Oury Chocron, Liaison Psychiatrist, CHUV

When I started studying medicine, I wasn't particularly attracted to psychiatry. During my 5th year of studies, I was able to do practical training in several medical disciplines (paediatrics, internal medicine, surgery, for example) and it was when I spent two months in psychiatry that I decided to specialise in this branch. The FMH, which awards specialist titles, specifies for each discipline what an assistant doctor must do to obtain the desired title. For psychiatry, one year in non-psychiatric medicine (e.g. internal medicine), at least two years in a psychiatric hospital and two years working as an outpatient are required, to which must be added a certain number of courses, training sessions and supervisions. This experience will provide a rich and varied background for our future professional practice. At the end of my studies, I first worked for 9 months in psychiatry: 50% of my time was devoted to my thesis work (on the objective recording of motor impairment in depression) and 50% to psychiatric emergencies at the CHUV. You don't have to do a thesis to practise medicine, but if you want a career in academia (in a teaching hospital), you'll soon be involved in research. At the CHUV, for example, the job description for doctors includes clinical work, teaching and research. I then worked for a year in internal medicine in Fribourg, then two years at Cery Hospital, before returning to the CHUV to work in liaison psychiatry. I am now deputy head of clinic in the liaison psychiatry department at the CHUV and am in the process of completing my specialisation. One of the great advantages of medicine is that you can be sure of having a job when you graduate, in a wide range of disciplines where everyone can find their own path according to their interests and aptitudes. Medical studies may take a long time, but as soon as you leave university, you'll be an assistant doctor and earn a salary.

One of the missions of the liaison psychiatry service is to act as a consultant for other CHUV departments. We are called in by care teams when a patient needs psychiatric advice. In this way, we can offer an approach that can range from monitoring the patient during his or her stay in hospital, whatever the reason for hospitalisation, to outpatient follow-up. Another important activity of the department is team supervision. In the hospital environment, care staff can sometimes be confronted with difficult situations that can be very emotional. One of our missions is to look after the teams who look after patients, by offering discussion groups where everyone can share their experiences and learn to live in a profession that is still very demanding. My current role is threefold. I do some clinical work with inpatients and outpatients. I also supervise two assistant doctors and help them where necessary to ensure that everything runs smoothly for them and the patients they follow. Another part of my work involves teaching, which is spread across the department. We teach courses in communication and psychosocial medicine at UNIL. For example, we have a practical module in 4th year where students practise breaking bad news. Finally, my third mission is research. At the same time, we regularly attend further training courses and take part in seminars, conferences and specific psychiatric training centres. As an assistant doctor, there are lots of opportunities, but all medical staff take part in ongoing training throughout their careers.

Psychiatry is a little-known discipline with a certain stigma attached to it because psychological problems are taboo in our society. It is a very rich discipline, combining highly technical and scientific medical aspects with important human and relational aspects. There is a general tendency in medicine to introduce protocols. But generally speaking, we have to learn to live with uncertainty, doubt and perpetual questioning, because it is precisely this that enriches us and enables us to respond to patients in the best possible way. Medical knowledge is certainly important, but the qualities of a good doctor depend on a certain amount of know-how and interpersonal skills. Aspects of communication are therefore central to the doctor-patient relationship, and relational and emotional aspects are necessarily present and partly influence scientific and medical care, at least in disciplines where patient care is at the centre of practice.