Last two posts in my Clerkships! I actually have now officially completed third year (!!!), and I should have definitely posted these recaps by now but tis life. I will also be posting about my feelings about the end of the third year in the next week or so and what is up next.
My last two rotations of third year were two disciplines that I knew that I did NOT want to do. Although falling in love with Surgery and OB took me by surprise, I knew that I did not have to worry about that for Psychiatry and Pediatrics. Nevertheless, I was still excited for both rotations just purely for the fact that I love what I do, and I know that everyday I step into the hospital or clinic, I can make a choice to either phone it in or become a better clinician and I choose the latter.
I had heard many good things about our psychiatry core, so I was excited to get started. My rotation was broken up between inpatient, outpatient and jail/corrections. Other of my colleagues also had a stint in what we refer to as "Crisis" which is the ED for Psychiatry.
If I am being completely honest, my week of outpatient was my least favorite because we just were not that involved in actual patient care but my attending was incredibly kind. However, my time on inpatient was an incredible experience. I am not sure if it is just because we live in a metro area, but we were fortunate to see and treat a lot of our textbook diagnoses and actually be able to see the diagnostic criteria played out in real life. Of course, it also breaks your heart at the same time because with certain diseases like Schizophrenia and Bipolar, your patients literally have no control over their actions and really cannot comprehend what is going on with their mental status. It is challenging, humbling and eye opening. During rotations, when you are actually able to put a face to an illness, it really helps bring together all that you study and this happened repeatedly during my psychiatry rotation on inpatient. And more so than other rotations, you really learn about the tremendous failures in our health system in taking care of individuals with mental illness. Whether it is the cost of medicine, the lack of follow up to care, the time restraints that are placed on inpatient treatment, the lack of facilities for individuals who need continual inpatient treatment, all the pitfalls of healthcare are potentially most evident in psychiatry and I assume that is a result of our culture and the long established lack of acknowledgement of severity and reality of mental illness. Although we have progressed a great deal, I had patients that I saw my second week who had been discharged and was back again by my 6th week because of a host of various reasons including lack of social and financial support.
Due to the holiday, my time in jail was limited but for many of my other colleagues, it was their favorite week. Our attending was great, and although the experience was initially intimidating (I mean you are in jail), it was incredibly interesting.
All in all, I was really happy with my psychiatry experience despite having no desire to do psychiatry. However, psychiatry is one of those unique facets of medicine that no matter what you type of specialized medicine you practice, you will always have to deal with psychiatric patients, so it is incredibly important that you not only understand the disease pathology and treatment but more so that you just understand how to talk, communicate and sympathize with these patients.
You already know this if you have read ANY of my prior posts. :-)
They help. You may even have some questions that look very very familiar on your actual exam.
This book is GOLD. It is nice because it is pretty short but it literally has all the information you need for both the wards and your shelf exam in a very easy to read format. I read through it twice during my clerkship and this + UWorld + Online Meded is probably all you actually need to do well on this shelf.
Your Dedicated Step 2 CK Book (MTB, First Aid, Step Up to CK)
Read the Psychiatry chapter. Always helps solidify the information you see on the wards.
I know that some people also recommend using Lange for Psychiatry and although I did not use it so I cannot comment on how good it is, I definitely feel that you don't need it. I did well on my shelf without it so that's my two cents. I am still including the hyperlink for you anyways because I love you.
As I alluded to before, no matter what specialized part of medicine you go into, you will always have psychiatric patients and let's be serious, we also have people in our lives who also have psychiatric and mental health issues, so there is a lot to get out of your psychiatry core. For the majority of hospitals, psychiatry is a lighter core both in hours and in difficulty of the shelf, so utilize your free time wisely and try to avoid phoning it in on the rotation itself. More so than others, our mental health patients really need us not only as their health care providers but also as their health care advocates, so try to be cognizant of that as well. You will learn a lot and you will feel a lot, so just be open to it all.
Up next-- PEDIATRICS aka END OF CORE CLERKSHIPS!!!!