Psychiatry – Day 15

My first solo History & Physical on this voluntary inpatient psychiatric unit. I thought it went pretty well. The patient had been experiencing some questionable delusions and paranoia (I say questionable because they themselves were questioning whether or not what they were experiencing was based in reality), and I thought I did a decent job of making the patient feel heard without necessarily validating their delusions.

As frustrating as I find management of psychiatric illness, what I do find interesting about it is the challenge of working with patients, with people, similar to the challenge that draws me to primary care. A lot of people are reluctant to receive psych treatment because it’s either unknown territory or because they have been burned by psychiatric treatment in the past (side effects, refractory illness, mistreatment, etc). The challenge is: how do I reach this patient who is scared and closed-off for whatever reason, and get them to a place where they are able to be open minded to the possible of trying a new approach? How do I get this person to trust me despite having relatively good reason not to? This is where more of the “art” of medicine comes into play, and I think there is a lot of opportunity for that in psychiatry.

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