Exposure to new techniques or treatment strategies – how did that go?
During this rotation, completing a history and physical was unique in the sense that it was necessary to inquire more specifically about patients’ sleep, appetite, spending habits, drug or alcohol use, past or current trouble with the law, level of education, employment status, and support system. It was also imperative to perform a mental status exam for each patient, which one of the PAs described as the review of systems for psychiatry patients. In addition, it was important to obtain collateral information by calling families, friends, psychiatrists, case managers, social workers, or group home nurses/staff to get the full picture of what brought the patient in, given that patients may not be reliable. As this rotation was in the psych ER, I saw many patients who were agitated, manic, or acutely psychotic and required IM injections of Haldol 5 mg and Lorazepam 2 mg for stabilization. Some patients also required restraints for aggressive, threatening behavior. It was really interesting to directly see patients exhibiting manic symptoms, such as pressured speech and labile mood, as well as acute psychotic symptoms, as many appeared to respond to internal stimuli. Many of these patients presented due to medication noncompliance, and I was able to see how observation and treatment were really effective for patients who became stable over time.
Managing new types of patients and the challenges that arise from that.
During this rotation, many types of patients were challenging to manage, some of which included patients with intellectual disabilities, manic patients, and acutely psychotic patients with poor impulse control and unpredictable behavior. However, one new patient population that I found particularly difficult to manage were patients under arrest for serious crimes. During one specific encounter, one of the police officers had shown me the paper which listed the patient’s alleged crimes. The second I saw murder on the page, I felt something change in my body. It was an experience that reminded me of how important it is to be aware of the unconscious bias each one of us may have and how it can impact the care we provide.
What was a memorable patient or experience that I’ll carry with me?
A memorable patient experience that I will carry with me is one I had with a young single mother with persistent postpartum depression, who presented with suicidal ideation and felt she had no support system. During the initial interview, she presented very dysphoric and depressed with such a low tone in her voice. However, despite how she felt, she was really trying to do her best for her daughter. After some time speaking with her sister and further observing her for stabilization, the patient became more optimistic and motivated with future and goal-oriented speech, which was encouraging to see. It really made me hopeful because it made me feel that despite the depths of some patients’ despair, they can be empowered to turn things around and keep going to see the other side.
How could the knowledge I’ve gained here be applicable in other rotations/disciplines?
The knowledge I have gained during this rotation could be applicable in other clinical settings because mental illness can be encountered in every discipline. In fact, I saw a patient who has agoraphobia during my ambulatory medicine rotation. Additionally, many patients during my family medicine rotation admitted to being depressed, as I screened each patient using the PHQ-2 and consequently the PHQ-9 if warranted. Ultimately, I have learned that depression and anxiety are very common among all populations and can significantly affect patient’s physical health in addition to their mental and emotional health. Therefore, knowledge of their appropriate management in addition to the various psychiatric conditions I have learned more about during this rotation will help me to better treat patients more comprehensively when I start to practice as a PA.
What one thing would you want the preceptor or other colleagues to notice about your work in this rotation?
One thing I would want the preceptor and the other providers to have noticed about my work in this rotation was my willingness to be proactive and elicit important information from patients and their loved ones despite how difficult it was at times, then type different types of notes, including consult notes, admission notes, disposition notes, progress notes, and discharge notes, based on the information obtained. I also hope they noticed the way I spoke empathetically with patients’ family members who often times felt that they were at a loss when it came to caring for their loved one, as doing so also weighed heavily on them. Many of the conversations I had during this rotation reminded me of the importance of the reality that you never know what people are going through and that kindness can really go a long way.
