Starting up in Psych...

My second rotation is underway and it is quite interesting for sure. I am still adjusting a bit to it and tomorrow I will complete week 1. Compared to Family Med, there is no where near the patient load (at least so far) that I am used to. I have been told that it has been a light week so maybe it will pickup next week but who knows. The consults however are much, much longer than FM. Today, I finally got to start the process of interviewing psych patients on my own and the interview lasted a good 45 mins or so. It was a case of depression which was a nice transition into the rotation, as this is the most common complaint to receive. Nothing really too difficult though. Prior to beginning this rotation, I have been doing my reading up on psych interviews, flow of questioning and laying out all of my handy mnemonics for psychotic disorders, mood disorders, PDs and more.

I do not think that this rotation will be overly difficult but I am very much enjoying it so far. I have not crossed out psychiatry as a specialty but already I can see how it would be a tough job, quite demanding of patience and energy. On the first day of the wards, I already got the pleasure of getting the "boot" out of the room. So many patients just hear "psychiatry" and feel the need to express how they are not "crazy" or "retarded". It is a shame that so many people feel that there is shame in talking to physicians in such a field. So far, there has been a couple suicide attempts, one in which I saw and plenty of BPD (Borderline Personality Disorder) to go around for all.

The biggest adjustment I think that I am making is getting used to different styles. For my first two weeks I will be in the hospitals then rotating a bit around with other physicians. While in the hospitals, students could be with one of three people - all with different styles of teaching, interviewing and treatment. In FM, it was better because I had one great model to follow and it made it easier to develop my own style quicker that would fit the liking of my preceptor. Now, doing interiews one way, isn't necessarily liked by all. So far, I am in no way getting any heat from how I do my interviews or presentations, but I assume getting to know my teachers (albiet - quickly, as I rotate from person to person on nearly a daily basis) will aid in my ability to blend better with them. I find that I have a pretty good flow with my interviews and alternately, many just do "bulleted questioning", sometimes not allowing the patients to really speak much. Of course, some patients have that gift of going on and on - but to me there are more creative and less abrupt ways of directing the interview to where you would like to go for investigation.

Also, I am finding that some of my teachers go above and beyond what we were initially called down to do. For instance, an initial depression consult (which was stable and basically a recheck) turning into a mild (very mild) dementia - ordering brain imaging, fixing metabolic disturbances noted in the electronic chart, etc. At first, I was turned off. Why were we doing this? It just seemed out of the realm of what we were called down for. It seemed like just doing it to... well, do it. I know that in consults you have to do what you can for the patient and CTA (cover your... hiney!) but I didn't know if it was thoroughness or overkill. Furthermore, the patient was even happy with her medication for her depression and felt that it was doing a good job as now with her recent illness, she is now facing the difficult adjustment of being more limited in her life activities. After discussing increasing her dose of her MAOI, she was not interested and already didn't feel completely comfortable taking any mediation for it - yet the executive decision was made to increase her dose anyway, of which was known to all but the patient, as this decision was made post-interview while charting. Even now, I feel it bad to cast any judgement on my preceptors (like my one week has any bearing at all on their lifetime experience) but it just really opened my eyes keeping an open mind to look at the bigger picture at times than just focusing in on the one thing that you were initially investigating.

Sigh, it has been an interesting few days though and I know it will be a really great experience in the weeks to come. The psych department here is really into teaching the students and getting us some wonderful exposure to a vast array of clinical senarios and ethical issues. Now, onto finish week one - I wonder what tomorrow will bring? :)