The following are links to documents that I have created throughout my sixth rotation.

The following is a link to a History and Physical I presented during my site evaluation on a patient BIBEMS activated by her fiance for making suicidal comments: varghese_hp1

The following is a link to a journal article and summary (first page of attached document) that reviews over 20 articles in an effort to understand the effect of probiotics on the alleviation of symptoms of depression and anxiety: liu2019

The following is a link to a report generated via Typhon that lists my hours, diagnoses I saw, and some of the procedures I did: tally

The following is my site evaluation summary:

During my site visit, I facetimed my site evaluator. We started the visit by presenting our cases. The preceptor was reflective about my case and would interject to ask about a differentials including both psychiatric diagnoses as well as medical diagnoses that should be ruled out. During my presentation on a 35 year-old-female, my preceptor reminded me that I should be sure to rule out hypothyroidism and check TSH in my initial evaluation. The preceptor provided much education on different types of SSRIs that could be used depending on the patient’s symptoms due to their different side effects. The site evaluation went very well.

The following is my reflection of this rotation:

Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them

Psychiatry is unique because of the patient presentations. So far, most of the patients I have encountered have been appreciate and polite. My patients during my psychiatry rotation, however, were not as easy to interview. Throughout more than one interview I was called Ms. Indian or Coolie girl or other derogatory names based on my ethnicity. I found this difficult to ignore initially because it felt like while I was trying to help these patients, they were trying to insult me. I brought this up to one of the nurses who had been working there for several years, and he told me to always remember that these patients are sick. He explained that, unfortunately, the nature of their illnesses may manifest in unpalatable ways and that as healthcare practitioners in psychiatry we must remember that their illness is speaking; these insults are simply symptoms of their disease. I took his advice seriously and was better able to emotionally deal with the name-calling from future patients.

Types of patients you found challenging in this rotation and what you learned about dealing with them

Patients who are malingering are difficult because they are using hospital resources, but they are often doing so because of the condition into which they have been squeezed. For example, many times, patients who do not meet their shelter curfew will come to the hospital looking for a place to stay. These patients are homeless and need help, but they do not need medical help. These situations often became troubling to me because these patients would often arrive later at night when social work wasn’t around, and I would have to decide between admitting and discharging them for my disposition when presenting. Throughout this rotation, I learned that unfortunately many times these patients must discharged but they can be discharged with shoes or clothing that were donated. When dealing with patients who are malingering but due to other unfortunate circumstances, it is helpful to be able to discharge them with some items that may be able to help them for a few days if available.

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc). 

People often dismiss those with schizophrenia and other delusional disorders as “crazy,” or even scary. Although I never took such a polarized approached to patients with mental health issues, the thought of their condition depressed me and seemed formidable. After working with these patients, however, it became evident that their disease pathologies were cruel but they were easier to confront than I thought. People with schizophrenia are often terrified and confused and truly need much help. Working with patients with these conditions helped me better empathize with them rather than sympathize for them.

What did you learn about yourself during this 5-week rotation?

I learned about how much my perspective can change in just 5 weeks. During the first week of my rotation, I was gullible. I wanted to take patient’s story for face value because throughout all my other rotations, that’s what I’ve mainly been doing. If someone were complaining of stomach pain, I would believe them. This approach in psychiatry, however, can often lead practitioners into many issues and time consuming fruitless conversations. Within 5 weeks I learned that with seeing high patient volumes, I could change my lens and better gauge when patients were being honest vs. malingering. My preceptor taught me to how to be more observant – to notice how patients behave before interviews, to see if they’ve eaten their breakfast, etc. This rotation taught me how important it is to see as many patients as possible because it allows for one to better notice trends and obtain more fine-tuned clinical gestalt.