Rotations! #1: Psychiatry

After many delays with COVID, I finally started my third year medical school rotations in July. I’ve been meaning to have a moment to reflect on these experiences–which are meant to be a snapshot into a variety of specialties to help us decide what we want to do for the rest of our lives. Because of COVID delays, our normally 4/8 week rotations were shortened to 3/6 week, and some experiences and activities were cut down. I started my third year with three weeks of psychiatry as my first rotation.

I am that weird person who actually enjoys dressing up for rotations sometimes (we got to wear both scrubs and business casual here, so it was a good mix)

My psych rotation was unique in that it was with the Psych Consults team at a busy hospital that sees mostly patients with cancer, transplants, and other complicated conditions. The way this worked is if a patient’s primary team (medicine, surgery, etc) felt like their patient had psychiatrist concerns, they consulted our team. So, the diagnoses we worked with most were delirium, depression, and personality disorders. I was able to spend an evening in the Emergency Psych holding area of another hospital where I saw individuals with schizophrenia and other psychotic disorder(s).

It was cool and interesting to start with this rotation because it allowed me to see the flow of the entire hospital and parts of inpatient medicine without being thrown into the craziness of a busier rotation. Psychiatry is one of the “chiller” rotations in third year (I had initially planned for this to be during Ramadan before COVID pushed everything back) — this meant I was working ~8:30am to 4pm, no weekends, and often very relaxed afternoons if we didn’t have new consults.

Made this little template to help me take notes during a new patient interview

The daily schedule looked something like this:
~8:30am: Individually see our own patients (preround)
9-10am: Talk through the entire list of patients together with the team (table round)
10-11:30am: Visit each patient in their room with the team (rounding)
11:30pm – 1pm: Write our daily progress notes and eat lunch
1-4pm: Work up new patients if there was new consults. Or go home around 2-3pm 🙂

Our room was in an old Ob unit with a manual button for the newborn lullaby (I believe this is automated overhead somehow now)

Because of COVID, the medical students got to hang out in their own room in an abandoned unit all day (so we were more distanced)–which was a fun plus. The physicians/PAs were great at teaching and working through different diagnosis. They were also just great at working with patients; one of my favorite parts was seeing them talk to patients during rounds and learning from their conversation style that led to trusting relationships.

Ultimately, I knew when I started that psych probably wasn’t going to the “the one.” But each part of medicine interacts heavily with psychiatric diagnoses, so my goal was to learn as much as I could during my rotation to be a good, well-rounded doctor one day that is cognizant of psychiatric conditions and knows when to consult the specialists.

Here’s the more broken down Pro/Con list for me:

Pros
+ Psychiatrists really value long, relationship-building conversations and listen to their patients. I love this.
+ Especially in consults, we weren’t only taking care of the patient, but we often spent time talking extensively with loved ones and helping provide support to them
+ The team also prioritized explaining to patients what was going on with their medical care overall
+ Everyone on the rotation was super kind 🙂
+ Mental health and social environments greatly affect physical health, and the psych team really has the ability to dive into social determinants of health for patients and understand social stressors

Cons
– It’s really hard for me to wrap my head around psychiatric conditions like schizophrenia. I’ve been taught by some great teachers who have helped me frame it as a sickness of the brain — but I think I would take a lot of burden home if this was my primary patient population.
– many psychiatric disorders are not well understood scientifically currently, which makes their treatment options very limited
– psychiatric conditions greatly overlap with difficult social situations (homelessness, trouble keeping jobs, family issues) and the American healthcare system is not well equipped to fix or support these issues, putting physicians in a difficult spot on how they can be most helpful to their patients. This specialty requires passionate advocacy — and I don’t think this is where my personal passionate advocacy falls.

Social Determinants of Health are so important to psych we had an entire assignment about drawing our neighborhood and recognizing how that impacts one’s opportunities/health

I really felt like this rotation made me more cognizant of the mental health impact of long-term hospital stays — not only on the patient but their families. It also made me realize how much time can make a difference — we had fewer patients on our list, so we had the extended time to spend each morning really listening to each patient’s story. I think while actual psychiatric diagnosis aren’t my passion area, these lessons about listening and treating patients holistically can be applied to any specialty I go into. 🙂

Big fan of last day thank you notes and snacks 🙂

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