For the new overseas doctor

So, you have recently arrived in Britain. You are
in a state of bewildered excitement, getting used
to a strange new world. All four seasons occur in
the same day. Strangers smile at you warmly
while people avoid your gaze in the London
underground. Everyone despises the party that
seems perpetually in power. You believed that
this country was class-ridden, yet you call your
boss by first name. Trains run on time, but
everyone complains about them. You are 'gob
smacked', and still uncertain of its meaning.
Here are a few tips to help you find your personal
niche as a psychiatrist in this strange and
fascinating country.
Names
Announce your name clearly when you meet
people. The diversity of accents in Britain is most
entertaining in its treatment of foreign names.
The successive distortions of one's name can be
an endless source of amusement or pain. After
the Preet in my name was changed to 'Preep' and
later 'Creep', I decided to drop it completely when
introducing myself. Venkat, a friend working in
London, still winces every time he is called
'Vacant' by the switchboard.
Food
You are likely to eat in the hospital mess for some
months before the assault of the insipid on your
taste buds forces you to start cooking. There is
no need to believe that hospital cooks are experts
in black magic, able to boil away every remnant
of flavour from a wide variety of food items. It
won't be long before you can appreciate the
inherent qualities of a boiled potato. Consider
yourself truly integrated into British society
when you start looking upon Indian food as a
fitting challenge to your machismo, to be boldly
confronted after a few pints. The British have
been led to believe that Indian food is made by
throwing lumps of meat into an oily mixture of
chillies and gunpowder. A quick way of making
friends is to invite people over for some authentic
Indian cooking and dispel the notion that Indians
consider dripping sweat over food, bleary-eyed
and runny-nosed, an uplifting experience in
spiritual or culinary terms. Remember too, that
the British have dinner at noon and 'eat' their
tea.
Meetings
George Mikes wrote that forming queues is a
strange passion that the British indulge in, a
single person often making an orderly queue of
one at bus-stops. In psychiatric practice, holding
meetings has a similar fascination. You may
find yourself spending more time talking about
patients than to them. The result of these meet
ings will often impress upon you the truth behind
the saying that a camel is a horse put together by
a committee. So it is important to understand the
rules of conduct.
(a) Never disagree with anyone
Everyone has a right to be right. This conceals
the greatest advantage of multidisciplinary team
work: no one can ever be blamed (contrary to the
conventional wisdom that to err is human, to
blame it on someone else is even more human).
People will say 'interesting' when they agree with
you and 'very interesting' when they think you
ought to be locked up for your views. Maintain
this noble tradition by vigorously agreeing with
social workers when they denounce ECT as
diabolical, devious, dangerous and politically
incorrect.
(b) Don't show off your theoretical knowledge
You may have been taught the importance of
phenomenology in your training back home. You
may also naively believe that knowing the differ
ence between euphoria, elation and exaltation is
important in describing manic symptomatology.
Perish all such grandiose ideas. "This rather
pleasant young lad has been up and down re
cently and is now rather on the high side" is more
humanely descriptive, especially if you describe
the same individual as a "pathetic wimp" in the
discharge letter to the GP.
(c) Learn the key issues
Every patient in Britain has a key-worker. These
are easily identified as the individuals who are
away on holiday when the patient is being dis
cussed. Sometimes they may have just returned
from a holiday or sick-leave to convince you that
they are not abstract concepts but are living
entities. Their existence justifies everyone else's
ignorance of the case. You may discover at the
end of two hours of considered, and rather seri
ous sounding discussion, that you are still un
aware of the age and gender of the patient.
Queries in this regard will usually be answered
by other team members with a pleasant "I don't
know, I am not the key-worker". You may some
times meet the elusive key-worker, usually in the
corridor. Remember then that key-workers are
profoundly philosophical and carry grave re
sponsibilities. So questions about the age or
gender of the patient may evoke the response "I
am still struggling with that one". Many a keyworker
has brought me close to tears with images
of such poignant struggles.
(d) Use appropriate jargon
Don't talk to your patient - have a 'one-to-one in
a therapeutic setting'. Always insist: 'there are
family dynamics', disregarding the fact that this
is as meaningless as saying that 'the patient has
a blood pressure'. 'Struggle' with answers - don't
simply know facts (see above). When a drunk
throws a chair at you with the idea of cracking
your skull, consider this 'the challenging be
haviour of a vulnerable individual'. Patient's
attempts to fool you are 'maladaptive coping
strategies'. 'Community care' 'purchased' by
'consumers' that allows 'autonomy' and 'empowers'
the 'clients' is desirable, everything else
results in 'institutionalisation'.
When in doubt, blame 'financial constraints'.
(e) Appear busy
When in corridors, rush frantically, even from
the coffee room to the sandwich bar. If you meet
colleagues on the way, project the heavilyweighed-
down-by-the-woes-of-the-world look
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turn up. For instance, a query about what time it
is may reasonably be answered in about ten
weeks.
It is remarkably easy to feel comfortable and
relaxed in this country. You must not allow
nostalgia to colour your judgement. Follow the
instructions provided, and you may soon, in the
words of Ogden Nash, find yourself "thrilled and
tinglish" at belonging to an exclusive club:
"A club to which benighted bounders of French
men and Germans and Italians et cetera cannot
even aspire to belong.
Because they don't even speak English, and
Americans are worst of all because they speak it
wrong".