Mind matters

PUBLISHED : Saturday, 02 June, 2007, 12:00am
UPDATED : Saturday, 02 June, 2007, 12:00am

Dr Richard Fung Wai-choy, a psychiatrist in private practice for three years, casts his mind back over his career

I graduated from the Chinese University of Hong Kong in 1993, having taken a Bachelor of Medicine and Surgery - five years, plus a one-year internship.

Before you make up your mind which branch of medicine you want to specialise in, you can spend three months in each of the four rotations. During the one-year internship, the first thing that came into my mind was that it's really interesting to know what people are thinking and the rationale behind their actions. I still find it fascinating.

I began to practise psychiatry in 1994. The professional system encourages psychiatric doctors to have a wide variety of exposure. I started in Pamela Youde Nethersole Eastern Hospital, then Queen Mary Hospital, the Kwai Chung Hospital, Castle Peak Hospital, and Kowloon Hospital, before finally going back to Eastern Hospital.

Each hospital is different. Kwai Chung and Castle Peak are gazetted psychiatric hospitals; Castle Peak has a forensic unit; Kowloon Hospital has a community psychiatric unit; Queen Mary is a university teaching hospital. I spent one or two years in each hospital, a total of 10 years in the public sector. I loved working in public practice because it was very challenging, but the pressure was tremendous due to the long hours.

When a patient is committed to a hospital involuntarily, the hospital has no right to refuse. Back then, that meant each frontline doctor could receive one or two new patients every day. Each patient could stay a few weeks.

That meant your patient load increased rapidly. Sometimes we needed to work continuous shifts for more than 30 hours. Because of this, in 2004 I decided to go into private practice.

The beauty of psychiatry is that when you're treating a patient, you're helping the entire family. When a patient falls ill, the entire family is affected.

I come to the clinic every day and spend roughly 45 minutes with new patients and about 30 minutes with existing patients. So I see 10 to 15 patients a day.

Occasionally I need to see some psychiatric patients in private hospitals. I also do some psychiatric assessments and writing of forensic reports that may be for injury assessment, or mental capacity for financial access, for risk assessment.

Sometimes I need to go out to see patients, often for an initial assessment. This can be both interesting and intimidating. Obviously they are mentally disturbed to the extent that they are not able to come to the clinic. I definitely like to have their family members around and sometimes I bring a nurse.

The nature of the illness depends on the cause. There are three elements: biological, psychological and social. It takes more than just the doctor to manage the problem. A surgeon may cure the patient's physical illness on his own, but when it comes to mood disorders, there are other social issues behind them. It takes more than me and the patient's co-operation to achieve a result. I hear my patients saying: 'I understand what you're saying, doctor, but I'm going to go bankrupt!' or 'My wife is leaving me tomorrow!' Some of the circumstances are out of my control.

If you like to talk to people, share your feelings, show empathy and you don't feel upset about people's social hardships, then you're probably a good candidate for the job. And of course you need to be patient.

When I see a patient, I can control the quality of communication. If it's someone else, I can't control the quality. A psychiatrist has to be very professional and neutral, with high integrity. It's not easy to tap into a person's personality, but as a psychiatrist, my training helps in assessing them.