Wednesday, January 05, 2005

Interns 1

This is the first of a series of posts about interns (not the type of intern of who works in the White House and ends up with white stains on her dress, but the type of intern who works in a hospital after completing medical school and ends up with all kinds of stains on his/her lab coat)
Intueri writes (1/2/05):

Tomorrow is my last call night as an internal medicine intern.

She goes on to say that she will be starting the psychiatry part of her internship:

It’s like starting internship all over again! I don’t remember anything about psychiatry—it feels that way, anyway. I don’t remember how to conduct a psychiatric interview. I can hardly recollect the medications used, the psychodynamic methods employed, or how to successfully manage feelings of transference and countertransference (don’t ask me what those words mean, because I don’t remember).

As far as psych medications, the most important thing for a psychiatry intern to know is how to quickly calm down an agitated patient. Pych interns need to be especially familar with intramuscular haldol, thorazine, ativan, cogentin, geodon, and zyprexa. Psych interns should also be familar with the risperidone M-tab, and how to load a manic patient with oral depakote. Psychiatry interns do not need to know too much about psychodynamics, transference, or countertransference. The main things to know are that you should never have sex with a patient, and a little bit about the defense mechanisms used in borderline personality disorder (e.g., splitting). How to perform a detailed suicide risk assessment is necessary.

I’ve spent the past six months repleting electrolytes. I’m great at dosing potassium for patients, oh yes. And writing for antibiotics. And giving fluids. And blood. And running around as middle(wo)man for the nurses, social workers, and discharge planning.

Psychiatry interns usually won't have to transfuse a patient with blood. Many psych patients do need IV fluids, though not all psych wards allow the administration of IV fluids. Running around as a middle(wo)man for nurses and social workers is a big part of being a psychiatry inter.

I’ve worn a white coat for the past six months. And now—in two days!—I’m supposed to molt and shed that thing to become the beautiful butterfly of psychiatry (or something).
Nearly one and one-half years have passed since I’ve done any formal psychiatry. What if I’ve made the wrong choice? What if internal medicine is my true calling? What if I miss using my stethoscope? What if I miss reading x-rays? What if I miss repleting electrolytes (unlikely)?
I seriously don’t even know what I am going to wear on Wednesday.

I suggest wearing your lab coat and bringing your stethescope. You'll have plenty of x-rays to read (though in psychiatry it's usually not mandatory to read the x-ray yourself- but I recommend trying to read x-rays yourself instead of just passively reading the radiologist's report)- in my experience, psych patients frequently need chest x-rays and occasionally abdominal films. There will be many brain CT's and MRI's to look at.

Managing the medical problems of psych patients is a big part of being a psych intern on the inpatient psych wards.

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