Psychiatry is so different from any other specialty. It is the place where I got to most work on my interpersonal relationship skills as very often patients were uncooperative and sometimes even aggravated and violent. Learning how to decelerate volatile situations was extremely useful and exciting.
At first it was a bit difficult to fit in as, as in the other places, it was a small microcosm of people who work very tightly together, and a new influx of people may seem like a distraction in a busy ER setting facility. However, once I showed initiative and interest, things have changed for me dramatically and everyone became very eager to teach, answer questions and give me interesting patients.
I have worked out a routine where I see the patient and write an HPI and a SOAP note on every patient I saw. I would ask the providers to check my notes/HPIs and give me feedback. After some time, when the providers I was working with started to use my notes as their own, I knew I was in.
Interviewing an agitated patient or a patient who is refusing to speak to me remains my biggest challenge. I plan on practicing the skills I’ve learned in Interviewing and Counseling such as defining their goal (most of the patients just want to go home and I’m there to clear them), so asking “How can I help you better, would you like to stay here for a little bit longer or are you ready to go home?” usually helps elicit “I want to go home”, to which I would answer “ So help me clear you so you can be on your way soon”. I also plan on hopping in on as many patient interviews as I can as that’s the best way to learn how to tackle any situations.
My perspective on mental illness has changed dramatically as I realized more people have it than we think and majority are well functioning members of society if they are compliant with their medication, so compliance education is key.
A memorable patient experience I will carry with me was with the patient who had “florid psychosis”. I spoke to her for over an hour and the autobiographic information she was giving me was just mesmerizing. Of course, none of it was true but it made me realize the beauty of our brain and limitlessness of our imagination. She could have written the next Harry Potter if she wanted to.
Having experience in Psychiatry is useful for any practitioner and for anyone period as it helps navigate interpersonal skills in a tremendous way. I definitely feel more comfortable speaking to “difficult” patients knowing how to bargain with them to get what I need to be able to help them better.
I have learned about myself that I love psychiatry, which was not a surprise for me at all, and that I absolutely see myself comfortably practicing it once I graduate.
This rotation made me more confident in navigating EMR and constructing a good HPI, which started to come more naturally than ever before.