I enjoyed my Psychiatry rotation very much. I found it very interesting how this specialty was the most integrated with non-medical fields, such as legal and social work. It was interesting to see the multidisciplinary team work so well together, made up of social workers, doctors, PAs, NPs, nurses, behavioral health associates, clerks, etc. Furthermore, while it is technically an emergency room, it seems that the team’s responsibilities do not end upon discharge. I was very interested in how the medical staff/ social workers would go out into the field in the form of the Mobile Crisis Unit or the ACT team. I also had a lot of contact with law enforcement during my rotation, as we had a few patients under arrest, and even an arraignment in our CPEP. 

 

The patients were definitely very different compared to the typical medical rotation. One thing I had to be very conscious of was my safety and being aware of my surroundings. When interviewing patients, I made sure that there were a few feet between me and the patient, there were no other patients behind me, and that I was not interviewing the patient when they were so agitated to the point of being potentially violent. Furthermore, much of the assessment was not based on what the patient told us but what we observed, thus giving rise to the Mental Status Exam. Another interesting aspect about working with psychiatric patients was the component of collateral. This would be speaking to a family member or social worker, etc, which often involved a certain level of investigative work to find such numbers. It was interesting how after speaking to a patient, you would come to one conclusion, which would be completely changed after talking to collateral. 

 

For my next rotations, I would like to be more proactive. For example, especially in the beginning it would often be slow and I would just study or do other work, especially since I was not accustomed to the patients. However, as time went on I should have gone on my own and interviewed patients, even without the direction (but with the permission)of the preceptor. This would have allowed me to get more experience with a larger number of patients than just those assigned to me. In my future rotations,  I will make an effort to see patients even when not directed to do so (and also as long as I am not agitating them) in order to further my experience. Also, I saw some of my classmates writing HPIs for patients we saw just for their own benefit which I thought was a great idea. I definitely want to try to write more HPIs on a daily basis to get more familiar with writing the report and being more conscious of the things I forget to ask/ the components of the history that are important. 

 

I am interested in working in the field of psychiatry, but I think the knowledge I have learned here will help me in many other specialties. Especially since I would like to work in ER, knowing how to assess a patient, write an HPI, and do a Mental Status Exam, will help me to evaluate some of the less intense psychiatric patients and thus not call for unnecessary psychiatric consults.