Ah, psychiatry rotation! The six weeks every third year medical student looks forward to. Also known as the "psychation", this clerkship is notorious for great hours, low stress, and relatively easy content. In all honesty, I began my psychiatry rotation with these same expectations, only to be caught off-guard by brilliant teaching faculty who kept me on my toes, complex patients, and the mystical nature of the human mind. Here is a little taste of what I learned on my psychiatry clerkship:
Mental illness is real.
One of the most amazing things I was able to witness is the stabilization of an acutely psychotic patient. When someone is admitted with auditory hallucinations, homicidal thoughts, and bizarre behavior, it is easy for someone to write them off as “crazy” – as if an element of their illnesses is fabricated. However, as my patients began responding to treatment, they also gained insight on their disease process. I now understand that distorted perceptions lead to a legitimate distortion of reality. I often found myself wondering how I would react if everyone told me that my reality was wrong. It wouldn’t be easy to accept. After seeing my dear patients experience the hardships of mental illness, it is clear to me that their suffering is no less real than any physical illness.
Mental illness does not discriminate.
Another fallacy is that mental illness is a plague of the low socioeconomic status and under-educated - that these individuals are destined to live at a lower level of functioning and intelligence. On the contrary, mental illness affects the millionaires and homeless alike, from the medical student to the high school dropout, and everyone in between. What's more, health disparities seem to be more pronounced in the diagnosis of mental illness. Silent and dangerous, inequalities in diagnosis, treatment, and other modalities of care can be combated best by choosing not to ignore them. Awareness of these health discrepancies is crucial to optimizing patient outcomes.
Psychosocial issues cannot be ignored.
Medicine can be hectic - nurses are desperately trying to get medications dosed to patients at the appropriate time, physicians are trying to fit in one more consult before the day is over, and supervisors are trying to ensure that time to discharge is minimized. However, we often forget that the best treatment approach is a holistic one that extends beyond medical care to encompass psychotherapy, social work, occupational therapy, and other types of treatment. It is imperative to understand the patient's home life, finances, support system, and stressors so that our treatment plans can be more effective and realistically followed through by the patient. What's the point of writing a script for antibiotics that cost $100 if the patient won't be able to afford anything more than $50? We should work together with our patients to formulate a plan that not only works best, but works best for them.
Being a doctor is not only an opportunity to treat, but to heal.
People with mental illness are largely disenfranchised in the world we live in – by their families, their friends, and even by healthcare providers. Yes, I said it. Even if they have good intentions, many medical professionals simply do not want to work with these patients. Some may feel caring for them is out of their scope or that they are too complicated to care for in a typical appointment time slot. However, it its core, medicine is about being a source of support and healing for a person who is suffering - even if we do not have the all of the answers or the resources to do so.
My psychiatry rotation helped me develop my identity as a future physician. Being able to talk to people from all walks of life about their deepest, darkest fears has helped me cultivate a deeper understanding for the common thread that runs through all of us. It fine-tuned my ability to communicate empathy to others and handle emotionally stressful situations as a healthcare provider. Last but not least, it made me immensely thankful to be in a profession where I am able to offer compassion to others and serve their most basic human needs.
Mental illness is real.
One of the most amazing things I was able to witness is the stabilization of an acutely psychotic patient. When someone is admitted with auditory hallucinations, homicidal thoughts, and bizarre behavior, it is easy for someone to write them off as “crazy” – as if an element of their illnesses is fabricated. However, as my patients began responding to treatment, they also gained insight on their disease process. I now understand that distorted perceptions lead to a legitimate distortion of reality. I often found myself wondering how I would react if everyone told me that my reality was wrong. It wouldn’t be easy to accept. After seeing my dear patients experience the hardships of mental illness, it is clear to me that their suffering is no less real than any physical illness.
Mental illness does not discriminate.
Another fallacy is that mental illness is a plague of the low socioeconomic status and under-educated - that these individuals are destined to live at a lower level of functioning and intelligence. On the contrary, mental illness affects the millionaires and homeless alike, from the medical student to the high school dropout, and everyone in between. What's more, health disparities seem to be more pronounced in the diagnosis of mental illness. Silent and dangerous, inequalities in diagnosis, treatment, and other modalities of care can be combated best by choosing not to ignore them. Awareness of these health discrepancies is crucial to optimizing patient outcomes.
Psychosocial issues cannot be ignored.
Medicine can be hectic - nurses are desperately trying to get medications dosed to patients at the appropriate time, physicians are trying to fit in one more consult before the day is over, and supervisors are trying to ensure that time to discharge is minimized. However, we often forget that the best treatment approach is a holistic one that extends beyond medical care to encompass psychotherapy, social work, occupational therapy, and other types of treatment. It is imperative to understand the patient's home life, finances, support system, and stressors so that our treatment plans can be more effective and realistically followed through by the patient. What's the point of writing a script for antibiotics that cost $100 if the patient won't be able to afford anything more than $50? We should work together with our patients to formulate a plan that not only works best, but works best for them.
Being a doctor is not only an opportunity to treat, but to heal.
People with mental illness are largely disenfranchised in the world we live in – by their families, their friends, and even by healthcare providers. Yes, I said it. Even if they have good intentions, many medical professionals simply do not want to work with these patients. Some may feel caring for them is out of their scope or that they are too complicated to care for in a typical appointment time slot. However, it its core, medicine is about being a source of support and healing for a person who is suffering - even if we do not have the all of the answers or the resources to do so.
My psychiatry rotation helped me develop my identity as a future physician. Being able to talk to people from all walks of life about their deepest, darkest fears has helped me cultivate a deeper understanding for the common thread that runs through all of us. It fine-tuned my ability to communicate empathy to others and handle emotionally stressful situations as a healthcare provider. Last but not least, it made me immensely thankful to be in a profession where I am able to offer compassion to others and serve their most basic human needs.