Psyched Up

Lately I’ve been thinking a lot about specialties.  I know taking it seriously this early is the cute-yet-eye-roll-y equivalent of my 6th grade self “thinking a lot about whether I’d rather marry Lance Bass or Nick Carter”* , but it turns out that I’m actually not very good at essentially working 12 hour days without a concrete goal.

(Previously, my “concrete goal” was to simply become a doctor who Knows Things.  Without thinking about specialties, the most specific I could get was picturing myself as a doctor who Knows Things and wears high heels all day because she’s just that awesome (or has developed some extreme peripheral neuropathy and is immune to the pain).**

But now I want a temporary label for my future goals, just to get me through these 12 hour days.  And then in two years I can change my mind 10 times and have a dramatic identity crisis about it like a normal person.

So as a way of making me feel like I’m working towards something concrete, I’ve started paying a lot more attention to psychiatry (both my research gig and the class), and anesthesiology (by, somewhat less impressively, reading up on anesthesiology blogs and trying to find somebody to shadow.)

So because of all that, last week I volunteered to interview a psych patient for our small group session – tomorrow.  I remembered this only about 4 hours ago – along with how the psych resident had told me I should read up on how to conduct a psychiatric interview beforehand.

It took me at least a solid half hour of internet research, plus twenty minutes of talking to Boyfriend (currently on his 3rd year psych rotation)  to determine that there actually isn’t one specific structure to the psych interview, and that was apparently our resident’s idea of a practical joke.

So.. there’s that.  But what I lack in foresight, I think I make up in my ability to improvise.  And honestly, now that we’re done with the “Can you hold a conversation with another human being?  Let’s learn!” patient class we had last semester, any patient experience that doesn’t involve purposefully steering the conversation away from a diagnosis sounds great to me.

*  Cause, you know, who knows?  One of the two specialties I like now may, in two years, turn out to only be interested in other specialties.  (And the other one might star in a terrible reality show.  And not the so-bad-it’s-good kind of terrible, like My Super-Sweet 16 or I Didn’t Know I Was Pregnant.)
**  Future painful orthopedic problems aside, this potential future died for good once I remembered that 1) I only own 1 pair of heels because I’d rather spend the money on boots or books, and 2) I learned how to walk in high heels by watching a youtube “how to” made for newbie cross-dressers, because it was the only thing I could find at my knowledge level.  Neither of these boded well.
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19 thoughts on “Psyched Up

  1. I’ve always been keen on paeds, and it is the one which gets suggested the most (because I’m childish?). But then I have no idea sub-speciality wise. One that doesn’t involve too many dead babies 😦

    • Sounds like a compliment to me (cheerful, good with kids, etc)!

      Yeah, my mom was a NICU nurse for most of my life, and I still have no idea how she managed her emotions so well in that area.

  2. Google “Mental Status Exam.” Wikipedia has a decent entry on the subject. As I recall, you’ll want to go over the basic questions for the HPI just like you would for a “medical” complaint, and touch on the stuff in the mental status exam. Also, there is the “psych review of systems” where you’ll ask the patient if they experience symptoms in the basic areas of psych illness (anxiety, depression, mania, psychosis, drug and alcohol use, etc.) kind of like you’d go over the ROS for the cardiac, respiratory, gi, etc systems for the “medical” ROS.

    I hope that helps! Good luck. Psychiatry is awesome.

      • What Ninja said. Also, I was thinking about the MSE, and how you don’t necessarily ask the patient the things on it. A lot of it is stuff you kind of “pick up on” over the course of talking to the patient about their problem. Take appearance and attitude — you’re not going to ask the patient about those things, you will observe them. It’s the physical exam of psychiatry. So yeah, *ask* the patient about the HPI, etc (all the things Ninja said) and the psych ROS. THEN when you present the patient, present that, and then present the MSE like the physical exam would be presented for a “medical” patient.

  3. High heels, high shmeels (though I will secretly admit that I do think they look awesome on those brave, masochistic – ? – medical peeps who can pull them off). After my first full two weeks in the clinic I broke down and bought some Danskos. I looooves my Danskos :).

    Also there is *sort of* a basic Psych Eval format. Of course, it sort of depends on what your Attending wants in them. I looked at the wiki article OMDG talked about and per my own Attending it’s pretty much that. Plus as OMDG said, CC/HPI, plus past medical/psych/social/family history, meds, diagnoses and treatment plan.

    Good luck trying on specialties! Have fun!

  4. Hahaha, I’m 5’2 and I learned how to walk in heels from watching an obscene amount of America’s Next Top Model reruns, so…I don’t think either of us is very well-off. Though, kudos on seriously watching any video made for beginning cross-dressers.

  5. * Cause, you know, who knows? One of the two specialties I like now may, in two years, turn out to only be interested in other specialties.

    ahahahahahahahaha – just thought you should know I’m cracking up over here.

  6. I too wish I could wear heels. Bought two pairs over Christmas and look like a newborn foal in them when attempting to walk and appear womanly.

    I agree with all OMDG/Ninja say regarding the prep (and pretty much everything else, in general).

    The only things I’d add: know a few buzz words to describe affect, know the difference between that and mood. Say things like ‘affect congruent to mood’ and your psyche res will think you are a genius (which you prob are).

    Might want to also look at things tested in mini-mental as well…in case you end up in geri-land. In that case, also good to talk about differences between delirium and dementia.

    I just realized that you are doing this today and therefore my 2 cents is late! Hope you had fun!

  7. My two pence (pronounced tuppnce) is also a tad late, however, if anyone in a position of authority (i.e. psychiatrist, or worse, examiner/exam) ever see’s you or asks you about a psych exam, make sure you ask about suicide .

    • I didn’t get a chance to read this before presenting, but man, I’ll keep that in mind in the future. Suicide was definitely a thread I didn’t doggedly follow like I should have. Takes some courage…

      • 100% agreed with Legalalien.

        I worked in an acute 6-bed lock down unit (on an adult psyche ward) for a year as a student nurse and then for another year casually after I graduated. Never, never, never feel weird or hesitate about asking about suicidal thoughts or a plan. It is like asking someone in a GI history what their BM’s are like, you just work through some (non-ambiguous) phrases that you are comfortable with and let ’em fly.

        You are there, in a position of privilege and trust, which gives you an all access pass to asking them questions. This includes suicide/homicide risk. It feels weird the first few times, but you will find that often people will not volunteer the info but appear relieved when you ask them directly and allow them to unload that burden on you. Or they’ll just say–no, absolutely not, and you can move on.

        I put my entire ER department at risk one night because I didn’t ask enough questions at triage to a patient who presented with ‘suicidal thoughts’. We see these patients every day in ER and most of them have no real plan, and no real intention but they need help so we are the entry point. This girl told me that she had a plan which was to blow herself up. I looked at her, a 17 year old street kid and assumed this was another case of ‘unrealistic plan seeking help/shelter’.

        Nope. She actually had enough explosives under her shirt to blow an 80ft hole in the department (as told to me by the bomb squad which we had to call later when it came out that she actually HAD a BOMB strapped to herself).

        Yep. I had put her in the ‘quiet room’ and she was in there for a couple of hours before the doc saw her and ascertained that she had explosives on her. I didn’t think she was a real threat/risk when I triaged her so I didn’t come straight out and ask her if she had explosives on her. I asked her if she had a way to GET them but not if she actually had them.

        I was an idiot for not going that one step further. Lesson learned. We were all very lucky that night. (Did I mention it happened on Christmas Eve??)

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