Agraphia Medical Tragicomedy

15Nov/07Off

Anecdotes: Psychiatry

Next up: psych. I'm not sure I have a single defining story yet, so we'll just use this little tidbit in the meantime. I'll come back to this one by the end of the rotation in a month.

Psychiatry

One of the things I really enjoy about psychiatry is that you get to be rather... expressive while writing notes, which gets to be a lot of fun. You're supposed to be as descriptive as possible; capturing someone's mood and psychiatric progress goes far beyond single word descriptors as can be done in the rest of medicine. My writeup of a patient at one point contained this gem.

Currently, we cannot tell if this patient's particular affect is due to residual schizophrenia, or if it is due to his long and often colorful past history of psychoactive drug use, including being breast fed "raw alcohol from my mother's tits", at least 100 LSD trips since the age of 13, and "so many shrooms, it would blow your mind".

Of note, this is now a legitimate entry in his permanent medical record.

Awesome.

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  1. Awesome? Not really. I think most head shrinkers are poor examples of physicians and are dangerous. I’ve rarely had an experience with a Psychiatrist that made me feel they understand medicine – at all – and can properly take care of patients.

    Side effects of drugs are often taken as “new psychiatric manifestations” and the need to intervene beyond adding more psychotropic drugs is often ignored. For whatever reason they are still trained as MD’s, but they honestly aren’t.

  2. whoa! it sounds like MSG has got some hating words towards psych docs! I agree that the awful side effects of the drugs that they prescribe stink but thats not their fault and they do know how to manage them well.
    you are right–managing a pt medically is not what they are known for, but thats sorta how medicine is working these days—everyone is getting so specific they don’t know how to deal with anything else anyway….

  3. Actually I meant side effects from other drugs, not their own. They do understand those quite well.

    And yes, I don’t like Psych that much.

  4. What keys said is basically true. I was shadowing an oncologist the other day who was managing a patient with multiple cranial nerve palsies. She couldn’t remember how to test the function most of the cranial nerves and then she laughed, “I’ll just call a neurology consult anyway!”

    The only things that I find scarier about Psychiatry than the above scenario is that a) psychiatric symptoms are a lot more subjective than “patient cannot adduct rt eye,” and b) often they will have an NP do all the medical management.

  5. See, that’s why I could never go into psychiatry. After hearing “being breast fed ‘raw alcohol from my mother’s tits’”, I’d come back after my shift was over to talk more and get nothing done.


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