Wayfaring MD
And for the 5,000th time, let me clarify that I am female.
Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes.
My residency’s self-proclaimed narcissist psychiatrist
After explaining about a new patient who had a history of suicidality and was currently very depressed and was not on meds…
Me: I want to start her on an SSRI, but I’m afraid about the possibility of her making suicidal gestures if we start her on meds and don’t supervise her closely enough. I’ve tried to get her in with a psychiatrist but everyone is booked for months. I think we’re walking a fine line on this one.
Attending: Yeah, let’s call Dr. Psych and get his opinion on this before we pull the trigger….
Me: 
Attending: poor word choice. My bad.
Me: Talk about a Freudian slip…
Me: so tell me what brought you in tonight.
Patient: I’ve been dizzy and falling all over the place and I’ve had double and even triple vision and I’ve got pain on top of my kidneys (points to lower pelvis) and I can’t think straight because I have aphasia and and and and and…
Me: 
Ok, and tell me about your medical history.
Patient: I’m pretty sure I had some surgeries as a kid that my parents hid from me and I saw the records once and I probably also had cancer and they told me it was just colds and I don’t think my parents are my real parents because our eyes are different colors and and and and….
Me: 
Patient:…oh, and I’m pre-med. I made a 40 on my MCAT and I’m going to be a psychiatrist.
Me: 
Resident: So what do you take Seroquel for?
Patient: You see those bugs crawling on the wall over there?
Resident: Ummm… no….
Patient: That’s what I take it for.
Resident: 
In a few months I’ll be choosing a specialty to start my residency and I have doubts between choosing Psychiatry or Family Practice; I like both. Any advice? -entropycomeseasy
When I first started med school, my dean told me “if you like a little bit of everything and you don’t hate psych, you should be a family doctor.” She’s totally right. We see tons of psychiatry in family medicine. And I really enjoy the FM-type psych stuff. I like treating depression and anxiety and cognitive disorders. I am not a big fan of treating acute psychotic breaks and such. Which is why I’m a family doctor and not a psychiatrist.
But if you like it all, why not do both? There are combined Family Medicine-Psych residencies out there. They’re rare, but they do exist. I think in the next few years there may be an expansion in primary care-psych programs, especially considering the shortages of each these days. There was an article about these programs on KevinMD recently.
If you want to choose one or the other, consider the following:
- A: Is there anyone you didn't give Haldol to last night!?
- B: It was a full moon! And Haldol is my full moon medicine.
First clue that our alcoholic patient was not developing Wernicke-Korsakoff’s but was, in actuality, just manic and off his Lithium.
DL: I couldn’t think of a reason not to put in a rectal tube on him.
Dr. W: other than he’s schizophrenic and is wondering what the aliens are doing to him now.
Manic ER patient: There’s a problem with my junk. I’ve lost it.
Dr. F: It’s probably still there. **Examines patient** See, it’s still there.
Patient: But doc, where’s the other 5-6 inches?
patient
Can you give me tips on dealing with depression? I’m a second year med student (on a international university, so is second year of six) who really loves medicine, especially surgery, but feels that does not have what it takes to be successful, to be a good doctor. I’m constantly thinking, “I’m not good enough, not that smart, I don’t have the abilities…” :S (can you please answer this on anon?)
I once told my mentor (and imo the best freaking doctor in the history of ever) that I didn’t feel like I was smart enough to be a doctor. This was like late in my fourth year of medical school, so I should have felt more confident, right?
Her (very wise) response?
“I wake up every day and think I’m not smart enough for this job. That’s what keeps me reading and learning.”
The point is, none of us feel good enough, smart enough, compassionate enough, competent enough, etc, at least at some point in time, if not all the time. The people who claim they do have everything under control are the ones most in danger of hurting someone because of their arrogance. Shoot, I have the “I’m not smart enough to be a doctor” thoughts at least weekly, and I’m already a doctor.
Lately I’ve been seeing a lot of posts on my dash where people talk about misusing their anti-depressants. Some take an extra because they had a bad day, while others will go without for a few days just to see if they can. These posts really bother me and worry me, and I’d like to clear some things up.
1. Anti-depressants (SSRI’s) are not magic. Please hear me when I say that their purpose is not to make you happy. Their purpose is to treat depression. They are there to get you out of the funk so you can function like a productive member of society. Presumably they bring you back to a physiologic baseline, which you can then improve upon with prayer, counseling, meditation, lifestyle changes, etc. Happiness cannot be found in a pill.
Me: Ok ma’am, can you tell me what day it is?
Pt: Tuesday.
Me: Right, and do you know where you are?
Pt: The hospital.
Me: Good. Now for some silly questions. Can you spell the word “World” backwards?
Pt: D-L-R-O-W
Me: Good! Can you tell me what this thing on my arm is (point to my watch)?
Pt: A condom.
And it was all downhill from there…
I got so many questions the last week about my thoughts on antidepressants and anxiety medication. And 99.9% of the people I were talking to, were reluctant to seek professional help, because it would mean that they have failed.
THIS!!!
As another example, would you get mad at your immune system if you got the flu? No, you just take medicine and get back to your old self! You can’t kick yourself or blame yourself for not being able to will healing into existence, whether the disease is the flu, cancer, or yes, even depression.
What is your advice for encouraging medical professionals to pay more attention to the patient in front of them and less to their preconcieved notions regarding their diagnosis? (Mostly mental health related)
-sweetnessspokane
- Depression or anxiety can look wildly different in different people. A 75 year old widower will present very differently than a 15 year old girl, 40 year old housewife, or 35 year old businessman. Don’t expect everyone to come in complaining of SIG E. CAPS type symptoms. You have to dig for that
- Don’t assume they’re not taking their medicine just to spite you. Ask them. Maybe they can’t afford it, or they’re having unpleasant side effects, they don’t understand how to take it correctly, or it’s just not working for them.
- Don’t forget that their psychiatric diagnosis can affect their other medical diagnoses and vice versa.
