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

In this rotation, many patients with psychiatric conditions were not compliant with medications. They would be found with disorganized behavior by friends and family and got admitted to the inpatient unit. They would also usually have poor insight into their psychiatric condition and the need to take medication. In this situation, it was also very difficult to explain the importance of medication to patients with psychiatric conditions because they had difficulty understanding. They had lack of awareness of their illness. Some even heard voices telling them not to take medication. Patient’s failure to adhere to their medication as prescribed would also have a major impact on the course of illness and treatment outcomes. Long-acting medication would solve the problem of having to take medication every day. I learned that it was very important to understand the medications, such as their mechanism of action, metabolism, side effect, and indication in order to help patients to be more compliant with medication.

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc). 

My perspective had changed as a result of this rotation because I had found out that I was enjoying this rotation more than I had expected it to be. Although the psychiatric patients were poor historians, it was interesting to interview them. These patients were able to provide different kinds of stories. Clinicians actually had to sit down and observe in order to get to know their symptoms and come up with the diagnosis, without even touching the patients. Psychiatric patients were also acting in very disorganized and bizarre behaviors. The attendings, NPs, social workers, and nurses all know their roles in order to be in the team to provide quality care for the patients. They were also very friendly and willing to teach students.

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

I have learned that the mental status exam for the psychiatric patients is like a stethoscope. We have to ask specific questions to know what they are thinking at the moment, as well as utilizing great observation skills. We have to observe their appearance, behavior, affect, speech, psychomotor activity etc. In the previous rotation, I have never observed patients in this much details. I learn that the time we put into observation can greatly help in the assessment of the patients. Paying attention to details will also be applicable in other rotations. When interviewing patients, I would not spend all my time writing notes in my book or typing in the computer. I would be paying more attention to the patient instead.

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

In this rotation, I was not able to complete a lot of hands-on procedures on the psychiatric patients. Although I had done procedures in the previous rotations, I would still like to have the opportunity to practice more procedures. For the following rotations, I would like to be more proactive in order to get the chance for hands-on procedures. In addition, I would like to work on setting up treatment plan and know what to do with discharging patients. I would try to discuss with my preceptors and know how to improve my treatment plan for the patients.

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