Rotating at QHC’s psychiatry department was very eye opening. The whole approach to interviewing and counseling the psychiatric patient is completely different than how we interview patients with medical concerns. I learned that “eyeballing” the patient is very important – is the patient disheveled? Tearful? The general survey provides valuable insight on how we should approach the patient thereafter. Obtaining collateral information is crucial since we cannot (unfortunately) believe everything that the patient says. For example, a patient may appear to be A/O x3 and tell us a really compelling story but you may call the family later and discover that the story is completely different.
At first, presenting the patients to the attendings or PAs was somewhat challenging since I was not aware of the types of questions that I should ask, thus there was some information about the patient that was left out. However, with practice and time, I was able to present a patient comfortably in addition to knowing what to ask and how to elicit such answers from patients. For example, suicidal or depressed patients proved to be more challenging than patients with auditory or visual hallucinations due to the nature of the problem. With those types of patients, I learned to be more patient and really empathize with the patients without being swept up in all the emotions. The aggressive patients were also a new experience since you have to learn to stay calm while they curse you out, spit at you, or start banging on the windows.
One time, I interviewed an Asian male with my preceptor and another student in English. He was c/o hearing voices telling him to go kill himself. We tried to figure out why he wanted to commit suicide but he was guarded and paranoid. Since we could not get much information from him, I thought of connecting and relating to the patient by interviewing him in Chinese. By removing the language barrier, I was able to learn more about the patient and why he was depressed since he was more willing to talk. From there, I was more aware and appreciative of how I was able to speak another language. I also learned that my approach to interviewing patients is calming for both adult and pediatric patients. I am able to gain the trust of patients and get them to open up to me, ultimately allowing me to understand their situation better and empathize with them.
Unfortunately, I was unable to perform procedures such as venipuncture or injections since most of these patients were unpredictable. However, I plan to ask the nurses or other providers during my future rotations so that I am able to practice the skills learned in our clinical skills class. I also have to review how to take the history of a medical complaint since I have become accustomed to interviewing the psychiatric patient. The knowledge that I have gained rotating at psychiatry will definitely help me in future rotations such as urgent care or emergency medicine by identifying patients with underlying psychiatric conditions or calling for a psychiatry consult, if warranted. There were times where psychiatry consults were called for bizarre reasons that were more medical in nature.
Ultimately, behind every psychiatric patient lies a story. A story, a voice waiting to be heard. We, as medical providers should listen and empathize with every patient (without becoming jaded) to provide them with the best help that we can offer them.
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