Rotation roundup: psychiatry

So I never seem to get to these on time.  So help me, it’s the med student semi-professional procrastination taking effect.  I also had 12 hours of driving over the weekend.  So mleh.

With psychiatry, we end the B track, now heading into the “core” rotations of pediatrics, general surgery, and general internal.  And while I’ll miss the more chillaxed B rotations, I’m ready to get going and finish up the rotations I doubt I’ll enjoy as much.

So with that, I give you the latest rotation review!

The where: Misericordia community hospital

The good: Psychiatry at the Mis has a bit of a reputation for being overly chill and with very few hours – this isn’t always true, but generally psychiatry hours are pretty great.  Typically you’re doing pre-rounding by 8:30 and done stuff on the wards by 11:00 since that’s when preceptors have clinic.  Some preceptors would rather you didn’t go to clinic with them, some are really keen on it, so it’s pretty person-dependent.  Either way, starting your day at 8:30 is an absolute luxury after obs/gyne.

And the staff.  Bless the staff, they’re by-and-large excellent people and excellent physicians and I was lucky enough to have 2 that I got along well with.  What always strikes me is the endless patience they give – no matter how many relapses or deteriorations a patient has, they still get excited when things are going well or they’re getting better.  It’s exhausting work, but they invariably use humour and empathy to get through the tough days, rather than getting snippy or short with the students…

Psychiatry isn’t exactly the most instantly gratifying specialty, but the work is immensely rewarding.  While suturing up a laceration is fun to do and can really do some good, you can change people’s lives in psychiatry.  You can help people get (and keep!) a job, help them battle addiction, and occasionally save a life.

On a personal note, I’ve always been a bit uncomfortable with psych, especially the diagnoses with bizarre behaviour.  This rotation really helped me get beyond my own biases and fears, so I have the patients to thank for that.

The not-so-good:  As previously alluded to, psychiatry is exhausting.  Not in the physical sense, like obs/gyne, but emotionally and mentally.  Especially the ER cases – you usually end up getting the patient’s life story (which is often horrible and heart-breaking) and if you don’t, you’re usually trying to talk to someone who’s experiencing an acute psychosis or mania and are difficult to communicate with.  While those on-call days often ended by 5:00, I was just as tired having done 6 hours of psych as I was doing 11 hours of obs/gyne.  And for me, on-call days didn’t usually end earlier than 8:00.  Plus it feels odd to spend 1.5 hours taking a history, 40 minutes reviewing with the staff and patient, then 45 minutes dictating.  There was one day where I spent an 11-hour day looking after 3 patients.

I’d never had a concern about on-the-job safety until psych, so that was a bit of a shock to the system.  After a while, you get acclimatized to the routine of getting a security guard to accompany you when seeing the aggressive patients… but I still felt pretty nervous seeing patients in lock-down rooms.  That being said, I worked on an “open” ward so we never followed anyone beyond ER if they were an immediate threat to themselves or others.  (As an aside, there are just as many potentially aggressive patients on other units, such as folks with delirium!  It’s just that psych tends to be the best-prepared and most cautious.)

The patients can be great to follow, especially if they do well, but some can be frustrating or downright infuriating.  Counter-transference is a huge deal on psychiatry, especially given the high percentage of patients with personality disorders.  I witnessed this several times, not just with myself but also with other staff.  And the trouble with personality disorders is that… well, it’s a personality thing.  It’s extremely difficult to unseat personality disorders and they often make treatment more complicated.

The verdict:  While I don’t see myself doing psych exclusively, I really enjoyed the time I spent on the unit and I feel immeasurably more comfortable treating psychiatric conditions.  All these things keep nudging me towards family medicine…

Time to meet some sick kids – see you on pediatrics!

 – Atalanta

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