My Psychiatry Sub Internship Midpoint Reflections

My Psychiatry Sub Internship is basically a month-long audition where I'm evaluated on my skill set, knowledge-base, and fit within the field of Psychiatry. It's also an opportunity for me to get a more in-depth understanding of what my life would be like as a Psychiatry resident. Halfway into the rotation, I can genuinely say that I've loved my time on the Mood Service at the Pennsylvania Hospital. Every day, I wake up excited to go to the hospital, and at the end of each day, I feel as though I've made a difference in the lives of my patients.

This isn't to say that there haven't been challenges. It can be emotionally difficult as I meet patients who are either so different than I am that it takes extra effort to connect or the patients are so similar that their illnesses hit eerily close to home. In both of these scenarios and all the other variations in between, I'm learning to balance caring for my patients, while also caring for myself. I'm looking forward to continuing to hone that skill while in residency. In the meanwhile, I wanted to take some time to reflect on what I've learned during my two weeks on the Psychiatry Sub Internship thus far.

3M Littmann Lightweight II S.E. Stethoscope, Black Tube, 28 inch, 2450

Week 1: Acclimating to a new environment

Every transition back to clinical life is a little anxiety provoking for me. As an MD/MBA student, I spend a bit of time bouncing back and forth between "MBA land" (as I like to call it) and medical school. Thankfully, this transition was a bit easier from a clinical knowledge standpoint, compared to my previous reentry to the hospital. Prior to this current rotation, I was last in the hospital in May. The ~3 months between the two rotations was, thankfully, not enough time for me to forget all the things I learned for the Psychiatry Shelf Exam - a national Psychiatry exam for medical students.

In addition to being nervous about remembering how to treat patients with psychiatric illnesses, I was worried about how Psychiatry would differ at the Pennsylvania Hospital, an academic center that has to deal with the hassles of insurance companies, compared to Psychiatry at the Veteran Affairs Medical Center (VA). If you've ever heard me talk about the VA, you know, I LOVE working at the VA because of the great patients and the laid back environment. So I was hopeful that my newly discovered love of Psychiatry wasn't just actually my already known love of the VA.

On day one of the Psychiatry Sub Internship I jumped right into the action. I picked up new patients, and the interactions with the treatment team (social workers, nurses, psychologists, and Psychiatrists) were all integral to my enjoyment of the experience from the start. More than that, I recognized the role that family interaction plays in the treatment of our patients; I was happy to keep the families as informed as I could.

Additionally, as the Psychiatry Sub Internship geared up, I realized that my clinical knowledge didn't fail me! Of course, there's always more for me to learn, but it's nice to know that I have a relatively comfortable understanding of the basic disease pathology and psychopharmacology needed to treat patients as a Psychiatrist. On top of that, I learned that Psychiatry at Pennsylvania Hospital wasn't really any different than Psychiatry at the VA. I loved them both!

Dickies Women's 28 inch Lab Coat, White, Small

Week 2: Stepping up to the plate

For the second week of my rotation, the resident Psychiatrist who oversees my day-to-day activities went on vacation. So in a sense, I was promoted to "resident" after just a week on the rotation. The weekend prior, I was pretty nervous about whether or not I'd be able to fill the shoes of my resident. I took extra time to study treatment plans as well as review all of the patients on our team. I wanted to make sure that I could handle any challenges thrown my way.

Showing up on that first day of my "promotion," I again realized the importance of teamwork in patient care. I did my best to take care of patients throughout the day along with my fellow med student, and we received a great deal of support in doing so. After all, medical students need everything cosigned (notes, orders, etc.) since we're not officially MDs as yet. It so happened that we got an active patient during this week, who truly required me to step up to the plate to help coordinate his care and keep him safe. I feel blessed to have had this opportunity to really see what it's like to be a resident Psychiatrist.

Another learning from this second week was the importance of monitoring my countertransference and its effect on patient care. In Psychiatry, countertransference is an emotional reaction that the Psychiatrist feels in response to a patient encounter. One patient, in particular, led me to feel quite frustrated. He was not amenable to taking the medication that we prescribed and didn't want to be seen by the consulting physicians we recommended he see. After a few days of the same song and dance, I was truly frustrated and wanted to acquiesce to the patient's desire to be discharged without further care. Thankfully, I had a moment of clarity where I remembered that above all, my role as a medical provider is to do no harm, and sending this patient home would not have been in his best interest. This encounter truly made me realize how residents and attendings become jaded to patient care. Having numerous similar encounters over and over again must be challenging. Nonetheless, I'm glad to have this learning experience now, so that I will be even more cognizant of how my countertransference toward a patient can potentially impact patient care. As a result, I'll fight even harder against the countertransference to make sure that all of my patients receive my best effort.

Sterling Silver 2-rows 6.5-7mm White Freshwater Cultured High Luster Pearl Necklace, 17"

Summary

I have two weeks remaining in my rotation, and less than one week to complete my residency application >.< It's definitely going to be a busy 2 weeks, but I'm looking forward to seeing what else I learn on my Psychiatry Sub Internship.

Peace and blessings,

Atasha Jordan, MD (to be)