, after the case presentation I called the patient in the conference room, took consent and started interviewing him. After few minutes of starting the conversation, the scene changed, patient started seeing here and there, neither making eye to eye contact nor answering my questions, even not able to focus what I was asking. I was nervous and shivering, sitting on stage in front of everyone, having no clue of what to do next. This goes on for another 1-2 minutes, I tried to collect all my focus and continued asking general questions to establish rapport. Soon
these efforts showed response and he started replying to my questions related to Psychopathology. I was able to show third person auditory hallucinations and the diagnosis was reviewed on stage along with the treatment plan. This experience motivated me to sharpen my observation and interviewing skills which are the most precious weapon in the armamentarium of a psychiatrist. The presentation was appreciated by all the teachers. It was also a learning that in psychiatry Psychopathology, presentation can change at any time hence having presence of mind and good interviewing skills are essential for every learner. Perhaps on personal front this learning also helped me to restrengthen my belief of having patience in any difficult situation and mantra is to take a step back, analyse, rethink and act.

A thank you note

While I was an International Training fellow in UK and doing community Psychiatry rotation, I had an interesting case of emotionally unstable personality disorder. This was a typical case with all the classical features of feeling of abandonment, emptiness, self-harm to name a few. Every time I had an appointment with this patient; she used to present same complaints and demanded early appointments with reports of no or minimal improvement. I was wondering how to manage this case as there was no improvement subjectively despite being on a lot of medications including mood stabilisers and antidepressants. Although objectively I can sense definite improvement in her mood and reduction in frequency of self-harm episodes. In next few appointments we discussed about other potential options of helping her including other medications and psychotherapy. But she refused to consider those, stating that she had received psychotherapy earlier and find it of no use. Around this time since I was about to reach end of my
placement, I thought of informing her ahead of time so that it will not reinforce her feeling of abandonment. Honestly speaking I had also developed countertransference towards this patient and wanted to handover the case. To my surprise in our last appointment, she gave me a thank you note and showed her gratitude towards me for listening to her every time and not giving up on her which had happened earlier. This left me in guilt and I started questing my feeling of countertransference. Perhaps this was a learning in disguise that every patient wants an empathetic ear to listen to his or her problems independent of diagnosis and outcome.