Reflections on Psychiatry

As you may recall, save for the time I got to spend interacting with my preceptor’s patients, I did not enjoy my psychiatry rotation. At all. (Until the last 3 days, but I’ll get to that.) I took to attending the patients’ group therapy sessions to pass the time, which manifested into a couple Medical Mondays posts, so…at least there’s that!

Most of my friends had already done their psych rotations by the time I got to doing mine, and all of theirs had been super chill. “You’ll probably get out by noon every day. Maybe 3 p.m. on a really late day.”

I admit that I walked in with these thoughts in my head, and this may have initially colored my perspective. But only by a little bit. If my past educational history tells you nothing, I am completely fine with long hours. But only if I’m actually doing something productive, meaningful and/or useful.

My shifts were 11-12 hours each day, and 85-90% of my first three weeks was spent in a corner of his office trying to study without internet access whilst listening to him do his dictations. His supervisor actually came in one evening to tell him that he was keeping me for too long…and he laughed, and kept me there for another hour.

Reflections on Psychiatry

reflections on psychiatry

  1. Do. Not. Want.
    The first 3 weeks of my rotation pretty much cemented the realization that OB/GYN was actually no longer on the top of my “do-not-want” list. Nope. Psych shoved it out of the way on the very first day (I haven’t even done my OB/GYN rotation yet.) But you can’t have everything in life, and you gotta take the bad with the good.
  2. Learn how to work with someone you really don’t mesh with.
    Be understanding.I think I’m a fairly easygoing individual, and I honestly cannot recall a time where I really, truly couldn’t find some sort of a common ground with someone. This one took a lot of work. It wasn’t that my preceptor wasn’t nice–he was pleasant and very polite, but would also simultaneously make me feel like I had no functional brain cells when he was asking me questions. I had a very hard time understanding his accent (especially in the beginning), and he had a tendency to mumble and/or trail off his thoughts, so it always took a lot of repeating before I’d finally get the entire question, and by then, he’d already have chalked it off to my apparent stupidity.While I really do hate feeling like a brainless moron, that actually was not what made this rotation so miserable for me. It was in how he talked to his patients. Don’t get me wrong–medically speaking, my preceptor was brilliant, and he definitely got the job done. Mayhaps I’m just one of those bleeding heart cases, but I think psych is arguably one of the fields where you need to be an amazing listener, and even if you don’t care on the inside, you should at least act interested in helping them.As a fledgeling third-year medical student, I realize that I am in no place to criticize, but in the future, I would like to think that I’d show more compassion, and that I wouldn’t have a set script that I’d ask each patient, almost-regardless of what they were coming in for. I’d like to think that I’d actually listen to them, and that I wouldn’t answer, “Any other problems?” after a patient had just told me that she’s been on her own since she was 19, because her parents left her, and her grandparents died in a car accident.
  3. Fake it til you make it.
    Shortly after realizing #2, I decided that approaching this rotation with the negativity I was feeling was not going to cut it, so starting on my second day, I walked in each day with internal pep talks galore. I talked with the staff and the patients whenever I could, and also brought half a billion books/notes so I’d have something to study for all the hours that my preceptor was gone for. I think my [previously-nonexistent] poker face has vastly improved because of this rotation. I’m not sure my first preceptor ever realized anything that was going on through my mind during the majority of this rotation.
  4. Pick your battles wisely.
    I avoid conflict whenever possible, but when necessary, I do like to try to explain my point so that possible misconceptions can be cleared up. This is good and all, but when you realize that there’s no point in arguing because the other side is clearly not listening to what you’re saying, you learn to bite your tongue and just smile and nod.Case in point, I was actually given an 85% in “interpersonal communication” and “professionalism” for this rotation, and I have no idea where that came from. (I’ve never gotten anything lower than 90 or 95% in those two categories, and even for that 90, I was all sorts of upset. So imagine this.)I liken the “interpersonal communication” grade to the “being a nice person” grade, and I do not think I deserved a B in that realm at all, especially when I’d spend so much time talking to the patients, actually listening to what they told me, and trying to help them to find better ways to cope with their problems.But of course, my preceptor would never have known that, since he was never there to see it happen.
  5. Silver linings. Look for the good in everything.
    The staff was amazing, and almost all the patients were very pleasant (at least to me). This rotation really made me miss my family, so I have it to thank for bringing me somewhat closer to my mom, too. I called home a lot because I was pretty miserable.During the last week, I got a new preceptor who was all sorts of amazing. She took the time to listen to her patients’ concerns and to explain things to them. I wish so much that I’d had her for the entire rotation, because my entire experience would’ve been infinitely more positive. But you know what? I’m going to count my blessings. I will take 3 days over none at all.She would actually speak to me/have a real conversation with me, and learned my name within the first 5 minutes of meeting me, as opposed to never for my previous one. (Trish: So you’re saying she treated you like an actual human being?) She took the time to explain things to me, to ask me relevant questions, and let me see patients on my own. I enjoyed working with her so much that on the fourth day (aka hello, snowstorm), I actually still tried to make it out there (but was advised to stay home by the chief resident).
drugreplunchpsych

At least I got free lunch every day!

Memorable Cases

  • Elderly patient with Alzheimer’s who was combative and paranoid :[
  • Schizophrenic patients with many delusions of grandeur
  • Lots of substance abuse/detox :[
  • One of the patients was on the phone and crying, so I scoured the unit to find a box of tissues for her, and sat with her for an hour afterward to talk/listen
  • I really loved seeing how supportive and encouraging the patients were of each other. I know it’s idealistic of me to think/hope for this, but I sincerely hope that they all kick their addictions.

paranoid

Notable Quotes/Conversations

  • “Thank you so much for talking to her; I wasn’t sure what to say.”
    “Sometimes, all someone really needs is for another person to listen to them.”
  • “I feel a lot better now. Thank you for listening to me and talking with me. I’ll remember what you said.”
  • “You should make sure you get enough rest. I can’t believe I’m telling you this…look at where I am right now. Who am I to be giving out advice?”
    I really appreciate it though. You’ll be out of here before you know it; I’ll be rooting for you and sending good thoughts your way!
  • “Do you think I’m crazy?”
    No. I don’t think you’re crazy. Suddenly having thoughts like that out of nowhere would be hard for anyone to deal with, and the fact that you’re here to try to do something about it is a really good thing. I know it’s a lot easier said than done, but try not to dwell on the negative things–that often make it worse. I think you’re a good person though. Hang in there, okay?
    “Thank you.”
iciclesoncar

Oh, winter. :[ I’m glad you’re finally gone…

Resources

  • Case Files: Psychiatry, by Eugene Toy and Debra Klamen
  • First Aid for the Psychiatry Clerkship, by Latha Ganti & Matthew Kaufman
  • NMS Psychiatry, by Joshua T. Thornhill IV
  • UpToDate

winterinpsych

Read about my other rotations here!

Permanent link to this article: https://www.fairyburger.com/reflections-on-psychiatry/

26 comments

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  1. Great post and great advice! Im not a med student and I can relate to all of those when working with people. All of it…truly. P.s. thats the best looking free lunch Ive ever seen..Perks!
    Autumn recently posted…Positively PricelessMy Profile

    1. I try to make my reflections at least partially applicable to everyday life! :D! And ohhh, yes. Drug reps make my life better, haha. :]!

  2. I’m not all entirely sure how the psych WAres work, but were you at least paid for your unproductive hours?
    Linda @ TheFitty recently posted…Labeling Meals ā€œBreakfastā€, ā€œLunchā€, and ā€œDinnerā€. {WIAW #14}My Profile

    1. Hahaga, nope. No one ever pays medical students. I’m paying $50k/year to learn from them. ._.

  3. I am sorry to hear about your difficult experience, but your reflection on it shows how much you’ve learned and been able to grow as a doctor, but also as a person. it can be TOUGH working with someone you don’t mesh well with, or who is a lot more firm/stern/less friendly than you are. I always say, “kill em with kindness”

    Side note, your comment luv isn’t working for my blog….hm. any idea why?

    1. Agreed! It wasn’t a pleasant experience, but I learned a lot from it and I like to think it built a lot of character! :P I love employing the “kill em’ with kindness” approach in life! :]

      I’m not entirely sure, but my blog in general seems to be pretty fickle if the “http://” part is left out. (Then it just redirects to the “page not found” page on my blog. I wonder if that has anything to do with it?)

  4. Really enjoyed reading about this rotation! It sounds like even though it wasn’t the best experience for you you still have your best to the patients and were able to look at all the positives. I think you’re going to be an amazing Dr!
    Jill recently posted…Weekend Contemplations: On Being HumanMy Profile

    1. Thanks so much, Jill! I really hope I will be! I figured life definitely won’t always hand me the things I want, so I might as well learn something from the negative experiences!

  5. So maybe psych isn’t for you (it was my least favorite clinical experience in nursing school) but think about all you learned. You sound like an amazingly compassionate person, and medicine needs more physicians like you. Take all that you learned and apply to the rotations you love. And remember when you are training students how this guy made you feel. <3
    Wendy@Taking the Long Way Home recently posted…#RunthisYear 2015 March SummaryMy Profile

    1. Psych was definitely my mom’s least favorite clinical experience in nursing school too! I’m glad that I did manage to learn something, and I will definitely be taking those lessons to apply to my life! :] I hope I never make any students feel the way he made me feel!

  6. Thank you so much for talking to her; I wasnā€™t sure what to say.ā€
    ā€œSometimes, all someone really needs is for another person to listen to them.

    This. Also? A lot of times, yes, people are crazy. But I agree–don’t tell them that they are lol. Also, sometimes they are just still realllly high on something (I remember Alex going through psych and getting a lot of people who just wanted “the rock” IE cocaine). I think that people everywhere have to remember that the brain is an organ and component of the body–it can be just as sick/off kilter as any other!
    Susie @ SuzLyfe recently posted…Lyfe Kitchen Chicago Review (Streeterville Opening)My Profile

    1. It worked out fairly well because I think I’m way better at being a good listener than knowing “the right words to say.”

      Ah…yes, haha. A lot of people in the place I was doing my rotations in actually met their significant others in there! (I guess all the time spent together and soul-searching together can do that?) And yes, there were definitely people who wanted all the drugs ever. ._.

  7. Farrah – I love your attitude – it shines through in this post! It takes a pretty mature and smart lady to realize she needs to start looking for the silver lining! And you have poured so much of yourself into other peoples lives – that, my friend, is the making of greatness!

    1. Thanks so much, Shashi! I figured if I couldn’t change the situation I was in, changing my mindset would be the next best thing, and it definitely helped a lot! <3

  8. Interesting reflections, Farrah! I really enjoyed reading your post, psychology and psychiatry seemed always fascintating to me!
    Lily Lau recently posted…Worldā€™s Most Expensive GuitarsMy Profile

    1. Thanks! I always enjoyed reading about it, so seeing the conditions I’d studied in actual people was definitely interesting!

  9. At least you have the experience and know what you want!
    Rebecca @ Strength and Sunshine recently posted…Baby Purple Brussels SproutsMy Profile

    1. This is true! :O It could definitely have been worse too!

  10. These are life lessons too!! I have a hard time listening and interrupting. I blame it on being Italian. ;)
    Melanie recently posted…Wordless Wednesday: Inspire Me!My Profile

    1. haha, I think you’d listen though if the situation called for it! :]

  11. I’m loving these wrap ups and learning so much!
    Glad that one is over for you!
    Julie @ Running in a Skirt recently posted…6 Ways to Workout for Free {Video}My Profile

    1. I am too! :D! This one was definitely infinitely better! <3

  12. I love reading about your behind-the-scenes med student experiences! The medical field is so fascinating to me, but I never had the stamina & I was always way to squeamish to even consider it back in my college days, but I still love to read posts like this! Sorry your experience in this rotation wasn’t too much fun. But, like you said, at least you now know what you don’t want!! :-)
    Vicky @randomlittlefaves.com recently posted…March Faves & April PlansMy Profile

    1. Yay! :D I’m glad that you like to read these! :] Although this definitely wasn’t close to my favorite rotation, I did learn a lot about changing my mindset in negative situations/experiences, so it wasn’t all for naught! :P

  13. On the bright side, at least you now psych is not for you? Hehe. “PIck your battles” is something I’m learning to do, and man is it tough sometimes!!
    Jess @hellotofit recently posted…Try This Thursday 4/2 – variation of runner’s stretchMy Profile

    1. Yes indeed! It’s never what I wanted to go into, but now I know that for sure! :P I’m still working on the “pick your battles” one too!

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