Disclaimer: contains sensitive topics and may be triggering for some individuals.
Schedule
- Inpatient child & adolescent psychiatry (2-3 days/week)
- 8 am: Chart review (no pre-rounding)
- 9 am: team sign-out with nurses and therapists
- 9:30 am – 2 pm: rounds, interview patient with attending and resident/fellow
- 2 pm – 5:30 pm: lunch, write notes, call family, study
- Telemedicine (1-2 mornings/afternoons a week)
- 8 am – 12pm: interview patient with attending via Zoom
Daily Duties
- Chart review: read notes from therapists and nurses, check vitals, PRN meds given, significant events, overnight events
- Rounds: interview patients
- Write notes
- Call family to obtain collateral information or update
Other Clerkship Assignments
- Evidence-based medicine report: ask clinical question based on patient and find evidence to answer the question
- Didactics: presentations on bread-and-butter topics
- Clinical education session: interview patient with attending and other medical students present, give feedback, preparation for OSCE
- Shelf exam (clerkship exam) and OSCE
Reflections
What I Liked
- The interdisciplinary nature of psychiatry is astounding! You work with social workers, occupational therapists, counselors, and individual therapists extensively!
- You get to spend a lot of time with each patient and you get to know them well.
- The doctor-patient relationship between a psychiatrist and a patient is even more sacred in psychiatry given the content of the specialty.
- You see patients at their most emotionally vulnerable.
What I Disliked
- Mostly medication management with occasional ECT
- As someone who loves Medicine, I didn’t touch my stethoscope once! It is not a hands on specialty.
- It can be emotionally draining. See below.
Personal Reflections
“Have you been had any thoughts of hurting yourself? Thoughts of wishing you were dead? Thoughts of killing yourself? Do you have a plan? Would you act on it?” These were questions I was asking kids and teens every day from the ages of 10 to 17. We would also screen for violence, rape, and abuse. Many times the screening would be positive.
I knew being on an inpatient child/adolescent psychiatry service wouldn’t be easy, but I didn’t think I would be affected by it as much as I have.
At first I wondered: Is it just me? Am I just being too sensitive? Is anyone else in this room feeling what I’m feeling right now?
At first, I hated myself for feeling the way I did. I felt selfish. What these kids are going through is nothing compared to how it’s making me feel. I shouldn’t be feeling this way. I shouldn’t be taking away from their experiences.
But at the same time, am I not allowed to feel? Then I realized that I’m human. I’m allowed to respond to what’s happening around me, but it doesn’t mean I’m invalidating other people’s experiences or taking away from it. It just means I’m human.
Perhaps part of the reason why it affects me so is that these kids are still so innocent. Many of these children come from horrible family situations, orphanages, with a history of extensive psychosocial trauma. They don’t deserve this. No kid, teen, or young adult deserves this.
Perhaps it is because these kids remind me of my little sister who is 12 years old, who is trying to find her identity and navigate what’s about to be the toughest years of womanhood. Despite having different fathers and being raised by different parents, I’m her big sister nonetheless. And perhaps I feel guilty that I can’t be there for her because I’m here.
Perhaps it is because it reminds me of my upbringing away from my parents and my own mental health struggles. Again, not to take away from their experiences, but the theme of parent abandoning a child is not foreign to me.
No, we will never understand what our patients are going through. But their experiences can remind you of other things in your own life. It can be so easy to gaslight yourself and invalidate your past, but your feelings are just as valid.
During the first week of our rotation, we were asked to read an article about vicarious traumatization, compassion fatigue (includes burnout), and countertransference. I felt like I caught a glimpse of each.
Vicarious traumatization: the transformation of the clinician that comes from the empathetic engagement of a patient’s trauma.
Compassion fatigue: emotional duress experienced by persons having close contact with a trauma survivor – a natural response to the
survivor’s traumatic material with which helpers may identify
and empathize.Countertransference: psychodynamic concept that relates to the past experiences and psychological defenses of the therapist, who then responds to a particular patient determined by these processes whether unconscious or conscious.
Marriage (2015)
Vicarious traumatization after hearing about rape, suicide attempts, and abuse. Compassion fatigue because whether you want to or not, you can’t help but feel for your patients when they open up to you. Countertransference because some of these girls remind me of my little sister. That could have been her.
It frustrates me No, it angers me when people don’t take mental health seriously, when people think it’s made up. After all I’ve seen, how can people be so dismissive of mental health? I hate that there are people out there who think it’s “just in your head”. But you know what? Maybe it IS happening in our heads, in our minds, but why should that mean it’s not real? It starts there, but it spreads everywhere. The health of our mind affects how we think, what we do, how we interact, and how we approach life.
Many times I wanted to cry listening to our patients tell their story. Sometimes, it was hard to leave all of it at work. It was hard to come home and not be able to talk about it. Those were the hardest days.
It was a challenging rotation on many levels, but it can be rewarding if you know how to take care of yourself. Reach out to the counseling center or your therapist if you have one. Hug your partner if you come home, even if you can’t tell him/her details. Keep your mind off of it. Do things that you enjoy.
Psychiatry is a hard field. I think it is arguably the hardest specialty. All specialties need to show psychiatrists the respect they deserve, as well as society.
Thanks for reading this far!
With lobe,
Kelly
