The consult/liaison psychiatry service at Ben Taub was pretty busy through June, but I worked well with my three incredibly awesome teammates to get the job done. 🙂 The oral exam last Thursday was a friendly reminder of how short a 30-minute presentation really is – I felt like I had spoken five minutes, looked at the clock, and rushed through the remainder of the presentation, hoping to touch on the major points. The resident said I did a great job, but there’s a part of me that knows I could have been better organized. Oh well, it’s finished. 🙂 And as far as the pass/fail shelf exam on Friday, true to shelf exam format, I felt like I read a novel after finishing. 100 questions with long stems are a nightmare for someone who has probably read 20 books in his lifetime. But that’s a different topic altogether. 😉
Psychiatry has shown me that, more often than not, it’s prudent to leave my opinions in the hallway while interviewing, diagnosing, and treating patients. Countertransference can be dangerous, especially in a field like psychiatry, where the very nature of treatment often involves improving emotions and relationships.
It also amazes me how some psych patients cope with their respective situations. For example, someone who got in trouble with the law repeatedly as a child going on to study criminal justice and work in a juvenile center to help those with the same problems he once had. Another patient who was a belligerent alcoholic, hospitalized and arrested several times in his youth, is now a counselor at Alcoholics Anonymous meetings. Life really does come full circle in these cases. 🙂
Recognizing the cardinal signs of suicidal ideations was a difficult objective from the beginning and even more difficult to address directly with patients. How do you ease a conversation into essentially asking someone if they want to commit self-harm? How do you gauge the patient’s response? I’ve seen numerous cases of depression secondary to prolonged bereavement, a general medical condition, drug use, etc. No matter the etiology of the depression, it’s always important to consider the patient’s safety to themselves and others.
I’ve also seen how debilitating conditions like paranoid schizophrenia and Alzheimer’s dementia can be to loved ones. The patient may be accustomed to their disease, but it’s always interesting to see the family’s perspective and how they cope.
So overall, my greatest accomplishment (aside from now being able to tell the difference between schizophrenia, schizophreniform, schizoaffective, schizoid, and schizotypal) is leaving psychiatry with a strong foundation in the psychotherapies, diagnoses, medications, and future undertakings of the field.
Now I’ll be putting away the DSM-IV-TR and swapping out my shirt, tie, and pants for some good ‘ole fashioned scrubs in preparation for my next rotation after the summer break – OB/GYN. 🙂