Reflections on Psychiatry

As you may recall, save for the time I got to spend interacting with my preceptor’s patients, I did not enjoy my psychiatry rotation. At all. (Until the last 3 days, but I’ll get to that.) I took to attending the patients’ group therapy sessions to pass the time, which manifested into a couple Medical Mondays posts, so…at least there’s that!

Most of my friends had already done their psych rotations by the time I got to doing mine, and all of theirs had been super chill. “You’ll probably get out by noon every day. Maybe 3 p.m. on a really late day.”

I admit that I walked in with these thoughts in my head, and this may have initially colored my perspective. But only by a little bit. If my past educational history tells you nothing, I am completely fine with long hours. But only if I’m actually doing something productive, meaningful and/or useful.

My shifts were 11-12 hours each day, and 85-90% of my first three weeks was spent in a corner of his office trying to study without internet access whilst listening to him do his dictations. His supervisor actually came in one evening to tell him that he was keeping me for too long…and he laughed, and kept me there for another hour.

Reflections on Psychiatry

1. Do. Not. Want.
   The first 3 weeks of my rotation pretty much cemented the realization that OB/GYN was actually no longer on the top of my “do-not-want” list. Nope. Psych shoved it out of the way on the very first day (I haven’t even done my OB/GYN rotation yet.) But you can’t have everything in life, and you gotta take the bad with the good.
2. Learn how to work with someone you really don’t mesh with.
   Be understanding.I think I’m a fairly easygoing individual, and I honestly cannot recall a time where I really, truly couldn’t find some sort of a common ground with someone. This one took a lot of work. It wasn’t that my preceptor wasn’t nice–he was pleasant and very polite, but would also simultaneously make me feel like I had no functional brain cells when he was asking me questions. I had a very hard time understanding his accent (especially in the beginning), and he had a tendency to mumble and/or trail off his thoughts, so it always took a lot of repeating before I’d finally get the entire question, and by then, he’d already have chalked it off to my apparent stupidity.While I really do hate feeling like a brainless moron, that actually was not what made this rotation so miserable for me. It was in how he talked to his patients. Don’t get me wrong–medically speaking, my preceptor was brilliant, and he definitely got the job done. Mayhaps I’m just one of those bleeding heart cases, but I think psych is arguably one of the fields where you need to be an amazing listener, and even if you don’t care on the inside, you should at least act interested in helping them.As a fledgeling third-year medical student, I realize that I am in no place to criticize, but in the future, I would like to think that I’d show more compassion, and that I wouldn’t have a set script that I’d ask each patient, almost-regardless of what they were coming in for. I’d like to think that I’d actually listen to them, and that I wouldn’t answer, “Any other problems?” after a patient had just told me that she’s been on her own since she was 19, because her parents left her, and her grandparents died in a car accident.
3. Fake it til you make it.
   Shortly after realizing #2, I decided that approaching this rotation with the negativity I was feeling was not going to cut it, so starting on my second day, I walked in each day with internal pep talks galore. I talked with the staff and the patients whenever I could, and also brought half a billion books/notes so I’d have something to study for all the hours that my preceptor was gone for. I think my [previously-nonexistent] poker face has vastly improved because of this rotation. I’m not sure my first preceptor ever realized anything that was going on through my mind during the majority of this rotation.
4. Pick your battles wisely.
   I avoid conflict whenever possible, but when necessary, I do like to try to explain my point so that possible misconceptions can be cleared up. This is good and all, but when you realize that there’s no point in arguing because the other side is clearly not listening to what you’re saying, you learn to bite your tongue and just smile and nod.Case in point, I was actually given an 85% in “interpersonal communication” and “professionalism” for this rotation, and I have no idea where that came from. (I’ve never gotten anything lower than 90 or 95% in those two categories, and even for that 90, I was all sorts of upset. So imagine this.)I liken the “interpersonal communication” grade to the “being a nice person” grade, and I do not think I deserved a B in that realm at all, especially when I’d spend so much time talking to the patients, actually listening to what they told me, and trying to help them to find better ways to cope with their problems.But of course, my preceptor would never have known that, since he was never there to see it happen.
5. Silver linings. Look for the good in everything.
   The staff was amazing, and almost all the patients were very pleasant (at least to me). This rotation really made me miss my family, so I have it to thank for bringing me somewhat closer to my mom, too. I called home a lot because I was pretty miserable.During the last week, I got a new preceptor who was all sorts of amazing. She took the time to listen to her patients’ concerns and to explain things to them. I wish so much that I’d had her for the entire rotation, because my entire experience would’ve been infinitely more positive. But you know what? I’m going to count my blessings. I will take 3 days over none at all.She would actually speak to me/have a real conversation with me, and learned my name within the first 5 minutes of meeting me, as opposed to never for my previous one. (Trish: So you’re saying she treated you like an actual human being?) She took the time to explain things to me, to ask me relevant questions, and let me see patients on my own. I enjoyed working with her so much that on the fourth day (aka hello, snowstorm), I actually still tried to make it out there (but was advised to stay home by the chief resident).

At least I got free lunch every day!

Memorable Cases

• Elderly patient with Alzheimer’s who was combative and paranoid :[
• Schizophrenic patients with many delusions of grandeur
• Lots of substance abuse/detox :[
• One of the patients was on the phone and crying, so I scoured the unit to find a box of tissues for her, and sat with her for an hour afterward to talk/listen
• I really loved seeing how supportive and encouraging the patients were of each other. I know it’s idealistic of me to think/hope for this, but I sincerely hope that they all kick their addictions.

Notable Quotes/Conversations

• “Thank you so much for talking to her; I wasn’t sure what to say.”
  “Sometimes, all someone really needs is for another person to listen to them.”
• “I feel a lot better now. Thank you for listening to me and talking with me. I’ll remember what you said.”
• “You should make sure you get enough rest. I can’t believe I’m telling you this…look at where I am right now. Who am I to be giving out advice?”
  I really appreciate it though. You’ll be out of here before you know it; I’ll be rooting for you and sending good thoughts your way!
• “Do you think I’m crazy?”
  No. I don’t think you’re crazy. Suddenly having thoughts like that out of nowhere would be hard for anyone to deal with, and the fact that you’re here to try to do something about it is a really good thing. I know it’s a lot easier said than done, but try not to dwell on the negative things–that often make it worse. I think you’re a good person though. Hang in there, okay?
  “Thank you.”

Oh, winter. :[ I’m glad you’re finally gone…

Resources

• Case Files: Psychiatry, by Eugene Toy and Debra Klamen
• First Aid for the Psychiatry Clerkship, by Latha Ganti & Matthew Kaufman
• NMS Psychiatry, by Joshua T. Thornhill IV
• UpToDate

Read about my other rotations here!