Always room for improvement!

This rotation is ending so quickly it is unreal! Already in my last full week of psychiatry and just about time to take my shelf exam and move on to OB/GYN. Things are still going well and feel very comfortable still with working in this department. I still feel like I could be really good at it but don't know if it is right for me. But that is what it is all about, right? Constantly learning, constantly learning about yourself and what you can improve.

Even today, I had to interview a patient for a suicide attempt by overdose. I've done my fair share of these in my rotation - so sure, no problem! It went smoothy and the case was presented back to the department heads. After the interview, I was immediately in the patient's defense. This was no suicide attempt nor was she drug seeking. Some thought from their many years of experience that they knew the diagnosis right off the bat. While I respect their long career and endless patient encounters, it really turned me off that barely through part of my presentation, it was - oh has she been in rehab? - she must have known what she was doing! - or even the rolling of the eyes from the nurse about her and the jokes made from the Internal Medicine doc of how she must have been so desperate to get high. It was an utter turn off. Is this what years in medicine do to people? Make them this cynical?? It was truly disappointing. Luckily, after my presentation it was time for round two - the doctor to do a bit of interviewing after me. Afterwards, they were convinced that she was a legit patient in a great deal of pain that was only taking medications because her previous pain management doc is not longer available and she has been out of her pain medications for months, left only to OTC medications she was left to desperate measures of going to buy something a bit stronger off the streets . While social work needed to help find her a new place for pain management, it was found that she indeed was not suicidal.

Room for improvement, no?

In that interview, all appropriate questions were asked for such a consult. Specifically, feelings of depression - denied. History of abuse - denied. But when the physician came in for the evaluation, confirmed and confirmed to both questions. UGH, I thought. You just told me 'no'! Why did she lie? Ok, ok... those were my first thoughts. After thinking about it, I realized that during the interview how much she was holding back, trying to be strong for her family as she was known as the strong one. Then I thought about what I did wrong and found that the way I asked those questions weren't as good as they could have been. At times certain questions in some interviews may appear unconnected or less important so they are asked quickly with the interview then continuing on.

Room for improvement again!

I now have a better understanding of how to at least attempt in opening up patients more, after looking to myself and what I could have done better and not blaming the patient for 'making me look bad'. Because of her I will be better and so will others if they let themselves truly think about how their countertransference plays such a huge part in professional and adequate treatment.

Finally, tonight my mother and I watched a program on Public TV about those with no health insurance. Alright, talk about room for improvement! It is so easy to look at the uninsured as immigrants, the voluntarily unemployed, etc. Just the toil that these families went through was unbelievable. Prospering families, stricken with a horrific illness or debilitating accident had left them with less than nothing. Even those with insurance, but not covering every single base left them without a basic necessity, for example a leg. This man lost his leg and was unaware his insurance didn't cover him, as the insurance company approved his visit to get the prosthesis. So here he is with his new ~$10k leg (by the way which was supposed to be only able to last 4 months) and all they can do now is hand him the bill. Finally now able to go back to work and a year and a half later still on the same old prosthesis waiting for benefits to kick in for his family of 5 - but of course with pre-existing conditions would probably not cover him anyway.

I could go on and on but just the constant need for everyone in medicine and for the system as a whole to improve is seemingly overwhelming but its water that we must tread. Drowning in this sea of uninsured, debt, MORE debt covering the uninsured (many with chronic illnesses because without some very basic health care, they were unable to get the medicine for which a simple pill probably would have cured them 5 years ago). Sigh. Definitely preventative medicine in this election is key, one which is the gateway to a less strained (already stretched) health care system. I just hope that our future, with all that has been going on as of late, gets stabilizes enough to instill a plan of action worth our time and hard earned money. I hope that the next president realizes that more than abroad - many domestic issues have gotten too ignored for too long and it is time to reel it in before insurmountable damage is caused... if not already so...