Just finished my Psychiatry rotation. We finished the clinical experiences in March but we completed the psychiatry NBME exam today. This is an old pic, just wanted to show you the psych attire. Usually scrubs or business attire with a jacket. I’m actually home comfy in bed. #TheQuarantineContinues

Most people deem the Psychiatry Clerkship a Psych-cation or Psy-cation ⛱️…I’m sure that accounts for the phenomenal hours and the faculty and residents that are understanding, down to earth, love to teach and just pleasant to be around. I appreciated that.

The Psy-cation was great but I’m not too sure that the “Vacation” part accounted for the clinical experiences, psychopharmacology and neurology. Psychopathology and pharmacology can be tough to grasp especially with the contraindications and drug interactions. So this vacation still involved some studying, just maybe not as intense. We had a good dose of psychopharm and psychopathology during our second year so it made the studying more so about recalling information then learning something new every time.  Some days I felt overwhelmed when it came to the patients I would see because I would continue to think about them throughout the day. I have a habit of looking at a situation and trying to understand what led to the circumstance along with what I would do if it were to happen to me. Then my mind begins to roam….

One of my patient’s was diagnosed with chronic schizophrenia, he heard voices daily telling him to kill himself and that he was worthless. For….YEARS. If I watch one horror movie I’m paranoid for a week. I see illusions of figures in the dark or hear things move in my apartment which creeps me out then leads to insomnia. I could not imagine going through what he was going through for that amount of time. Thankfully, we were able to help him with a regimen so that he didn’t hear the voices as often. Back in Surgery they called it “Vitamin H” aka Haloperidol.

I think a major problem I had was not being able to transition fully from that initial shock and empathy I felt after seeing the patient to figuring out the diagnosis and how to help them. In peds, as soon as I see a patient with asthma the transition is almost instant to thinking what can I do to make them better. But for some reason in psychiatry, I get so engaged with their history and presentation and I just feel so bad that I dwell too long in that initial state. The only time I feel better is when they feel better which could be within three days or a week or two…it depends. Then when I go back to see them the next day the process starts all over again. Sometimes I would freeze up or didn’t know exactly what to say.

I did have some good laughs though, every case didn’t make me feel bad. One of my patients started reciting a scene from the movie “Set it off”. She asked me, “Dr. Jones, what do you do when you’ve got a gun to your head!?” while she gestured holding a gun with two hands. She was smiling and playful the whole time she gave her history. My attending looked at her so serious, I just smiled. She finally cracked a smile and said let me stop playing with ya’ll. She had relapsed and felt herself going back to how she was before and wanted help so she voluntarily admitted herself. Another patient came in so he could better manage his bipolar disorder and find placement for housing. Every time I went to perform his AIMS exam he always gave me a motivational speech. 

Many of my patients were veterans and by the end of the rotation I gathered a lot of insight into what veterans go through. There was a lot of homelessness and substance abuse.

Whenever we would round, we rounded with a social worker or intern on our team to discuss resources available with our patient. It makes me so thankful for the resources available to veterans that don’t have a lot of family support because it’s so necessary. You basically dedicate your life to the military and when you’re finished life still goes on without all of the resources and admiration that came with being active duty. So many people struggle with that transition and some choose to do it alone. Another issue that was very prevalent was Military Sexual Trauma. I saw “MST” in so many chart reviews, I had to google it. There were too many clinical abbreviations, so I finally asked my resident…and when she told me I was shocked.

At least 75% of my patients had Military Sexual Trauma in their PMH, men and women.

I watched a film about it once, it was called the General’s Daughter. That’s instantly what I thought of. I know it’s a movie with a plot and all so it was made to be more dramatic and over the top but I still remember the scene to this day. There was another movie that came out in 2012 called the Invisible War that gave the accounts of soldiers who were assaulted and the repercussions that came after they came forward. The movie explained that Military women are more likely to be raped by a fellow soldier than killed by enemy fire. Only 8% of sexual assault cases are prosecuted in the military and only 2% result in convictions. At that rate…it would take a lot for anyone to come forward. Since the movie came out, it seems like a lot of legislation has been created to reduce sexual assault in the military. Hopefully the legislation is doing some good because with 75% of all my patients having MST, ranging from early 30s to late 70s…I can’t imagine how many cases would exist without it.

There were so many times I could really empathize with my patients because of my own struggles with anxiety and thoughts of sadness. Trust me, if you have ever been in medical school or really if you have gone through anything strenuous in life you’ve experienced that combination.

I ended up doing what the typical medical student does, trying to self-diagnose. My habit of making lists, planning excessively and sprinkle of perfectionism is a part of Obsessive-Compulsive Personality Disorder. I’m not saying I’m all the way there…I’m sure there’s a spectrum. LOL. Besides the perfectionist part…making lists and planning is a positive way to reduce stress and I do make a list for everything!

Sadly, I also noticed a lot of the symptoms of disorders in my family and friends. Of course, it is not in good taste to tell someone, “Ya know, it seems like you have a bit of _________ going on.” I’m just more aware of what that individual might be going through.

I can recognize different personality disorders with ease now. Even with the current psychotherapies that exist, they have to at least acknowledge that they have a personality disorder and want to make a change. So, I’ve used what I learned to identify personality types and how to deal with people with them. I’m sure everyone has a few characteristics from each personality type at times.

I feel like being a psychiatrist takes incredible skill. A psychiatrist analyzes every aspect of a patient’s history, behavior, affect and mood in a matter of minutes. In all of my rotations I felt like I could perform well but there were so many times in psychiatry where I felt like I just wasn’t doing enough (i.e. asking all the right questions or being able to observe and document every part of the mental status exam). Leading a psychiatric interview is something that cannot be mastered in just a few short weeks. You’ll be competent in it, but you won’t master it. Watching my attendings and residents during their interviews shift from topic to topic while staying focused on every detail of their speech pattern, thought process and then REMEMBERING EVERYTHING was remarkable. I’m over to the side just trying to write a word or two to remind myself of what to write in my progress note. One day…I’ll be that good. Lol. I was told pediatrics has a lot of psychiatry involved. I didn’t really get a chance to gain experience in child psychiatry because of my placement but I hope to gain some experience prior to residency. If not, I have 3 years to gain plenty.

So, overall Psychiatry was a bit of a Psy-cation but some of the cases I encountered really shook me. It’s different when you read about schizophrenia and how patient’s present versus sitting and interviewing a patient while they tell you about the voices they hear every night. OR watching a patient sit motionless for days at a time because the voices tell them not to speak or move. The greatest part is seeing them get better. Watching them transition from a full psychotic episode to just walking around having casual conversations was incredible. As well as seeing a depressed patient go from being suicidal to smiling and having hope for life again. I definitely feel more confident with leading a psychiatric interview and discussing mental health issues too.

—–Now, I’m off to finish this last rotation of my third year, Internal Medicine.