my secret life as a psychiatrist

so, im on this rotation named 'med-psych'. i actually thought about doing med-psych combined residency and was thinking this month might be like that, but the name med-psych is somewhat of a misnomer. the month is more a combo of physical diagnosis rounds, lectures, simulated patients, reflecting on experiences, clinic, and some psych here and there.

psych was actually one of my most fave rotations in med school, so im happy to be doing some psych this month and learning about how the psych department interfaces with medicine as a consult service and what services are available both on the inpatient and outpatient side of things.

i was basically just oriented on my first day on psych consults, saw a patient with the attending, and then listened to social workers in the ER talk to the attending about cases. the next time i was back on consults, the attending was swamped, and asked if i wanted to see a patient on my own. of course, i said yes! it was my chance to be a true med-psych person for one day.

the consult was to evaluate a woman who had some chronic chest pain for anxiety. i fumbled through my disorganized papers and kicked myself for not having on hand the lecture notes on anxiety disorders that this same attending had given me a few days before. i was paying attention during the lecture, i swear, but it still helps to ground myself before i go to see the patient. in any case, i read some stuff quickly online, looked over the patient record, and then went off to see the patient.

when i entered the room, the nurse was giving some medication, so i just said "Hi" and waited for him to finish. the first thing the patient said to me was, "Hi! You're really beautiful." internally, i was like uh-oh, this could be trouble. after saying thanks for the compliment and asking how she was doing, i introduced myself as an intern with the psychiatry team. the patient totally flipped and yelled at me to get out, saying she did not want to see a psychiatrist, did not need to see a psychiatrist, and didn't want anything to do with psychiatry. i tried to clarify that i was not an actual psychiatrist (but was working with the psych consult team) and just wanted to ask her a few questions. the nurse had my back (yay!) and was like, 'why don't you just listen to what she has to say before you tell her to leave?' unfortunately, this was to no avail, and she kept yelling at me, saying she was going to sue the hospital, asking who had sent me, etc. i switched tactics and asked her if she'd had a bad experience with psych before, but she wouldn't respond. eventually, i ended up leaving, and the nurse was like, "well, you can't help people who don't want to be helped."

i was dejected as i headed back to one of the doctor work rooms to page the psych attending. i felt like i had failed without even trying, and wasn't helping out because i wasn't able to complete the consult. when i talked to the attending on the phone, she apologized for putting me in that situation and said that i'd done what i could do. patients who are competent have a right to refuse psych consults (or any other procedure) but i still felt like there was unfinished work to be done on her - i hope the primary team was able to sort things out.

after my unsuccessful attempt to see a patient alone, i accompanied the attending to see a pleasant man who was totally manic after he had been taken off his psych meds during a medical hospitalization. he was seriously talking a mile a minute, not making a ton of sense, and constantly on the move. the psych attending miraculously was able to get him to sign a voluntary commitment form for him to be transferred over to the psych ward after spending about 10 minutes with him, redirecting him at times, and just trying to listen to what he had to say (which was a lot). i hope he gets back on meds that help him get back to his baseline and he can go back to living in his pseudo-assisted living facility for people with chronic mental illness.

despite not having gone into psych , im happy i had a chance to do some psych consults this month and attend some psych lectures, which i've really enjoyed, except for an off-topic comment by one of the lecturers about how he didn't believe that accepting pens or other paraphernalia from pharmaceutical companies was a conflict of interest. "As if we were so easily swayed," he muttered. it was the end of the lecture and i didn't want to drag it into lunchtime, but under my breath i was like, "We totally are! And there's tons of EVIDENCE to prove that marketing makes a DIFFERENCE in physician prescribing patterns." and then i remembered from amsa days that the APA has a really terrible record of accepting all kinds of $$ from pharma and that ive rarely seen a pharm-free psychiatrist. oh well - have to choose your battles, right?

in conclusion, even though my med-psych month is ending, im sure ill have *tons* of psych issues to deal with in my own clinic (ive already had two patients with bipolar disorder) and also on the wards. more to come! :)