For this site evaluation, we were evaluated by Dr. Saint Martin. For our mid rotation evaluation, I presented a patient who originally came into the ER for hypoglycemia but exhibited suicidal ideation. Psych was consulted and after speaking to the patient, we concluded she had major depressive disorder. One thing that was unique in the H&Ps that we wrote for this rotation was that as part of our evaluation of the patient, we had to perform a Mental Status Exam. This was the first time I had to write one out compared to just remembering the parts of it. Another thing that was different from our previous rotation evaluations was that Dr. Saint Martin asked us questions about our cases instead of just having us present our cases. This was a good way to discuss various topics and make us think about other concepts having to do with our patients rather than just what we wrote and know about already about the patient. We needed to have a good understanding of our cases so we were prepared to answer any questions. He asked me about differences between bipolar 1 and 2, different ways to check for alcohol use in patients and other workups I could’ve done for my patient such as a CT since she was an elderly patient. He also gave me feedback about my mental status exam write up and said that it was good. For my final site visit, I was assigned to present the differences between bipolar type 1 and 2. For the other students, we talked about use of CBT in depression compared to SSRIs, Botox use in depressed patients and prevalence of schizoaffective disorder in the U.S. 

For our final evaluation, I prepared a second case about a patient who presented with depressive symptoms and a third case about a patient experiencing a manic episode. I chose to present my second case. The patient for my second case presented with worsening depression after experiencing a miscarriage five months ago and was starting to exhibit suicidal ideation. Patient also had a depressed mood, fatigue, feelings of guilt and hypersomnia almost every day for the last 5 months. Patient was referred for outpatient therapy at the end of the visit. I was asked about my thoughts about starting therapy versus starting medications such as SSRIs for this patient. I was also asked about what I would do about the patient’s elevated blood pressure and if I would start her on any weight loss medications as well due to her high BMI. We discussed the requirement of postpartum depression as a differential and if we can consider that for this patient even if she did not give birth to a live baby. Definitely something I will read up on for the future. After that I presented my article about the classification of Bipolar type 1 vs. Bipolar type 2. 

 I really enjoyed this rotation because all the cases were unique and I was able to work on my patient interviewing skills because obtaining a good history was really important to treat the patient. No two patients had the same history which made it really interesting. Unlike other rotations, the physical exam does not play a huge role in psychiatry. From this site evaluation, one thing I had the opportunity to become better on is the mental status exam. Completing MSE for all three H & Ps really helped me become more comfortable with them and will definitely implement it more in my future rotations. Throughout this rotation I learned how to collect collateral information from family members, how to ensure my own safety and my colleagues and how to create a safe space for patients who might feel vulnerable. Going forward one thing I will work on is my differentials. For the H&Ps we wrote for this rotation we had to write why we considered a diagnosis to be possible instead of just listing them. This encouraged me to research each differential and get a better understanding of topics. I will also make sure I know the case I am presenting very well, even including the vitals. Overall, through these site evaluations I was able to master big topics in psychiatry such as depression and bipolar which I will carry on into my future rotations.