Types of patients you found challenging in this rotation and what you learned about dealing with them

In this rotation, I saw many patients came in for disorganized behaviors, which usually due to non-complaint with medications. Most of the time, the family members or friends were the first person who noted the patient’s symptoms. Due to the disorganization, the patient also presents poor insight. In this situation, it was also very difficult to explain the importance of medication to patients with psychiatric conditions because they had difficulty understanding. They had lack of awareness of their illness. Patient’s failure to adhere to their medication as prescribed would also have a major impact on the course of illness and treatment outcomes. In order to solve these type of problems, long-acting medication would be the best choice for these patients. It is very important to understand the medications, including their mechanism of action, metabolism, side effect, and indication in order to help patients to be more compliant with medication.

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

In this rotation, it has a lot of differences from interview patients who have medical concerns from emergency medicine. For interviewing psychiatric patients, the evaluation starts as you first saw the patient. The first sight of patient is very important, for example, how does patient look like, disheveled or well-groomed? Is patient agitated or calm? How is patient’s mood, fair or tearful? This kind of general survey is very useful, and it guides us through the interview. The main difference from other medical concerns interview is that for patients with psychiatric problems, we will always need to get collateral information from family members, outpatient psychiatrist, or someone know the patient very well, because we cannot fully rely on what patient told us. Sometimes, when we call the family for collateral information and they provide different stories from what patient told us.

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc).

Before this rotation, I believe it is really hard to interview patients who are angry and agitated. Usually they brought in by EMS because they have arguments or fights with others. For these patients, I learned that do not rush to get into questions about why they behave in this way. First, provide them food and water, leave the room and let them calm down a bit. Second, when we come back and approach them with empathy, and start questions by asking them how they feel right now. After patients calm down, they usually need a listener, this is the best time to interview them. In addition, for those really aggressive patients, we have to go back to our safe box, activate team code, and order stat medications to calm patients down.

What do you want to improve on for the following rotations? What is your action plan to accomplish that?

In this rotation, I was not able to complete a lot of hands-on procedures on the psychiatric patients. Although I had done procedures in the previous rotations, I would still like to have the opportunity to practice more procedures. For the following rotations, I would like to be more proactive in order to get the chance for hands-on procedures. In addition, I would like to work on setting up management and treatment plan. I would try to discuss with my preceptors and know how to improve my treatment plan for the patients.