(no subject)
So a quick update. There was that big exam, then there was the 6 weeks on psychiatry. I worked in a locked unit where many of the patients were confined to a single hospital floor often for a week or more at the discretion of the psychiatrists. There are reasons for it and I saw that for many patients-- like those who can't see a window without wanting to jump or who attack a neighbor because of paranoid delusions-- it can be a necessary and healing place. Still it's hard on those patients who hear about life going on outside and only get to see their family during a few visiting hours per week, those who are detoxing alone in an unfamiliar place, or even those who are not used to having someone else telling them what to do or limiting their freedom. While patients had legal recourse, few of them were organized enough to contact the public lawyer, and no one took the attending psychiatrists to court, during my rotation.
Besides the conversations about symptoms, medications, group therapy on the unit, and social work issues, the most frequent thing that came up when talking with patients was discharge dates. The psychiatrists were always hesitant to give them specific time frames because just as a medical floor won't discharge someone with a recent flare of fever, the psychiatrists didn't want to discharge anyone with a recent violent or severe psychotic behavior in the past few days. When a patient wasn't responding well to medications or when he quickly responded, felt better, and wanted to return home, it was difficult for me to relay the message that he had to stay. I became somewhat more comfortable with it after the first week but I had already realized that the ethical and legal issues involved made it not something I wanted to do in the long run.
I did appreciate the chance to talk at length with some patients and really get to know them, and even some of their families. I met a spectacular social worker who was able to get hostile patients to calm down and confide in her and she could sift through even the most disorganized story to find some leads about where a person might live after discharge. As one would hope, the unit had very serious social work that found viable living situations for many people with extremely difficult circumstances, particularly substance abusers who had alienated much of their family or who'd been living on the streets for years. They couldn't get people an apartment but worked very hard to reconcile people with their families where possible, or encourage them to go into rehabs, vocational programs, residence homes, or half-way houses depending upon what was appropriate.
On a personal level, it made me much more aware of the depth of intervention needed to actually help someone and much more skeptical of the spare change I've given out over the years to people with cardboard placards on the sidewalk-- something that I'm sure had done much more to ease my conscious than to ease their lives in any way. It was a humbling rotation to have first and I hope I can take some of the interviewing skills and lessons about learning to care for tough patients with me for the future.
This past week I spent on OB/Gyn which is a whole different ball game...
Besides the conversations about symptoms, medications, group therapy on the unit, and social work issues, the most frequent thing that came up when talking with patients was discharge dates. The psychiatrists were always hesitant to give them specific time frames because just as a medical floor won't discharge someone with a recent flare of fever, the psychiatrists didn't want to discharge anyone with a recent violent or severe psychotic behavior in the past few days. When a patient wasn't responding well to medications or when he quickly responded, felt better, and wanted to return home, it was difficult for me to relay the message that he had to stay. I became somewhat more comfortable with it after the first week but I had already realized that the ethical and legal issues involved made it not something I wanted to do in the long run.
I did appreciate the chance to talk at length with some patients and really get to know them, and even some of their families. I met a spectacular social worker who was able to get hostile patients to calm down and confide in her and she could sift through even the most disorganized story to find some leads about where a person might live after discharge. As one would hope, the unit had very serious social work that found viable living situations for many people with extremely difficult circumstances, particularly substance abusers who had alienated much of their family or who'd been living on the streets for years. They couldn't get people an apartment but worked very hard to reconcile people with their families where possible, or encourage them to go into rehabs, vocational programs, residence homes, or half-way houses depending upon what was appropriate.
On a personal level, it made me much more aware of the depth of intervention needed to actually help someone and much more skeptical of the spare change I've given out over the years to people with cardboard placards on the sidewalk-- something that I'm sure had done much more to ease my conscious than to ease their lives in any way. It was a humbling rotation to have first and I hope I can take some of the interviewing skills and lessons about learning to care for tough patients with me for the future.
This past week I spent on OB/Gyn which is a whole different ball game...