Tuesday, February 26, 2008

Psych Rotation

I am at the midpoint of my second-to-last clinical rotation of the year: 4 weeks of psychiatry. The first two weeks, I was assigned to the "medical psychiatric unit," which generally serves older patients who tend to have a lot of medical issues in addition to psychiatric ones. I chose this particular team because I know that I will have a significant elderly population in my family practice, and wanted to become better acquainted with the "three Ds": delirium, dementia, and depression. These three conditions are quite common in the older population and can all mimic each other, so I thought it would be important to get some experience at telling them apart. It was an interesting couple of weeks, but as the patients tend to stay in the hospital for awhile, there were not too many new admissions for me to interview and get to know. I did become much more familiar with a lot of the psychiatric drugs used on the unit, particularly some additional classes of antidepressants and then a bunch of the antipsychotic drugs and mood stabilizers.

I've just started my second two weeks, which will be on the consult/liason service. This is the psychiatric team that serves any patient who is in the hospital for a medical issue but needs to see psychiatry. Some of the common reasons we are called in to see a patient are depression and anxiety, particularly in the context of new or worsening medical illness, investigations of capacity to make medical decisions, and helping the primary team differentiate drug or illness-induced delirium from other neurologic or psychiatric conditions. I LOVE working on this service, because I get to go off and see patients on my own, take as much time as I like interviewing them, write up my findings, and finally present the patient to a resident and then the attending physician so that we can make final recommendations. It's a lot more independence and responsibility than on virtually any other rotation this year, which is very enjoyable! The residents trust the work that I am doing, but are also there as backup in case I have any questions, which is a perfect balance.

After this rotation is over, the entire 3rd year class will come back together for 3 weeks. We have some public health courses, some "back to basic science" lectures, a few experiences in the simulation center, and our Advanced Cardiac Life Support course where we learn how to participate in and run cardiac arrests in the hospital. Following that block, I have six more weeks of research time, then it's off to Arizona for surgery to finish off the year. It's hard to believe that the end of third year is in sight!

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