It seems I’m at a fork in the road in my life right now. I’ve spent the last ten months working in an Emergency Department in a hospital in South Wales. I’ve been seeing and treating many Covid-19 patients, amongst countless other ailments and injuries. I genuinely love my job. I was only meant to work four months in my A&E rotation, but when the virus hit, I was kept to work on the front line. I was due to rotate into an Old Age Psychiatry job after A&E, which was the sole reason I applied to work in this specific hospital. 

Now I’m working a further twelve months in the department as a Junior Clinical Fellow. I simply couldn’t resist the chance to stay on in a job that I thoroughly enjoy. I’ve always wanted to work in Psychiatry, but I feel fate is working its magic to sway me down an alternative path. Should I choose a career in Psychiatry, or in Emergency Medicine? This is something that’s been troubling me for some time now. I’m still deliberating over what career path to choose. In this piece, I’ll talk about my current thoughts.

A Career in Mental Health

Psychiatry has been my sole career goal for a number of years now. Even before starting medical school, I had a distinct interest in mental health. As a teenager I’d eagerly listen to people talk about themselves. I never liked talking about myself much, and therefore, allowing others to disclose their own issues to me felt like a form of escape. Perhaps it was an escape from my own, deep rooted issues that didn’t really arise, or come to light until my early twenties during my first ‘mental breakdown’. I enjoyed listening to others express themselves. Even from a young age, I still understood the importance of being receptive and lending my ears to people.

I’m now a fully qualified Doctor with a diagnosis of Bipolar Affective Disorder. This in some ways puts me at an advantage when it comes to treating patients with mental health issues. I have a level of understanding which allows me to empathise with, and correlate patients’ symptoms. If a patient presents to me in a psychotic, delusional state with altered mood, I can potentially relate to their mental state. I understand what that feels like. I don’t know specifically what is going on inside their mind, but I know how it feels to have those perceptions and feel that way. Conversely, having that level of empathy with a patient comes with its major pitfalls. It’s more difficult to detach yourself and your emotions from the situation, especially when you’re able to relate to the patient’s mental state. Becoming emotionally invested in patients could detrimentally affect my own mental health.

Having not had any professional experience working in Psychiatry, applying for higher training would be taking a risk. I wouldn’t know the ins and outs of the job. I may hate it. But there’s a chance I’d love it. And so, in the same vein, I’d be doing myself a massive disservice if I completely disregarded Psychiatry as a career choice. I know that if I enjoyed the job, I’d be good at it. I’d relish the opportunity to help those who are mentally frail and vulnerable. I’d love to apply the rationale I use when analysing my own mental state, to assess and help those in need. I’d feel genuinely privileged to do that.

A career in Emergency Medicine

When working in A&E, I’m able to switch off some of my emotions, and sideline much of my empathic nature. This allows me to do the job I love, with efficiency, safety and care. It allows me to work on a professional level with my colleagues, together as a team, to save lives. I don’t lose focus when someone is brought to the department by paramedics in cardiac arrest, for example. I don’t let my emotions dictate my actions. In order to help treat and resuscitate the patient, I know what is needed from me to do the best for them. If they die, I will likely cry later down the line, but whilst in the moment I have a job to do. This is the healthiest way to live and work as a healthcare professional, particularly in a specialty as fast paced and high octane as Emergency Medicine.

A career in Emergency Medicine currently seems much more tangible. I live, breathe and feel this lifestyle. I’ve already applied for the first part of the Emergency Medicine training programme. This is with the hope of not only boosting my prospects, should I come to apply, but also to put me in good stead for the rest of my year in A&E. I get on well with the people I work alongside. Anyone from doctors, healthcares and nurses, to security, porters and admin staff. They’ve taken me under their wing and shown me what a true work family is like. When Covid hit, morale remained high, and despite the stress, we all worked through it with a smile.

My shifts may be long and antisocial, and my shift pattern may be very sporadic, but I manage well with the pressure. I maintain a reasonable work-life balance and still have time to myself when I need it. Sleep is key in Bipolar, and yet I manage to work lates and night shifts, all whilst maintaining good sleep hygiene. Choosing to specialise in Emergency Medicine with my diagnosis might seem risky. The responsibilities are greater the further you progress in your career, and therefore so does the pressure. With more pressure comes stress, anxiety and the potential to fall sick. However, this holds true for all specialties. As I progress in my career, I’ll gain more and more experience and expertise, allowing me to deal better with the pressures of A&E.

Summary/ The Best of Both Worlds

Ultimately it’s my decision to make, and one not to make lightly. I’d much rather work in a field I know I love and enjoy. Having spoken with many senior colleagues, I’ve received lots of advice. There’s always an opportunity to work in Emergency Medicine with a special interest in mental health. I’m not quite sure how this would work practically, but it’s something to consider. There’s also the opportunity to go into a subspecialty of Psychiatry where I see and assess emergency cases. These are primarily cases which come through the Emergency Department and require the Psychiatric Liaison Team.

I’ll need to choose over the forthcoming weeks, as this is when applications begin to open. I’m currently leaning more towards the emergency training route, as this has suited me and my lifestyle for almost a year now. I’ve had very few troubles working in this specialty and it’s one that brings me great joy and satisfaction. Although I’ve had a taster week on a Psychiatric ward, it simply wasn’t enough to sway me; I’d need much more time to get a true feel for it. As it stands, I will likely be training as an Emergency Doctor over the coming years, which both scares and excites me. I may have the opportunity to make a career change in the future, but it seems that at this point in my life, the A&E world is calling my name. Loud and clear.