Residency Update

October 14, 2014

Hello, Readers!

Feels like it has been ages! Things have been so busy that I just haven’t had a free moment in front of a computer to reconnect. I will catch you up to speed! I am now 4 months into my residency. The first month was inpatient psychiatry, then internal medicine, then inpatient neurology, and finally I’m back on the inpatient psych unit.

There was a huge learning-curve. We were made to go to a lot of meetings towards the end of June and the first couple weeks of July, but there was so much to learn that wasn’t covered in the meetings. As a class, the interns have decided this year that we are going to request to have input in the orientation material for next year’s intern class. There’s learning how to do IVC (involuntary commitment) paperwork, learning how to determine Capacity, how to do face-to-face violent restraint assessments, how to handle agitated patients, how to work in the emergency department, how to do admissions, what to say in court, how to do discharges, and in the most general sense, learning how each of the inpatient units works. I know, a lot of that couldn’t be taught in meetings, but it was really intimidating to learn it as we were concomitantly responsible for doing it.

And that’s just the psych part. I spent the first 4 weeks learning psych and then was sent over to medicine. I think I really worried the resident I got sign-out from. The last day of psych, one of the upper-year residents walked me over to the medicine work-room so that I could stay for afternoon signout, to get information on the patients I would be taking over the next day. I think I said something stupid to the resident like, “so you just come in and what? examine them?” Physical exams are not something we do everyday in psych, but your basic chest, abdomen, extremities exam is something every patient should get every day in medicine. Then there was figuring out labs, what tests to order, how to do medicine H&P’s. My first on-call, I had to go do an admission on an overflow neuro patient with suspected GBS. I had no idea what to ask him, no idea what to order. It was a rough first week but then it got better. I learned very quickly and was told that I was on-par with the medicine residents by the end of the month.

Inpatient neuro was, I think, easier after having been through medicine. The neuro docs are really focused on neuro and it’s understood that all of the other co-morbidities such as HTN, DM, HLD, asthma, CHF are all managed in the background by the residents. As, prior to IM, I was not comfortable managing those conditions, it would have been rough just stepping into neuro.

I am happy to be back in psych now. I missed it while I was gone. While medicine and neuro were interesting, they don’t compare to the great puzzle that psych patients present as. I have a patient right now who presented COMPLETELY different than collateral information indicated, and then I’m getting another different story from the patient’s ED records from the referring hospital. I have this mystery on my hands, putting together all 3 stories and trying to figure out what’s accurate and what contributes to the diagnosis. Unlike medicine, there are no lab tests (aside from B12, Folate, RPR) that will confirm my diagnosis. I just have to know the right questions to ask.

I’ve figured out how much I really like being at a level I hospital. It’s great getting all these referrals from all over the state – really unique cases from everywhere. I think it would break my heart to get a really interesting case and then have to send it off to another hospital because my hospital was not equipped to handle such a patient.

Alright, should head back to bed and get ready for work in a couple hours. Good to catch up!

J