1) Types of patients you found challenging in this rotation and what you learned about dealing with them

During my psychiatry rotation, there were many patients I found challenging because everything had to do with trying to understand what is happening in the patient’s mind. Several patients in this rotation have a hard time trusting the providers and telling them about all their symptoms because so much of it is about the way they think and what is going on in their minds. They might be uncomfortable or feel judged about how they are feeling. For patients who come in for depression, I learned to make them feel comfortable by letting them know we are here to help them and they will not be judged. If they did not want to share something or looked uncomfortable we told the patient it is okay for them to take some time to themselves and then they can tell us later when they are ready to. When it came to agitated/aggressive patients, I learned to ensure my safety first. I noticed the providers administering medications if they are acutely agitated and aggressive and then going back to them later to interview them. Or we can call for collateral information from family members if the patient is too agitated or refusing to tell us anything. If they refuse to give information I learned to not spend hours forcing information or bringing in enforcement but rather to come back later and try again. 

2) What do you want to improve on for the following rotations? What is your action plan to accomplish that?

In following rotations, I want to improve on providing patient education and deescalating situations. Many patients who came in for suicidal ideation were non-compliant to treatment plan and just wanted to go home. But, the provider took their time to tell the patient that they are being kept under observation for their own safety. Getting frustrated at them or dismissing them when they repeat the same question will just escalate the situation and make the situation worse. Patient education requires a lot of patience and good emotional connection with the patient so they can feel comfortable enough to trust us. When patients become non compliant with their medications and become aggressive due to that, patient education also becomes important to calmly explain to them why they should take their medications. My action plan for the future rotations is to educate patients more and take the time at the end of the visits to tell them about the medications they were prescribed or preventative methods. This will help me become more comfortable at talking to the patients. I can also listen to other providers deescalate situations when patients are brought in by family members or NYPD and they do not want to be there, something I will probably see in my ER rotation. Listening and seeing how providers approach and deal with these situations will make me more confident in conversing with patients.

3) Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them

One skill that was difficult for me in this rotation was performing the mental status exam (MSE). It was very difficult to remember all the parts of the MSE in the beginning without having a checklist with me. In my past two rotations (peds and OB/GYN) I did not have to perform any MSEs. In the beginning of this rotation, one of the doctors we worked with went over the MSE with us which was the first time many of us heard about it after learning it in the didactic year. What also makes doing MSE more difficult is that sometimes the patients are agitated or aggressive and you have to quickly take notes mentally on how their MSE would be, at least the components that I can do without speaking to the patient. While speaking to the patient I had to make sure I was subconsciously noticing their concentration or appearance which are part of the MSE and remember them for later. What really helped was that when we did our H&Ps for site visits, we were required to write out MSEs for our patients. Doing those really made me take my time and review all the components of the MSE. I was also able to search different types of things I can say for certain parts such as different types of affect. Going forward, I would definitely incorporate them more in some of my other rotations such as in my ER rotation so I can memorize all the parts better. 

4) What was a memorable patient or experience that I’ll carry with me?

One experience I will carry with me is being able to collect collateral information from families/friends to collect more information about the patients. This is something that we probably would not do for other rotations because most of the patients will cooperate or be able to communicate better than a patient who is brought in for a manic episode for example. The patient might not be able to tell us how they usually are when they are not experiencing these symptoms. Calling family members and friends helped us decide our next steps with the patient. For one patient I was told to call the precinct so that was definitely interesting. It taught me what questions to ask without violating a patient’s privacy but at the same time obtain a good idea of how they are at their baseline. It was intimidating at first because we did not know what questions to ask but over time with more practice I was able to obtain the necessary information to decide if we should admit or discharge the patient.