Inpatient Psychiatry

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What do inpatient psychiatrists do all day? Do they interview each patient every day, or do they just function as the medical authority behind what the nurses and orderlies do throughout the day and only talk to patients on occasion?

Don't know if this is taboo, but I recently watched "one flew over the cuckoo's nest", and it seemed like the psychiatrists had a pretty low profile around there, at least with respect to the patients perspective. Is that a very accurate depiction of an inpatient psychiatric environment?

Originally Posted by Enkidu

What do inpatient psychiatrists do all day? Do they interview each patient every day, or do they just function as the medical authority behind what the nurses and orderlies do throughout the day and only talk to patients on occasion?

Don't know if this is taboo, but I recently watched "one flew over the cuckoo's nest", and it seemed like the psychiatrists had a pretty low profile around there, at least with respect to the patients perspective. Is that a very accurate depiction of an inpatient psychiatric environment?

It depends on the specific hospital and maybe the type of stay. I would suspect that most hospitals with acute care wards require the psychiatrist to see the patient everyday (or maybe 6 out of 7 days). At our hospital we have to see patients everyday they are here. Some chronic state facilities where patients might be hospitalized for longterm care and treatment might require notes once a week on patients.

The above applies only to the policies of the institution in question. Of course if you are billing Medicare for your services, then you have to provide the service (if not it would be fraud) and document in the record enough information to substantiate the service for which you billed.

Originally Posted by Enkidu

What do inpatient psychiatrists do all day? Do they interview each patient every day, or do they just function as the medical authority behind what the nurses and orderlies do throughout the day and only talk to patients on occasion?

Don't know if this is taboo, but I recently watched "one flew over the cuckoo's nest", and it seemed like the psychiatrists had a pretty low profile around there, at least with respect to the patients perspective. Is that a very accurate depiction of an inpatient psychiatric environment?

It depends heavily on the work environment. As a student, I've worked in a number of different places, and I'll tell you what I've seen. I'm sure the attendings here will fill in their points of view for their respective jobs.

Site 1, a community acute inpatient unit: Doc would see patients on the unit in the morning, then leave at lunch to see his outpatient patients (of the same community mental health center) in the afternoon. Someone was on call to cover the afternoons. Night call was from home via rotating beeper call.

Site 2, a state child inpatient unit: Doc would come in a bit later, and see patients on a treatment team in the morning. Staff new patients, see any problem patients. Orders were done. Then doc would start seeing patients individually in their office on the unit. This was broken up by collateral calls, talks with family and community resources regarding discharge or treatment planning, and other duties.

Site 3, a state adult inpatient unit: Same as Site 2, except doc was more removed from my own site. Not sure what they did after treatment team rounds, as I was busy doing didactics and other stuff. I imagine they saw patients.

Site 4, an academic inpatient unit: Treatment team rounds in the am, then round and see patients on unit. Orders given to residents. Then doc would go off to see office patients, work on research projects, teach, and was available by phone to handle any unit problems the residents had questions about.

Site 5, an academic C-L team: Doc rounded with team on C-L patients in the morning until we were done, usually by 1-2pm. Some afternoons he did Geriatrics rounds, others he had teaching duties.

So, they stay busy. It's not like they're sitting in their office playing Skyrim all day. Really.

Originally Posted by digitlnoize

It's not like they're sitting in their office playing Skyrim all day. Really.

I'm playing Skyrim right now. Got off work early. I haven't figured out how to play it during breaks at work...yet

How do you "round" on patients in the psych ward? It seems like they're just milling about the place in random places. Do they have to report to your office, or do you have to track them down?

Originally Posted by Enkidu

How do you "round" on patients in the psych ward? It seems like they're just milling about the place in random places. Do they have to report to your office, or do you have to track them down?

And the answer is...depends.

Some units involve seeing the patient wherever they are (say a patient in seclusion), or someone neurovegetative and not getting out of bed. Most units have independent interview rooms too. So rounding involves the same thing you do in rounding on any other medical patient -- review the chart for the last day, check up on labs, talk to the nurses and staff, and examine the patient. Then write (or dictate) a note.

Cuckoo's nest is a poor representation of anything in mental health aside from what state hospitals were like 40+ years ago.

Originally Posted by Enkidu

How do you "round" on patients in the psych ward? It seems like they're just milling about the place in random places. Do they have to report to your office, or do you have to track them down?

The best practice is to see the patient in a private settings. Some times it might not be the ideal way to interview the patients. I'm currently doing inpatient rotation, and I try to meet my patient early in the morning before morning round. Most of the time I meet them in Chart room, but those who are unstable, unpredictable, I meet them in the activity room.

What the Psychiatrist do all day?
-paper works...we have to protect ourselves from frivolous lawsuits..But honestly, we do MSE everyday and assess if there any adverse effect of the medications.

I rarely get any time to check my Facebook.

.

Originally Posted by ELOVL4

The best practice is to see the patient in a private settings. Some times it might not be the ideal way to interview the patients. I'm currently doing inpatient rotation, and I try to meet my patient early in the morning before morning round. Most of the time I meet them in Chart room, but those who are unstable, unpredictable, I meet them in the activity room.

What the Psychiatrist do all day?
-paper works...we have to protect ourselves from frivolous lawsuits..But honestly, we do MSE everyday and assess if there any adverse effect of the medications.

I rarely get any time to check my Facebook.

Always time for Facebook--between patients, of course.

Originally Posted by OldPsychDoc

Always time for Facebook--between patients, of course.

Or go on SDN?

Although inpatient psychiatry is unique in many ways, IMHO, the responsibilities of an inpt psychiatry attending is not all that different from those of inpt attendings from other specialties. Attendings usually round on pts with residents and help with critical clinical decisions. Attendings are ultimately responsible for all the patients, while residents and medical students actually carry out the tasks of caring for the patient. But most attendings have other responsibilities outside the inpt unit. (I am actually an attending from another specialty who is going into a psychiatry residency this fall.)

Originally Posted by Enkidu

How do you "round" on patients in the psych ward? It seems like they're just milling about the place in random places. Do they have to report to your office, or do you have to track them down?

You have the med student track them down...

At Site 1: I (the med student) went and got the patient from the activity room. Not much different from a FM office waiting room call. "Johnson. Johnson. Dr. Guy will see you now. Come on back."

Site 2: The team would meet in a room and discuss all the patients, then the new ones would be brought in one at a time, usually by the medical student, or sometimes by a staff who'd gotten to know them well overnight. Attending usually retrieved their own patients from the activity room and walked them to the office.

Site 3: "Hello, I'm Digitlnoize, the new patented Psych Patient Retrieval System from SlaveCo."

Site 4: Team met in a room and talked about each patient. Then we went to see them out in the milieu. We usually tried to pull them aside to a more private location, but wasn't always necessary, it wasn't THAT crowded, or maybe breakfast was going on (great time), and you just call them out one at a time from that and interview them in the little hall right outside the meal room.

Site 5: These were in-hospital patients, so we saw them in their rooms.