This is the first ever blog post created by a second year medical student, Evelyn Qin. I have been very blessed to have outstanding medical students on the service for the last few weeks. I can’t say enough about Evelyn’s reflections. I also got a couple of tokens of appreciation from them, one of them tasty:
And the other was a first rate drawing of stairs by Evelyn about our taking them everywhere in the hospital. The elevator is too slow, even for the geezer.
I’m so relieved about the future of the next generation of doctors.
Psychiatry Clerkship Reflection by Evelyn Qin
Following this four week clerkship in Psychiatry Consults, there are several important lessons I have picked up on that apply to both psychiatry and medicine in general. First and foremost is that communication can be the source of a lot of complications in healthcare and patient management. Some specific examples of these complications that I have seen include, understanding appropriate management of patients after multiple consultations, overprescribing of medications, and a lot of patient and provider confusion and frustration. This shows me a lack of the core competencies in interpersonal and communication skills, as well as professionalism. While these are not necessarily the fault of any one individual, but rather the healthcare system as a whole, it is still important to be aware of such pitfalls as a provider and do our best to prevent these communication issues.
Another lesson I have picked up on is that psychiatry can play an important role in patient care through the extended time psychiatrists spend listening to their patients. In many situations, there are not many things you can do to help a patient beyond their medical conditions because there are so many social factors affecting their lives. Simply listening and being supportive while they are in the hospital can relieve a lot of the stress and pressure a patient experiences. In order to do this role well, acting is sometimes required.
The role of a consulting psychiatrist, and consultees in general is to address management questions (simple or complex) by other providers who are not comfortable or are not qualified to manage certain concerns in a patient. I have found that a large percentage of the time the questions we are asked in psychiatry seem to be the former, in which the primary provider could easily do a suicide risk assessment or identify delirium, but are not comfortable doing so. Consultations are also made to psychiatry frequently when patients have a previously diagnosed psychiatric condition even though other medical considerations should be made prior to consulting psychiatry. However, it seems to be more logical to just see these consultations rather than teaching the primary providers how to do these assessments themselves. This probably has to do with many other concerns and responsibilities the primary team has to deal with as well as the underlying culture of the healthcare system.
Lastly, I am grateful for the opportunity to work on the consulting psychiatry team because being able to identify delirium, altered mental status, withdrawal, intoxication, drug side effects, mood disorders and personality disorders is going to be necessary for me to identify in many areas of medicine. Initially I was very unfamiliar with all of these areas, and even though I am not an expert in this area now, I am aware of these possibilities and can consider them in future differential diagnoses.
Evelyn Qin, M2