Wednesday, August 04, 2004

Psychiatry

As my first rotation comes to a close, I figured it was time to start a series. Not intending to go into psych upon graduation, this rotation was seen as a way to ease into 3rd year. In this regard, it didn't disappoint. However, I did come away with some surprises.

First off, the job is harder than most give credit for being. Because psych deals with many unknowns, it's quite easy for students and MDs alike to scoff at the purveyors of anti-psychotics as less than medical. While being wholy unfair, it's rather disengenious. True, the schedule is more lax,but to say the health professionals involved are not working as hard or expending as much effort as a CT surgeon is simply untrue. To paraphrase from a review article on dementia/delirium, the psych consult will have to make the distinction as most MDs will be unable. Try to remember that folks.

Secondly, I learned more in this rotation with regards to diagnosis, pharmacology and treatment than in my entire first two years of school. Maybe it's because I was finally able to put symptoms and diagnoses with treatment and drugs, as opposed to learning about them in separate 'pods', but whatever the reason, it's quite a feeling. We'll see how the shelf exam goes though before I post my 'Mission Accomplished' banner.

Lastly, I learned that while many individuals see physicians for more concrete reasons, taking psych into account is extremely important. The key to a good history is finding out some of those gritty details, such as family history of psych diagnoses, or even sexual abuse. Of course, these are usually the most uncomfortable questions to ask a patient, but that's why we get paid the little bucks. Most patients are more than willing to cooperate as long as you treat them as a human being, not as 1% of your mortgage.

All in all, it was a rather fulfilling experience. I know the upcoming rotations will test me in different ways (mostly stamina), but I fear I will not have the same great feeling that comes with taking an acute schizophrenic, restarting her Zyprexa, and sending her back out to conquer the world a mere 3-4 days later. The satisfaction that comes with seeing a truly sick individual recover in such a drastic fashion is something I will most certainly miss.

P.S. It's been rather hard, but I also learned that not being cynical of adolescent pysch inpatient is tantamount to treating them. Some kids are a pain in the arse, but any kid you see on the unit needs help. Be sure to provide it.