For those of you thinking about psych...

[OldPsychDoc]

One of those days--

Greeted at the hospital this am by a resident who informed me that one of my "stable" outpatients was now on a medicine service after an overdose of the meds I wrote for her.

In my afternoon clinic, everybody showed up (which means I'm still at the office late doing documentation), and none of them are appreciably better.


It's not always a great day.

Just thought I'd share that...

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[MDgonnabe]

One of those days--

Greeted at the hospital this am by a resident who informed me that one of my "stable" outpatients was now on a medicine service after an overdose of the meds I wrote for her.

In my afternoon clinic, everybody showed up (which means I'm still at the office late doing documentation), and none of them are appreciably better.


It's not always a great day.

Just thought I'd share that...

i'm sorry today sucked, doc. that's one of the major reasons why i'd been so reluctant to go into psych. it's impossible to objectively gauge how well patients are doing in their subjective worlds. i've spoken with many psych clientele outside of office/inpt settings who've outright told me that they get so fed up with doctors that they'll say anything to get out of the hospital regardless of how they're feeling. but keep in mind that such lying/noncompliant/drug seeking/sue-crazy patients will exist regardless of your medical specialty. and, despite what many in medicine would like to think, we're not gods. we're not infallible. for the time being all we have to go by are what patients tell us and what we see in the hospital/office. so of course we'll make mistakes- which is why i think it's great that you're telling everyone about what you went through. it reminds others to keep on their toes, never to get complacent and expect things to be idealistically perfect... but no job ever is, is it? another good way to think of your situation is thus: where would those patients be had you or another doctor never been involved with their lives?

 

[Anasazi23]

I know how you feel. I felt the same way a few weeks ago when I was made to rx against my will one particular medicine (for sleep) when a patient left the inpatient hospital, only to be called for the overdose consult of that same med in the ER two days later.

The revolving door and treatment resistance can get on your will...I guess we just have to remember that like all branches of medicine, some conditions our patients have are just harder to treat.

 

[peppy]

Doc, sorry to hear you had a bad day. I appreciate all the posts you've made on this forum to help those of us who are considering psych see the reality of the specialty. It definitely helps to get a firsthand perspective on both the positives and negatives!

 

[psydoc]

Thanks for sharing that OldPychDoc, I think it's a great post (like a lot of yours are)!
As a resident, I think that it is very important to learn from older physicians how to cope with the fact that we probably won't be able to help all the patients we see. A lot of people are very comfortable with telling "success stories", talking about cases when all went well, while they are less inclined towards telling about times when they don't know what to do, or when patients do not respond to treatment, or when no rational treatment plan can be devised.
I think that learning to accept these things and finding motivations despite the limits of our understanding and therapeutic possibilities is very important, and sharing these stories might help.

 

[DrIng]

To counterpoint:
Saw a woman the other day who had been unable (for 2 years) to leave her house, shower or use the bathroom because of her paranoia about cameras etc. (Paranoid Schiz.) that I had seen a year ago- she now has a job and is doing well and her son is leading a much more normal life.
You can't help everyone (in any branch of medicine) but you can sometimes make a real difference to their lives.
Sometimes the patients aren't the only ones who need an infusion of hope...

 

[OldPsychDoc]

To counterpoint:
Saw a woman the other day who had been unable (for 2 years) to leave her house, shower or use the bathroom because of her paranoia about cameras etc. (Paranoid Schiz.) that I had seen a year ago- she now has a job and is doing well and her son is leading a much more normal life.
You can't help everyone (in any branch of medicine) but you can sometimes make a real difference to their lives.
Sometimes the patients aren't the only ones who need an infusion of hope...

I couldn't agree more--had a similar discussion today with one of our nurses who bumped into a "satisfied client" at the mall this week.

 

[Anasazi23]

The successes are great.

Of all places, sat on the NYC subway next to a former young (early 30's) patient with severe acute onset anxiety disorder. Doing great now after a brief inpatiet stay (it was that bad).

I look forward to more.

Then again, I've had 3 of my medicine patients die this month for various reasons. You start to question yourself even though you know you did all you could, called all the right consults, etc.