Psychiatry Rotation Recap

It’s been 2 weeks since I finished up my psychiatry rotation. I was assigned to the consultations & liaison service. Other people in my rotation group were either assigned to outpatient psych where you see patients in an office or inpatient psych where you treat patients in the hospital’s psych ward.

The way the consultation & liaison service works is that whenever another team in the hospital (e.g. internal medicine, surgery, OB/gyn, etc) suspects that a patient needs psychiatric evaluation, they call us. The consult team then evaluates the patient and screens for conditions like depression, schizophrenia, bipolar disorder, and a number of other psychiatric illnesses. Then the consult team decides whether this patient would benefit from admission as an inpatient or if the patient should follow up with a psychiatrist as an outpatient.

Some days were slow, but when we were busy we were BUSY. It’s like the patients all had a group text together and decided that on specific days it was time to turn up.

But all jokes aside, I learned so much from my psychiatry rotation and got to interact with a new subset of patient’s that I’d never interacted with before.

If you’re a regular to this blog, then you know I like lists, so let's just get right into it. Here's what I learned.

1.   Not all patients are dangerous- The residents would frequently tell us “They’re more afraid of you than you are of them” when we first started out.  And I’ll admit, on the first day when they told us to make sure our hair was always in a pony tail and to always stand between the patient and the door, I felt like I was going into combat. But as time wore on, I was able to relax a little and focus on treating the patients. And in addition to treating psychiatric patients always be mindful of where the exits are and how to de-escalate tensions when your patient's get riled up. 

Psychiatry requires you to read your patients well. Before you go into the room (as with any specialty), you must read up on your patient’s history to take the proper precautions if need be. Reading and understanding your patients is not just for the physician, but also for the patient’s benefit. There were many times we were dealing with a “difficult patient”, and at the point where I would have call it quits, our attending would ask a strategic question and then the floodgates would burst open and the patient would tell us all the info we needed to know. So try to exhaust all avenues before you write off a patient.

2. Getting a complete psychiatric history is like playing Sherlock-  Because of their mental state many patients are  considered “poor historians”, meaning they either tell you incorrect information or just cannot remember certain information. Our team had to rely on a lot of collateral information from family, friends, core service agencies, and pharmacies to complete our patient histories and to get an accurate picture of what was going on with the patient. It’s not impossible, but it definitely takes some effort. 

3. Empathy is everything- You’re asking people to open up about the most personal aspect of their health- their mental state. Patients should feel comfortable enough to open up, and their openness should be positively reinforced with empathy and affirmation. 

There was an older lady we worked with one week, and I swear she hated me. I’m guessing it had to do with the fact that I slipped into the room in the middle of her interview with the resident and my other medical student colleagues (I had to use the bathroom, sheesh). Before I entered, I could hear her screaming from the hallway, so of course I went in. As soon as she saw me she turned alllll the way up. We’re mortal enemies at this point. I didn’t know the patient, so I just assumed she was whylin, especially since her history was significant for dementia.

As luck would have it, my attending wanted us all to go to her room a couple of days later to see how she was doing. I assumed that she’d be the same as when we saw her days earlier, so I hid behind the curtain in the room while the attending was speaking with her lol.

Shockingly, the patient was much more pleasant with the attending which I attribute to our attending being more patient and empathetic. The patient even said that our attending was the first doctor to ever really listen to her. Now don't get it twisted, the patient seemed to be a little delirious and possibly seeing things that weren't really there, but our attending's empathy allowed the patient to be more open.  From their conversation and some additional testing, our attending decided that the patient wasn’t demented, she was just getting older and needed someone to help her take care of herself.

Long story short, empathy benefits both the patient and the clinician and facilitates more honest and open communication which contributes to improved patient care.


4.  Practice Makes perfect- Taking a psychiatric history is totally different from taking a medical history. The easiest way to tackle this is to act like you’re having a casual conversation with the patient about life. There’s a wealth of information that can be gleaned from a simple conversation. 

No matter how you choose to structure your patient interview you must ask about the following: suicidal/homicidal ideations, hallucinations, depressed mood, and manic episodes just to name a few.

When I first started taking psychiatric histories, I’d run out of things to ask and just sit there lookin dumb, but that’s because I was being “overly clinical” (per the practice patient in the clinical skills center), meaning that I was merely asking questions to check off of a list instead of engaging the patient in conversation.

When you focus on asking specific questions instead of letting the conversation flow naturally, you will miss some things. The more patient interviews I was able to conduct the easier it was for me to get the information I needed.

So there you have it. My psychiatry rotation experience in a nutshell!.Hope you enjoyed. Now on to family medicine!

Judy Oranika