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Tag Archive for 'psychiatry'

speaking of psych hospitals…

So I’ve been done with my psych clerkship for awhile now. I’ve just been too lazy to write. But this article about a woman collapsing then dying in the waiting room of a psych hospital and then going unnoticed despite the activity there for an hour or so is appalling enough to make me break my silence.

You see, I was at a psych hospital myself for the last four weeks of the rotation. It was made out to be quite a scary place, what with all the warnings of, “always watch your back” and “take staff with you to interview your patients.” Not to mention the crazy long self-defense class they forced us to sit through on orientation where all I retained was to always yell, “STAFF!” if I got in trouble. Thankfully, I survived my four-week stint there unscathed and quite intrigued by these patients.  Sure, some of them are pretty manic and psychotic (at the same time, an awesome combination) and others have quite scary histories of assaulting family and staff, but I grew to be fond of most of them. Except for my super antisocial patient for whom I always made sure to have staff present. And except for the manic guy (who wasn’t even my patient) who had an Asian fetish and managed to trap me in a room (thankfully, I was able to shut the door on him before he got in, but then I had no way out). This same guy then made friends with another psychotic patient who also had a thing for women (not just Asian, but all women) and they teamed up to harass me. But I wasn’t groped or assaulted, so I was happy.

But back to the article that brought me out of hiding. From the rest of the story, it seems that this particular psych hospital has a history of not treating patients so well. This latest incident seems to be a sad and extreme example of the type of behavior that can occur at psych hospitals. I was always amazed that fewer incidents are reported of things happening between patients because they’re all allowed to mingle with each other. You would think that putting a bunch of psychotic/manic/depressed/personality disordered people together would not be a good idea. But it seems to work. For the most part. Things do happen. Patients do get into it with each other. But it works remarkably well. And in the case of the hospital mentioned in this article, what happened to this patient was not a result of other patients, but of lack of concern from the staff.

Even though nothing even remotely close to what happened in the hospital mentioned in the article happened at the facility I was at, I can see how things can deteriorate to such a point. There are not enough staff members to provide the kind of attention these patients often need. Staff is spread quite thin and many of these patients are not exactly easy to work with. They take a lot out of a person. I was always happy to retreat back into the residents’ room after spending just 15 minutes or so out in the patient area. Staff members cannot retreat. They must be out there all of the time, dealing with these patients. They also have their share of difficult patients. And, unfortunately, their dealings with these few difficult patients color how they deal with everyone else. They have to stick to strict regimens, such as not giving patients snacks if they miss snack time so that patients will adhere to their snack schedules. I understand that. But at the same time, there are patients that come into the facility on legal holds who are not psychotic and who are pretty reasonable who just happen to miss snack time or need an extra snack. It breaks my heart when these patients go ask for a snack and get sternly turned down when they could have been denied more gently. That kind of treatment of these relatively reasonable patients causes them to feel that they are not being treated as fellow human beings, which then leads them to become irritated and possibly get into altercations with other patients, even though they are not normally violent people.

I do not blame these staff members for how they approach their patients. Of course, I’m not out there everyday dealing with all of these patients, so who am I to tell them how to do their jobs? But what I can say is that the system is not perfect. Our resources are spread thin and patient care suffers. Perhaps, if there were more staff members, they would not need to be so limiting to everyone just because of a few bad apples and would be able to get to know their patients well enough to decide which ones are reasonable and which are not in order to better customize how their care. Oh, if only we lived in a perfect world…

i am so going into radiology

After 1 week of psych consult, I learned that I do not, under any circumstance, want to go into Internal Medicine. How anyone can stand the smell of someone else’s diarrhea is completely beyond me. And I’m from psych consult! I probably had to smell it for, what, five minutes? Yeah, well, five minutes is far too long. I cannot imagine being on Medicine and actually having to do a physical on someone who stinks of poo. Let’s just say that I was actually glad I hadn’t eaten before seeing this patient because I would have surely vomited otherwise.

We get a lot of consult requests from the various Medicine teams in the hospital. So I’ve had the distinct pleasure of visiting many Medicine areas in the hospital. And they all have that distinct hospital smell that I have now grown quite sick of. Sometimes, this smell is intermingled with the distinct smell of poo. The people in these areas tend to be pretty sick with multiple problems. And MRSA. I guess I should be glad I’ve learned how to gown up for such situations. But, really, I just don’t like it.

At the end of my second week, I learned that I don’t like talking to patients. Or their family. Or anyone else, really. Sure, I already knew that, but I thought it would change when I started wards. That something inside of me would magically change and I all of a sudden wouldn’t be socially awkward anymore or hate talking with people. No such luck. There’s nothing like knowing nothing to really make you not want to open your mouth when speaking to patients. Patients who expect you to know everything.

By the end of my third week, I decided that I’m going into Radiology. Over the weekend, I debated whether it was really what I wanted because I never really liked what little Radiology I had been exposed to in my first two years of med school. And it’s also 4 years on top of an internship year. Plus I’d want to either do a Neuro or Interventional fellowship, which would add another 1-2 years, making it 6-7 years total, far too long a time for someone who has already wasted 4 years on a PhD that she’ll likely never use. So I had my doubts.

Then, yesterday, my attending insisted on watching me interview a patient. These kinds of situations are particularly painful for me because of my social awkwardness and nervousness when being watched by other people. Of course, I get a psychotic patient. Which I’ve never seen before. So I really concentrated on making sure I asked the right questions on the timecourse of his symptoms as well as things to rule out depression and mania and the like. And because I was being watched and didn’t want to waste the attending’s precious time, I directed the interview more than I usually do, sometimes cutting off the patient’s rambling answers to interject my own questions, but never too brazenly. I also took this approach because I’ve gotten quite a few delirious/talkative patients who would talk and talk and talk without making much sense, making for really long pointless interviews and I was kind of tired of it. Also, I was modeling the interview style of the other attending, who I’ve worked with more than this particular one, who keeps things nice and short. Well, at the end of it all, this attending called me an unempathetic information gatherer. Now that might sound painful to those who aren’t used to hearing themselves being described that way. But it didn’t surprise me at all. I actually wanted to respond by saying, “Tell me something I don’t already know” because I didn’t find that assessment particularly useful. I know that I suck at empathy. That’s because I suck at social interactions, period. Sometimes, I think I have Asperger’s. And the sad thing is that I was actually trying during this interview. Though not as much as with unwatched interviews because I always feel so fake doing such things and didn’t want the attending to call me out on it. Yeah, that plan worked out well.

So, that’s how I’ve come to decide that Radiology is for me after just 3.5 weeks on rotations. The only thing that might change my mind is Surgery. But I doubt it. And I’m sure my attendings will be glad to know that I won’t be spreading my unempatheticness wide and far.

one week down, 47 more to go

So I’m done with my first official week of third year. And it sucks. I don’t know if I’m supposed to feel this way, but I kind of hate it. Maybe it’s because I’m on psychiatry adult consult and all I’ve seen this week is malingering, delirium, and dementia, all of which involve pretty hard to interview patients. I suppose my malingering patient wasn’t that difficult, except for the fact that he was a prison inmate and kind of scared the crap out of me. But I definitely didn’t figure out the malingering part, which makes me an idiot. I’m so tired that even 10+ hours of sleep last night wasn’t enough to make me not feel dead tired today. And this is just psych. It’s not medicine or surgery. I wake up at 5 in the morning so that I have plenty of time to preround on my one patient (I have two now, so I’m not quite sure how I’m going to pull it off on Monday). That’s how slow I am. At this rate, I might as well not leave the hospital when I’m on medicine and surgery because there’s no point when I’ll probably have to come back in an hour or so since I’m so slow. Not only am I slow, but I don’t know shit. My fellow psych consult-ees all claim they don’t know anything either, but it sure doesn’t sound that way when they present their patients. I’m just waiting to get yelled at because I’m so incompetent. In fact, I’m surprised I haven’t been yelled at yet. I figure they’re just holding it all in until next week, when they can safely assume that we should know what we’re doing.

I know I complained to no end about grad school sucking, but I think I almost prefer that now. At least I’ll have plenty of sleep and not be exposed to people with Hepatitis B and C every damn day. Nor will I be living in constant fear of getting yelled at. I hear it’s inevitable. My fellow psych consult-ees have all already gotten yelled at. It’s just a matter of time before it’s my turn.