For my psychiatric evaluations, I met with Dr. Saint Martin via Skype.  Dr. Saint Martin emailed my classmates and me early on in the rotation to send his requirements and details surrounding our evaluations.  Different from most of my rotations, Dr. Saint Martin provided a PDF of the documents and assignments he required for both the mid-point and final evaluation. I spoke with Dr. Saint Martin (via Skype) during the third week of the rotation for the mid-point evaluation and we reviewed my time in the psychiatric emergency department thus far. For the first (mid-point) evaluation, I was required to share one history & physical.  During this evaluation, we spoke in depth about the mental status exam and why it is particularly important for psychiatric patients and how it could be helpful in making a proper diagnosis but also to impact the plan for patients.  We also discussed the list of differential diagnoses I included and the reason they were included.  I found this to be a helpful exercise, especially as it relates to psychiatry, because of the similarity of symptoms that can occur across different diagnoses.  This particular exercise also helped me to think about any underlying medical conditions that may have lead to the patient acting in this particular manner and ensure no issues were missed.  We discussed the psychiatric emergency department as a whole and how it is different from the in patient setting.  I shared some experiences I’d had over the course of my first few weeks at QHC CPEP and we made plans to speak again during the last week of my rotation for the final evaluation.

For our final evaluation, I Skyped with Dr. Saint Martin while I was in Philadelphia for a board review course.  Given I was going to be away, I was proactive to ensure that I’d completed all of the necessary assignments ahead of my departure.  For the final site evaluation, I was required to send Dr. Saint Martin three additional history & physicals, five drug cards and an article relating to one of the cases I was going to present.  The drug cards I shared with Dr. Saint Martin followed the format he requested, which was different from the others I’d done throughout my rotations.  I included evidentiary support for the use of the medications for psychiatric purposes as well as the CYP interactions.  Dr. Saint Martin requested we submit these medications under different drug classes including SSRIs, Benzodiazepines, First Generation Antipsychotics, Second Generation Antipsychotics and a Mood Stabilizer.  I opted to discuss the medications I’d seen most frequently utilized in the psychiatric emergency department setting and our conversation was definitely reflective of that experience.  Dr. Saint Martin and I discussed one of the history and physicals I presented surrounding a pediatric patient, which sparked an interesting conversation about familial support as well as other social support.  This particular case was sad and involved a thirteen year old suicidal patient, who didn’t feel she had an outlet and no way for things to improve.  Given my interest in pediatrics, I often volunteered to go with the pediatric psychiatrist to see the pediatric patients and feel like I had a more well-rounded experience in doing so.  I opted to share this particular case (vs. the case that my article reflected) because the mental status really helped and was reflected by the diagnosis and I thought it interesting to share.  Finally, I shared the article I’d selected before ending the Skype call.  I had the opportunity to interview / evaluate a patient with catatonia during this rotation.  Prior to this rotation, I thought of catatonia only as a concept and didn’t think it was something I’d ever see in practice.  However, during one of my CPEP shifts, I was able to evaluate a patient with retarded catatonia who exhibited waxy flexibility and it made this concept more realistic for me (and is now something I will never forget).  We discussed this article and all of the various aspects of pathophysiology to diagnosis and treatment.  As we concluded the meeting, we spoke about my experience in the psychiatric ED as a whole.  I told Dr. Saint Martin how nervous I was to go into this rotation but shared how I truly enjoyed my experience with the team at Queens Hospital.

This entry is licensed under a Creative Commons CC0 1.0 Universal Public Domain Dedication license.