Psychiatry, a very different field –
To be honest I was very happy to be starting my clinical year with this rotation. I knew the schedule was going to be doable, the material was not going to be very complex, and I wasn’t going to be thrown at crazy medical scenarios. Knowing I was going to start in psychiatry comforted me in one way, but a part of me was also scared because I felt like my program did not prepare me for all of the psych medications.
Where I did my rotation
For this rotation, somehow I was matched with a Psychiatrist who was from Colombia. I couldn’t believe it myself. I completed about 4 weeks in his private outpatient clinic and worked 9am – 5pm, Monday – Friday. It was a very cool experience because we saw patients with textbook presentations of conditions that ranged from depression, anxiety, ADHD, Alzheimer’s, Bipolar disorders, PTSD, and many others. It was very neat to see the complexity and the knowledge of my preceptor when it came to prescribing medications and teaching me about the various chemicals in the brain and how everything worked. It was beyond my knowledge and sometimes I felt like I lacked all of this knowledge of essential components of brain chemistry, but I had to keep reminding myself I did not study psychiatry like he did and in PA school Psychiatry was just one short course.
For the other two weeks, I worked with a PA-C in a Federally Qualified Clinic, which was a completely different experience. Here, we saw a different patient population. It shocked me how the same specialty depending on the population can see such different patient presentations. Here, our cases were not straight forward. We did not see the typical anxiety or depression patient. We saw patients with complex psychiatric conditions. Most were homeless, consumed drugs, were alcoholics or smoked, and on top of that, they had some mental illness. This was a lot harder because simply prescribing medications was not going to do it, we had to incorporate many other resources such as therapy, and even social services.
My experience
When I told people I was going to start in Psychiatry, they told me how boring that was. During my rotation, I caught myself enjoying it and having a great time, but little did I know how different my next rotations were going to be and those people were RIGHT. Now looking back I can agree Psychiatry was probably the least exciting for me.
No stethoscope in hand, no rounds, no fun procedures, rarely seeing any patients on my own, it was SO MUCH LISTENING. I basically sat in all of my preceptors’ appointments with patients that agreed to have a student. I took notes, wrote down information, and that’s how the day basically went on. I got to do about 3 interviews all on my own because we rarely had new patients. OH and the best part is that I got to experience paper charts at first hand, lots of fun!
Patients are vulnerable, be empathetic
During this rotation, I saw patients at their worst times of their life. My day felt like a roller coaster of emotions, some patients were happy and thankful and couldn’t thank my preceptor enough for what he had done for them. Others were in despair, they had so many problems, felt so lonely and there was not much we could do. I learned not to judge patients for whatever problems they had or said during our interview. I just learned to listen, be attentive, and be empathetic to whatever situation they had going on.
How I prepared
If you think psychiatry is easy, you are wrong. It requires a lot more knowledge than what I had anticipated. My first preceptor was basically a genius and there was no way I could ever get to that level in just 6 weeks. Especially not when my pharmacology in psychiatric medications was so weak from PA school. I basically had to teach myself all of these medications, so here is what I did.
Every patient encounter was a learning experience – I would write down medications and what they were used for and when I came home every night, I would review all of these
I used a pretty amazing Medication chart and memorized all of the medications, usages, side effects, contraindications, and important facts.
Every night I studied the medications so that my brain can start remembering them
The conditions were the easy part, but knowing the duration of the illness, symptoms, and what differentiates certain conditions from others was key. For example, knowing Schizophrenia from Schizophreniform or bipolar I from Bipolar II disorder.
Studying very hard during this rotation really helped me solidified my knowledge in psych because you deff use it in your upcoming rotations and in your everyday life as a PA-C.
POST ROTATION CELEBRATION - NOLA
