Last Friday, I finished my 4 week Psychiatry rotation. I can’t believe I’ve already completed 3 months worth of rotations already (2 months of Internal Medicine + 1 month of Psychiatry). During my last rotation, I did a “Day in the Life” post that was well received. I decided to keep the momentum going by continuing with the series and sharing a day in the life of Psychiatry from a 3rd year medical student’s perspective. Keep in mind, the psych hospital I rotated at had pretty strict cell phone policies and so I don’t really have as many pictures as my Day in the Life of Internal Medicine post. With that being said, I hope you still enjoy this post and seeing what my day to day is like in the psych hospital.
6:00am – WAKEUP
I take forever to wake up. This is when my initial alarm went off. In reality I would have studied for the GRE early in the morning or got a workout in. But 9 times out of 10, I hit the snooze until the last possible minute.
8:00am – Arrive to the Psych Hospital
I was expected to arrive between 8-8:15am. When I arrived, I took about 20-30 min to orient myself and read any notes in the chart for overnight events for my patients. I also would use this time to catch up with some of the patients or I would observe them on the wards performing their daily activities and seeing how they interact with others.
9:00am – Morning Report
Normally I get kind of bored during morning rounds, morning meetings, or basically any organized morning activity. I’m not a morning person AT ALL and I prefer to start my days without having a meeting. However, on psych, it was different for me and I actually enjoyed these meetings. During morning report the occupational therapists, social workers, and nurses would meet to discuss each patient. One of my feedback on Internal Medicine was that I spent way too much energy on social history. Internal Medicine docs don’t care about your personal life unless it specifically affects the thing thats keeping you in the hospital. Psych is totally different. They want to know about home life, about your kids, about your family and job, who visited you, how you felt about the visit, etc. I love all the social aspects of medicine. So sitting in and seeing this discussed was enjoyable for me. This was also a great time for me to get updates on how the patients did after I left, if they are eating, if they’re taking their meds, and if they were attending/ participating in group therapy.
10:00am – Observe Group Therapy
Usually around this time, most of the patients were in group therapy. They are encouraged to go, but they aren’t forced. I would go as a bystander and observe the OTs (occupational therapists) who were leading the session. I would also keep an extra look out for the patients I was following and making note of who attended and who didn’t.
10:30am – Interview New Patients
After morning report and observing group therapy, I would meet with my team which was made up of a psychiatrist, an NP and occasionally an OT would join as well. During this time, I would perform the mental status exam on the new admissions for the hospital. My first time was a hot mess but after some feedback, I think I became quite good at it. I love talking with others and hearing their stories, so this was my favorite part of the day. A lot of the patients have very unfortunate circumstances or life traumas and I appreciate them opening up to me and letting me participate in such a vulnerable part of their care.
After the interview we discuss the plan of care for each patient and also discuss the old ones as well and make any updates to the orders or treatment plans.
12:00pm – LUNCH
I was super fortunate that the hospital provided a yummy lunch every single day. It made the stress of meal planning much simpler. I would usually take lunch for 30 min to 1 hr each day. Sometimes, I would write notes while I was eating but for the most part, I tried to enjoy this gap in my day.
1:00pm – Interview Old Patients
Ideally I would have seen all my patients in the morning. Bur in reality life on the psych wards get real and the patient’s schedules are sometimes unpredictable. They have group therapy, court hearings, meals, etc, so sometimes it can be hard to track them down on the unit. After lunch I try to catch all of my old patients who I didn’t see in the morning and see how they are doing.
2:00pm – Finish Notes & Go Home To Study
By afternoon, my responsibility is to write my notes and then go home. My notes were handwritten and since this hospital uses paper charts my note writing took much more time than usual for me. Additionally, sometimes it’s difficult when a chart goes missing or if it is in use by someone else. One day it took 1 hour to find the chart so I couldn’t write any notes. After that happened, I started keeping spare note template papers in my white coat pocket so I could still finish my work even when the charts went MIA.
My Child Psych Experience:
One unique part of my psych rotation was that I got to rotate on the inpatient child unit as well. I absolutely loved spending time with the kids. During my time on the inpatient pediatric unit, I spent my mornings doing play therapy and then after lunch I spent my afternoons debriefing with the kids, interviewing them, and also doing one-on-one sandplay therapy. It was pretty tough, especially since a lot of children with psychiatric and behavioral issues experienced a lot of trauma. I definitely cried in the car once when I was debriefing with a friend. But regardless, it was really rewarding to work with the kids.
Fun fact, but before medical school I worked at a neurodevelopmental pediatric clinic. The wait list for this clinic was over a year and children came from all over the world to be tested for neurodevleopmental and behavioral disorders. During that time, I actually found the role of the psychologist on the team to be a lot more interesting than the pediatricians role. For a while, I toyed with getting a PsyD instead of an MD and I often wonder if I would have preferred to follow the PsyD track instead. I like medicine but on Psych I definitely enjoyed the roles of the OTs and the psychologists much more than the psychiatrists.
This rotation made me realize what I really like and that’s talking to the patients about their lives and having meaningful conversations so this is something I will definitely take into consideration when I choose my final specialty. Overall I LOVED my psychiatry rotation! I’m also so happy that my school offered me 2 weeks in pediatric inpatient since not all medical schools offer that, so it was a real treat! Anyways, next up is Neurology! Have you done your neuro rotation already? If so please share any neuro tips/ advice below!