Inpatient psychiatry is a really interesting place to start rotations.
The patients have to be physically stable to be placed on the psych floor, so I haven’t had to perform a physical exam. The psych version of a physical exam is called a mental status exam, which assesses a patient’s cognition, thought process, insight, etc. The diagnoses we’ve seen include schizophrenia, bipolar disorder, major depressive disorder, borderline personality disorder, and drug-induced psychosis.
We just shadowed our residents the first day. After that we were each assigned one patient each to follow, which includes pre-rounding in the morning and present to the attending. Some of our patients are very difficult, so we won’t always get to see them on our own. Doors are kept locked, so we have to stay with our residents pretty much constantly. Eventually we’ll get more patients as we get more efficient and figuring out what we’re doing!
How much we get to do depends on the day. Thursday we had grand rounds from 8-9am and lecture from 12-4pm, so I was barely at the hospital to see patients. Friday was a bit more normal, and I got to pre-round with my resident, present my patient to the attending, and happily discharge. I’m still learning how to use the electronic medical record system, so for now the residents are walking us through how they write notes and discharge orders so we can start doing them on our own (with physician review and sign-off of course.)
There is SO much to learn! I feel like I spend lots of my time looking up different drugs and googling acronyms to try to follow conversations. Psychiatry involves a lot of figuring out which medication or combination of medication best helps the patient, but all of them have side effects and alternate uses, so it definitely gets confusing! The physicians know SO MUCH and are so good with the patients – definitely something to aspire to!
And geez Louise, does the back and forth between generic and brand name gets frustrating!
The hours so far have been pretty breezy compared to lots of other services. We arrive around 7-7:15am and usually get to leave mid-afternoon. I’ve been going to the gym (though I haven’t been in the mood for great workouts) and then coming home to get in some studying. I think that’ll be the biggest challenge this year– figuring out how to balance being at the hospital with studying for the next day (your patients’ specific conditions, anything the attending may quiz you on) and studying for the shelf exam at the end of the clerkship. I still have no clue how to best do that but I suppose I’ll figure it out.
I’m headed to Minneapolis this weekend for my little brother and his fiance’s last shower before they get married in a few weeks! I’m excited to see their city and spend some time with relatives, but will definitely do a little studying to! The need to study feels very different now than when it was just for a test in the preclinical years — now there are actual patients in front of me and I really want to know what’s going on and what to do. I definitely don’t at this point, but that’ll come with time.
And last (and maybe least?) some outfits! I usually leave my white coat in the car and put it on when I get there.
- Monday: similar navy pants, similar striped top, these beige loafers.
- Tuesday: surprise day off since the residents were on retreat! So I wore spandex:)
- Wednesday: similar black sheath dress, similar driving mocs
- Thursday: black Martie pant, windowpane blouse, similar loafers
- Friday: light blue chinos, short sleeve popover, beige loafers
Gotta pack and head to the airport! Have a great weekend!