Welcome to Fourth Year: A Rant for My Psych Elective and a Bit about Electives...
First Elective: Psychiatry
Fourth year started promptly after finishing my surgery core rotation, and I have been enjoying my time in my psychiatry elective. I chose to do a psych elective because of how applicable to the rest of medicine mental health really is, and because I figured it would be important to master some of the tools of inquiry I have learned through psych to be a better physician overall.
I forgot how much I enjoyed the diversity in what you see in psychiatry. From schizophrenia to manic episodes of bipolar disorder, you never know what a patient is going to yell at you next! I have met a patient who has a same-sex partner, and expressed feeling isolated in her domestic violence relationship and needed a way out. I have a met a patient who's schizophrenia has deteriorated over the many decades of suffering to a point where her baseline is scary to those observing, but appears to be joyful and fun if you listen to her perspective.
People want to be heard. That is the true lesson that I think psych can provide. Although I have learned to recognize signs of mental health disorders in both verbal and nonverbal cues, along with subtle signs that someone has an untreated mental illness, I think the most important lesson I have learned is the value of listening. Some of the most-responsive patients I have had on service have been the ones I spent extra time with just listening. There is something cathartic about spilling our emotions out to someone else as if the jar must come off for the contents of our mind the release some pressure. We all have our moments, and are lucky to have our support network of family and friends to whom we can vent to occasionally. But, what does someone do if they are isolated in their community and feel as though she has nowhere to go? The negative emotions and unhealthy coping mechanisms that can accumulate in some people will eventually find a way to express itself whether it be through a "psychotic break" or a mental deterioration subjecting someone to feelings of suicidal or homicidal ideations.
There is a lot talk in the media about mental health among health professionals, and I think this is just a minor piece our society as a whole. Granted, I do not have any research backing up any of my claims. I am just relaying what my intuitive sense about my community has lended me. Not everyone learns how to foster a healthy way of handling unwanted emotions. Furthermore, the media is quick to tell a story of a resident who ends his or her life, or a doctor who unleashes fire on a hospital ward. This coupled with our societies reactive approach to mental health leads to society's perception that there is a mental health problem among professionals. I charge that there are also mental health problems among professionals that appears more concentrated than what is seen in the general public.
If you are isolated in a room everyday with patients on a psych ward, and you see that 19 of the 20 patients are diagnosed with schizophrenia, then you will likely conclude that schizophrenia is a real problem in our community or society. However, if you look at the global statistics and see that schizophrenia is diagnosed in 1% of the population then your perception may change. Our nation doesn't have a mental health problem limited to healthcare professionals. Our nation has a diverse spectrum of problems with an under-appreciated subset in mental health.
Furthermore, I see a more global problem when it comes to the approach to mental health. The stigma associated with mental health treatment is palpable in some parts of the nation, especially here in Georgia, where I have heard innumerable times "I am not crazy." In many people's minds, the terms "mental health" and "crazy" have unified into an abhorrence for the topic and an automated prejudice against those with mental health conditions. Some of the nurses tease me that I would be good at psych and I should entertain the idea of applying for residency, but my heart tells me that this is not the field for me. Anyone can be great at psychiatry if they have the smarts to get through medical school, the ability to listen to the patient, the propensity to empathize for what it would be like to be in the patient's position, and the skills to motivate the patient to take charge of his or her own healthcare needs and goals. Funnily enough, the previous sentence applies to anyone wanting to become a great doctor. By the same logic, I think it should dawn on the reader that patients with mental health disorders are to be respected and treated like patients with any other medical condition. Until our society starts treating everyone with humanity and dignity, the stigma will continue and mental health problems will continue to be underdiagnosed and undertreated.
Other news
Wow. Now it is time to step down from the soap box and talk about something else: STEP 2 CK. I am in the ramping up to take STEP 2 CK in June. Expect a Step 2 CK study post with resource review once I have that hammered out for myself.
I have been dedicating each day to mixed review of material when I am not at the hospital seeing patients. I enjoy that now I am studying medicine for the joy of studying all of medicine. It is SO AWESOME TO BE DONE WITH SHELF EXAMS. Sure the exams will never end, but I am glad to know that I do not have an exam at the end of each elective. I can read medical books and literature for the enjoyment of the subjects now and not for the fear of a test.
On the topic of reading:
I have been reading books lately for enjoyment as a break between studies, and I must say that I have developed an interest in the history of medicine. I recently finished The Emperor of All Maladies by Siddhartha Mukherjee and I learned so much about some cancers and biostatistics by reading about the history of cancer treatment and how much it has transformed in the last century. Definitely a must read for any medical professional (or medical consumer for that matter) as you will see the humanity in medicine and the many, many mistakes that it has taken to reign so much control over a life-changing illness. Reading used to be an avid hobby of mine during middle-school and high-school years, and I have regained an appreciation for such an enriching hobby. Luckily, fourth year allows a little more time to do more things that you want to do. Keep going for those of you in MS1 through MS3 because MS4 will be great!
My electives for the next few months are scheduled, and I look forward to doing an Ob-Gyn elective in May (along with celebrating some awesome birthdays in my family!), ENT elective in June, and Pathology in July. I got approval yesterday for an Ob-Gyn sub-internship in October that I applied to months ago. I cannot convey how excited I am to be learning from Ob-Gyn residents and experiencing a glimpse of what I see for my future and how it can be as a resident. I will continue to document my journey through these posts, and as always feel free to message me or comment if you want to know anything!
