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Tag Archive for 'rotation'

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…

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.