Just Checking In!

September 27, 2015

Hello, Readers!

Happy end-of-September to you all!  For those of you currently in school, hope things are going well for you, and for those of you contemplating school, I hope the blog is helpful towards reaching a decision.

Lets see, what’s gone on since June?  Well, June was my last rotation of my intern year and also my last rotation on the inpatient psychiatric service.  I liked working on the inpatient unit and am sad that I will not be going back, except when I am on the dual-diagnosis unit rotations later this year.

July and August I was on our Geriatrics rotation.  That was fun.  It was fascinating to focus on that specific population.  Lots of folks (myself included) have the preconceived notion that there is nothing except depression and dementia in that population.  SO WRONG.  They have their own fascinating dilemmas and a variety of diagnoses just like the adult and pediatric populations which draw my attention and make me love psychiatry.  Oh, and also during this rotation, we get to run the ECT service.  That was my favorite part.  I loved learning how to do ECT and seeing the rapid, significant results it brought many of the patients.  It’s definitely something I want to do when I finish residency.

September I got to go our forensics rotation at one of the state hospitals (we have 3).  I enjoyed that as well.  I did not think I would like forensics as much as I do.  I have even found myself logging onto freida (http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page?), looking at forensics fellowships.  Don’t worry, my heart is still set on child and adolescent, but this would be a fun thing to consider after that.

Now I am on to night float.  There are two residents who share the responsibility, so I am off this week but will be on next week.  It seems intimidating because I will be the only house staff in the 950-bed hospital for the psychiatry service from 9:00pm-7:30am, but I am excited to take-on the challenge.  I have an on-call attending physician at my beck and call, I just have to pick up the phone, so I’m really not alone.  I will cover the patients who present to the emergency department with psychiatric complaints (I have done this before on the emergency psychiatry rotation), any emergent consults which are placed within the hospital (I have done this before on day float and on geriatric consults), and any issues which come-up on the inpatient psychiatric unit (I have done this before while on short-call during the many blocks of inpatient psychiatry).  So it’s really not anything new I haven’t done before, it’s just at a different time of day.

During our off-weeks on night float, we are scheduled for the outpatient psychiatric clinic (almost the whole third year of psychiatry residency is dedicated to outpatient psychiatry) which is our first exposure to outpatient psychiatry.  It’s cool to feel like you’re a third year, sitting in clinic.  I was unfamiliar with the flow of clinic, but the third years were very helpful orienting me to the correct templates, where to collect vital signs, where the after visit summary prints out, where the prescription printer is, what billing codes to use, etc.  Interviewing the patients is the same as in the hospital, it’s just in a different setting and you are under more strict time constraints.  I think I like it.  The in-office cameras take some getting used-to, but are admittedly better than having another person sit in the room and throw-off the interview.

Well, that’s really all that’s been going on.  You all have submitted some great questions in the comments section, which I’ve finally gotten caught-up on.  Please keep them coming.

Thanks for reading!


Hello, again!

June 17, 2015

Hi, Long Lost Readers!

My apologies for the extended break.  I had some busy rotations and then was studying for step 3.  So…7 months later, here I am!  I am beyond thrilled that I will be a PGY-2 in 13 days.  And too, found out just today that I passed Step 3!

When last we spoke, it was November.  I was just finishing-up outpatient peds and starting outpatient neuro.  Absolutely loved peds–was probably the happiest I’ve been all year.  Reaffirmed my decision to do child/adolescent psych.  (Interestingly enough, peds was my best age-group in terms of performance on Step 3).  Outpatient neuro was…jarring.  Everyone says it’s supposed to be so chill–don’t get me wrong, it’s great having holidays and weekends off, working 8:00-5:00ish, but you literally work with a different attending every day.  There are 7 or 8 attendings, so you never quite get used to any of them.  I felt constantly on my toes.  At least in most of the other rotations, you get to a point where you feel comfortable.  Oh–and there’s the same old accompaniment of off-service rotations–losing a weekend.  It’s where you have to go in and do dayfloat (cover ED and consults from 7:30-7:30).  For me, it was 4 days in a row Thanksgiving weekend.  Ugh.  Never. Again.

I had been wondering, for a while, how December worked.  I asked early-on, for December vacation time (we get 3 weeks of vacation per year but there are lots of rules about when we can take it) and was informed that I was not allowed to take additional time off in December (independent of what rotation I was on).  Everyone either gets Christmas week or New Years week off, outside of your 3 weeks of vacation time.  It’s nice unless, like me, you have to work the flanking weekends of that week.  Then it makes travel difficult (though not impossible).  Things on the unit slow down and you decide amongst your teammates who will be on short call and cover the unit each day.  It’s a pretty good month.

January started my month in the ED.  I heard it could be pretty hectic.  The first week was.  I would come in to several people waiting to be seen, then would see 10-15 throughout the day.  You start to learn what the upper years refer to as “b-s consults.”  There are many times we are called to consult on someone who does not have a psychiatric issue but because they are a liability, the ED docs decide they need “psych clearance” before they are discharged.  The only problem with this is, as I’m sure the ED doesn’t take time to notice, our consults are 6 pages long!  It’s not just a quick thing to walk in and make sure a patient isn’t suicidal.  You have to go through what happened leading up to the this event, determine if they have a substance abuse issue, argue with the ED over drug screening (no idea why they don’t do this BEFORE calling a consult), get a whole social history on this person [who just came in drunk], and do a cognitive eval on them [when they’re still sobering-up].  Then the ED wants a decision as soon as you walk out of the room…um no?  Often times, your attending that day will disagree with you or have additional recommendations–if you tell the ED that someone is clear, they will discharge that person before you have a chance to discuss them with your attending.  And then get mad at you for not giving them an answer quickly!  If you think they’re so stable, then why did you call the consult in the first place?!

After the whirlwind of ED, I was back on the inpatient unit.  Starting to get an idea of how things work and felt like I knew what I was doing, so this was a good month.  And it was my birthday.

The next two blocks were inpatient family medicine.  After my experience on inpatient internal medicine, I was nervous, but the family medicine folks were great.  They’re more laid-back than the IM folks and I felt like I had more autonomy on that service.  It was EXCELLENT review and learning in preparation for Step 3.  I decided that I would need to take Step 3 in close proximity of my family medicine blocks, while I was still in that medicine mindset.  2 weeks of the first block was night float–again, little nervous about that after my experience with IM–but it actually wasn’t bad.  We were steadily busy most nights, and I got to experience a code during one of the nights, which was a good learning experience.

I felt the pressure once family medicine ended.  I had 3 weeks before my Step 3, but also was starting a new rotation–outpatient addictions.  It involved learning the policies and practices of another facility, who just happen to do everything on paper.  Lots of new experiences for me–while I was a secretary in a paper-charting facility, having to find the chart to write orders or notes is a completely different experience.  Somehow, I still found time to study and prepare.  I was able to take some time off immediately before my exam, to clear my mind and review last-minute subjects–mainly Step 1 pearls and bio-stats.

Before I knew it, Step 3 was over.  Addictions rotation was over, and I was back on the inpatient unit for my last block of the year!  It’s second-nature being on the unit now, don’t really have to think about doing things before you find yourself doing them.  You figure out how to stay a few steps ahead of the patients and anticipate what they might need.  Because one of our attendings is leaving and in the process of moving to a different state, I have had the opportunity to work with some of the other attendings who are filling-in on the unit and have enjoyed my experiences with them.  It’s different than rounding with them on the weekends, different in a good way.

Now off to reply to everyone’s comments and requests.  Ta-ta.

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!



July 5, 2014

Hello, Readers,

OMG. Residency is quite different than I expected; very, VERY busy. I am frequently reminded of my internal medicine rotation during third year. It’s taking time to get used to things–figuring out how different processes work at the hospital, learning to navigate the computer system from a resident’s perspective. Oh, and learning my way around the hospital: I can find the cafeteria, the other cafeteria, and the Emergency Room. I was shown where the GME office is once, but am not sure how to get back there without going outside and approaching it from the nearest exit.

I like that we don’t have to work every weekend. Even though I have to come in to work this weekend, I’m happy to have next weekend off. Though orientation is over, we continue to have many meetings. The good thing about working on the weekend is that we do NOT have meetings; it’s much easier to sit down and concentrate on a task when you don’t have to worry about getting to a stopping point just so you can make it to another obligation on time.

Spooky having everyone call me Dr. And carrying around a pager, still getting used to that. I find that having to dress up most days, I look forward to coming home and having a reason to go somewhere and wear casual clothes. Oh, and I’ve got this dorky habit now of reaching for my pocket to get my keys/badge ready to unlock/swipe into most doors.

In for a penny, in for a pound! I’m a resident now!

The Move

June 19, 2014

Hello, Readers,

Greetings from “down East.” I’ve officially completed the move 4.5 hours to the East where I will be doing my residency for the next 4-5 years. I’m so happy to finally have finished unpacking the last box. You take small things for granted when you live in one spot for more than a few weeks. It’s nice to be able to go shopping for real housewares knowing that you’ll be in a permanent spot for at least a year.

Originally I had looked into buying a house here, but then saw that the housing market here has been really stagnant (houses on the market for 200+ days) so I thought it would be less complicated to rent for the first year. Being a college town, there are tons of apartments available, many of which are relatively new and competitively priced. I was able to find a brand new one within a mile of the medical center at which I will be practicing. I’ve had fun over the past couple days enjoying the amenities like the pool, fitness center, and club house while I have no serious obligations.

Orientation has technically begun this week. Monday there were 2 benefits sessions which were optional to attend, though we had been sent the links to sign up for benefits online, in advance. Signed up online, skipped the sessions and instead went to get my parking sticker and ID badge made. I had one of those epiphany moments when I got my badge and it had my name and in big letters at the bottom, MD. Sure I signed all of my graduation thank-you’s with an MD after my name, mostly to be cute, but it really sank in that I’m finally an MD when I saw the badge. In all of my excitement and anxiety about the Match and residency, it didn’t seem like I’d passed any significant milestones since I still have years of obligatory training ahead of me before I’ll be out there on my own.

Tuesday I wandered over to the [giant] hospital campus again, this time to get something called a One Card which is, from what I’m told, a door pass. Not sure why that can’t be tied into my badge and why it has to have my photo on it, but whatevs.

Yesterday was Occupational Health day. Thankfully they had the brilliant idea to send most of the paperwork ahead to us in one of those waves of online check-lists we have to complete (which I was complaining about a couple of entries ago), so when I made it back to my appointment, they had all the paperwork and shot records in order. There was just the annual health screen (height, weight, (bmi calculation) BP, vision screening, fingerstick for cholesterol check/blood sugar, waist circumference [eek]), yet another TB skin test (I just had one done in Feb but the hospital requires all new employees to have 2, so they counted the Feb one as #1 and gave me another ::sigh::), MRSA nares screening, a urine drug screen, and fit-testing for N-95 masks. I was happy to discover that my cholesterol had dropped from 144 at my pre-first-year-of-med-school-physical down to 129 (I attribute this to giving up red meat and taking a fish oil supplement), and my HDL had increased from 39 to 41. It’s still not where I’d like it to be, but I’ll keep exercising, pushing fiber and add oatmeal to my diet. Nephrology elective Doc was urging me to get tested for Diabetes back in April (he had just been diagnosed, himself, so I think he was projecting) but happily my fasting blood sugar was just fine at 84. Not all fat people have diabetes and bad cholesterol! ::Crosses arms::

Today’s orientation obligation was to go to the local Uniform shop and pick out resident-length white coats–yippee! The hospital gives us a $100 credit at the store so we’re allowed to pick out 2-3 lab coats and then the store will send them off to be monogrammed for us. That was fun. I like these coats much better–they’re a much more flattering length. After trying on about 50 coats, I finally chose 2. At the register, they asked me my name and department which yielded a piece of paper with how my monogramming was to look! Another epiphany moment (OMG I’m really a physician now)! After proofreading to make sure that everything was spelled correctly, we signed and were told they would be back from monogramming within 7-10 days, that they would call. With no other obligations, we went for a road trip to the neighboring coastal towns along the inlets–Washington, Bath, and New Bern. Lots of fun, very pretty. We ended up having lunch in New Bern at a famous BBQ place called Moore’s which is in the Guinness Book of World Records for having created the world’s largest open-faced BBQ sandwich back in 2010. Their chicken wasn’t bad but their hushpuppies were fantastic!

Tomorrow I have to go back to get the TB test read but then I’m free [to enjoy the pool some more!]. The parts of orientation that everyone dreads start next week–where you’re sat in a giant conference hall for 8-hours while the hospital higher-ups talk to you about avoiding needlesticks and PASS/RACE and customer service and all of that stuff we’ve all heard about 3000 times. Maybe they’ll make it fun. During the later part of the week, we have orientation within our individual departments, which means I’ll finally get to meet the other psych residents! That, I’m REALLY excited about!

Oh–the 2014 MUA Match list went up today: http://www.mua.edu/images/downloads/MUA%20Residency%202014-LR-1.pdf