Morning report on the medical-psychiatry unit at Bellevue Hospital starts with the 9 a.m. multidisciplinary conference. The entire team consisting of psychiatrists, internists, psychologists, social workers, art therapists, and medical students listens to the nurse report any new developments with inpatients. We then formulate a group plan and determine how best to treat our patients, and we decide what new measures to add to their ongoing psychiatric care.
After morning report, the team interviews newly admitted patients. We introduce ourselves to the patients as members of their treatment team and ask both medical and sociolegal questions. Since this is a geriatric unit having patients with both medical and psychiatric problems, we students hold additional medicine rounds. The medical attending discusses pertinent physical findings and how they specifically relate to our patients. We pay close attention to drug-drug interactions that often occur with elderly patients on multiple medications. By seeing psychiatry from this different perspective, we gain an appreciation of how medications and medical pathology can influence the psychiatric aspects of patient care.
After these morning sessions, I meet with my patients individually, reviewing their history, monitoring any change in their symptoms, or discussing their disposition for discharge. Although I function independently in the care of my patients, there is enough attending supervision to answer any pressing question that I may have.
Around midday, we attend small group seminars, in which students rotating through the psychiatry clerkship meet to discuss clinical cases that solidify essential clinical concepts and provide a foundation on which our clinical reasoning in psychiatry is built. After the noon conferences, we return to our respective floors to continue interviewing patients and to write progress notes. Occasionally, we attend some of the floor activity groups designed for the patients, for example, the art therapy session where patients use artistic modalities such as drawings, paintings, or music as a way to gain insight into their illness. These groups also provide a nonthreatening environment in which we can observe how our patients relate with the therapists and with each other.
In the afternoons, we meet with a psychiatrist to discuss current ideas in psychiatry. Rather than being passive lectures, these conferences are more interactive and create an avenue to learn how practitioners develop clinical reasoning in their care of psychiatric patients. These conferences also offer an avenue to discuss current treatment plans for the patients we are following on the floors, including any necessary medication adjustments.
For on call nights, we proceed to the psychiatric emergency room, where we are allowed considerable freedom in interviewing patients and collateral sources and in formulating a treatment plan. It is interesting to see undiagnosed or untreated mental illness in this acute setting, and this experience provides an adjunct to the inpatient experience with very interesting and unique psychopathology. We are asked to interview the patient alone and present our findings in an informal case report format to the attending psychiatrist on call. The attending then interviews the patient in our presence to obtain any pertinent information we may have omitted. At the end of the case, we receive constructive feedback from the attending on what we did well and on areas that need improvement.
I particularly enjoyed seeing patients admitted to the psychiatric emergency room and having the opportunity to follow them for the entire duration of their hospital stay. It was gratifying to see the remarkable improvements in their mental and physical health after receiving care from our multidisciplinary team. I once had a highly intelligent and educated patient with schizoaffective disorder. I was able to follow her care from the time of her admission until her discharge, and I worked closely with her social workers to set her up in an outpatient facility for continuity of care. Patients like her serve to remind us that mental illness cuts across all economic and racial boundaries, and treating mental illness is just as important as treating physical illness.
Overall, I think that learning psychiatry at Bellevue Hospital, which has such a storied past in treating psychopathology, has been an invaluable experience, and I hope my experiences during this rotation will contribute to this legacy.