When I found out that my first rotation was in psychiatry I was honestly a little bit nervous. I have never been in a psych ward and I felt disconnected from the field. Psychiatry was actually my lowest score on the PACKRAT and I was anxious about how my performance would be on the rotation and on the EORE. On my first day at the QHC psychiatric ER I was unsure what to expect. But, over time I realized that although there is no physical exam or procedures to be done, I was still going to learn a lot.
Every morning my colleagues and I attended rounds. It was a great experience seeing how doctors, nurses, social workers and PAs all interact to form a well oiled machine that provides the best care for patients. One day the nurse representative did not show up to rounds on time and they had to wait for her to start rounds. This emphasized the importance of how healthcare only runs properly if we work as a team. We then followed different doctors and PAs to see the patients. In the beginning we just observed, but with time the providers allowed us to ask any questions that we had to the patients. When I led a patient interview I felt so accomplished that I remembered the important questions to ask to be able elicit a proper history.
When writing up my first H&P for this rotation I realized that I had to adapt to writing an H&P for this field of medicine. It was very different than other H&Ps that I wrote for the physical diagnosis class. One of the most distinct differences is that possibly the most important section in psychiatry is the mental status exam, which is not done regularly in other fields. Additionally, the HPIs in psychiatry rely heavily on collateral information. Therefore, I spent much of my time on the phone with family members of patients getting more information regarding their history and what brought them to the hospital that day. At first speaking to family members was overwhelming, but as with every other skill it got easier over time.
Overall, despite psychiatry being very different than all other fields of medicine I really appreciated having it for my first rotation. I learned that teamwork is so important, as witnessed during rounds. I also gained more confidence in my ability to speak with family members, which will be a necessary skill in all other fields. Most importantly, I learned how to adapt and write H&Ps in the style unique to the field that I am in. I did not practice any physical exams but did get to perfect gathering a history which will be useful in my future rotations.
