Takeaways from my psychiatry rotation 🧠

24 Dec 2022

It has been a little while since I took my psychiatry rotation, but it was a special time for me not only considering I want to do psychiatry one day but also because the whole month felt like the Lord had a hand in the wonderful moments of each day.

Here are a few lessons that initially came to mind from this unique period in my life:

Developing a trusting relationship with patients is essential in providing effective psychiatric care.

I remember walking into the unit each morning and passing some of the patients in the common room. I would try and purposely smile 🤗 and wave 🙌 to them as I went by, something that I didn't think much of until the end of the clerkship when one of the gentlemen that I tried and talk to 🗣️ I ended up interviewing at length. The time that I introduced myself 🙋‍♂️ several days before ended up creating a lot of rapport 🤝, and it's likely I would have had a different experience had I not said hello to him days before.

Effective communication is key in assessing and managing mental health conditions.

Tone and vocabulary needed to be carefully selected on this rotation; a principle that carries over into a variety of domains of life, reminiscent of Proverbs 18:21: "Death and life are in the power of the tongue." I rarely listened to anyone's heart with my stethoscope 🩺 on this rotation, but I think it is a reminder of how much one can accomplish using one's ears 🦻 and being a genuine person. Another takeaway I had was the power of strong eye contact 👀. We noted this in our mental status exams, but when you look at someone's eyes, you look at their soul. When we look at someone, we are giving them our full attention, allocating that precious resource of time in our lives wholly to them.

It is important to be mindful of the potential side effects of different medications and monitor patients closely when they are started on a new medication.

I vividly remember one patient who had tardive dyskinesia from prolonged antipsychotic use. This serves as a reminder that, while we aim to effectively treat illnesses 🤒 in medicine, it is important to also consider the potential unintended consequences of our actions. In our personal lives, it may be a good idea to frequently reassess the combined downstream effects of things that we have incorporated into our lives and consistently do. For example, let's say one starts an exercise program 🏃‍♂️. Continually monitoring and reassessing the effects of the introduction of that variable is important because the exercise program might have wonderful effects on one's physical health 💪 but may have more hidden effects on their family life 🏡 since they are away from their children 🧒 more often. Self-awareness and reflection 🤔 (potentially cultivated through a journaling habit on an app like Day One 📱) can help bring such deleterious byproducts to light and allow a potential compromise that can lead to a better outcome for all (doing home exercise videos 📺 with the kids 🧒 so everyone is together).

There are many evidence-based treatments (pharmacology, cognitive-behavioral therapy, dialectical behavioral therapy, interpersonal psychotherapy, etc.) but some treatments (smiling, empathizing, a handshake) may not have statistical backing but can make a difference regardless.

Stock traders 💰 try and accumulate small percentage gains over time in order to accumulate larger effects, and I think a similar approach to medical care can make a huge difference. If an illness is a foe, attacking from multiple angles can spread the defense out thin.

Addressing social determinants of health can be as important as the normal treatment.

In no other rotation have I had rounds where the social workers 💼 were so heavily involved. What financial situation the patient was in had a huge impact on the treatment plan, as those who had a history of not following up or not being able to afford medication 💊 or housing 🏠 were much more likely to need injectable medication instead of oral medication which is generally harder to reliably obtain. Being financially unstable 💰 can be a source of immense anxiety and stress 🤯, and this is something that medical professionals should take into account when considering the practical monetary implications of their prescriptions. This is beyond just the traditional considerations of a doctor, such as the mechanism of action and first line indications for a condition.

There is value in recognizing the unique strengths 💪 of individuals for managing their mental health conditions.

We would always ask what kind of things they enjoyed in their free time 🕙, not just to get to know the patients better 🤝 but also to encourage healthy coping mechanisms 🧘‍♂️ for when times get inevitably tough in the future 🔮.