improving the transition in conducting pt interviews vs other ms3 rotations?

[sirscrubsalot]

Hey y'all - I just began my MS 3 psychiatry core clerkship - I was wondering if anyone might have a moment to share a book resource and/or ideas on how I might improve the transition in interviewing patients from a typical medicine/surgery/non-psychiatric encounter to one that I would have in either an inpatient and more so on an outpatient setting - the Axis 1/2 elements.

Right now I have these sources :
> First Aid for Psychiatry Clerkship (to use for shelf mainly) haven't explored other text or question options just yet. Got a free used copy.

> Interview guide for evaluating Psychiatric Disorders and the Mental Status Examination by Marc Zimmerman ** this one is really nice so far, any similar ones? I got this as a recommendation here, which was awesome!

> Psychiatry 2006 Current Clinical Strategies - from a recommendation here on the forum, still waiting on it.

If there was something with management and treatment coupled within something like Zimmerman's text - that would be cool but not as important to keeping a patient engaged and not going astray.

I had a few inpatient schizophrenic encounters today where I wasn't sure on how to move my questions to get any further answers. Other times, I felt somewhat challenged on a few of the suicide/homicide idealization cases where they didn't want to answer any questions and told me to get the F* out because they were tired of answering the same questions everyone else keeps or has been asking.... many times, I was received with, "Why do you all keep asking the same questions every day?!?" Some other patients were already ready with answers or the method of the MMSE and said, "give it your best shot! This is going to be easy!"


I'm sure over time, I'll get better at it; like my other regular rotations encounters - but it'd be nice to hear some opinions of which might help steer me to continue to keep an open mind to improve on it. I'll be doing quite a bit of outpatient, which is cool and one of which I'm most interested about getting a handle on.

I'm going into Family Medicine, but I think this rotation would be a great additional primer for me to explore a whole new facet of conducting and maintaining these interviews and to get an overall idea of what's out there - and hopefully, I'd like to be able to give some feedback and input/answers to help those patients I would encounter. Thanks for reading this! It means a lot to hear some additional perspectives on this!

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[OldPsychDoc]

I'm glad you're trying to develop in this area on the clerkship.

There's always a tension between "running the checklist" and throwing out very open-ended questions and letting the interview flow. It does come with experience, as you mention.

What I try to emphasize to my students is the value of BEING CURIOUS. When you hear something interesting (e.g. a "pertinent positive"), follow up on it. "What was that like? How did that feel? How do you usually spend your time? What would you rather be doing if you weren't here? What did you think was going to happen when you kept smoking that crack after your AICD had already fired off once...?" If you find yourself asking the same questions regularly on inpatient follow-ups, refer to what you know from yesterday--e.g. "Is that voice still...? Are you still worried about...?" That shows that you're actually engaging with them, not a checklist.

 

[notdeadyet]

Hey y'all - I just began my MS 3 psychiatry core clerkship - I was wondering if anyone might have a moment to share a book resource and/or ideas on how I might improve the transition in interviewing patients from a typical medicine/surgery/non-psychiatric encounter to one that I would have in either an inpatient and more so on an outpatient setting - the Axis 1/2 elements.

I really liked this one. It's a real good starting point to conducting an interview that will help you with creating a differential diagnosis. I found it very helpful to know how to ask conversational questions that help lead you towards diagnosis, rather than falling into the checklist vibe that OPD is talking about.

 

[sirscrubsalot]

What I try to emphasize to my students is the value of BEING CURIOUS. When you hear something interesting (e.g. a "pertinent positive"), follow up on it. "What was that like? How did that feel? How do you usually spend your time? What would you rather be doing if you weren't here? What did you think was going to happen when you kept smoking that crack after your AICD had already fired off once...?" If you find yourself asking the same questions regularly on inpatient follow-ups, refer to what you know from yesterday--e.g. "Is that voice still...? Are you still worried about...?" That shows that you're actually engaging with them, not a checklist.

Thanks so much for putting those suggestions in - they really helped out during the past few days... I was able to reach some of what I had hoped for with that;

I really liked this one. It's a real good starting point to conducting an interview that will help you with creating a differential diagnosis. I found it very helpful to know how to ask conversational questions that help lead you towards diagnosis, rather than falling into the checklist vibe that OPD is talking about.

Hey thanks for including that link I actually mentioned above that I did happen to get that book a few days ago from reading one of the other fellow member posts in this particular forum... I glanced over a few relevant sections ahead of time to get an initial idea of things to keep in mind... despite its size, it has quite a bit of information inside! The only downside was to actually use it simultaneously in an encounter because it would have broken the conversation flow... however, I think it was great to keep a mental note on particular question cues;again over time I'm looking forward to some personal improvements in the coming weeks.

I'll have to search around this forum (if there was a link to a popular thread similar to it, let me know) for my other goals in this rotation - figuring out when and what drug class and specific drug to use for a particular indication or probable diagnosis based from positive criteria that was revealed during an encounter...

Overall though, the past few days have been awesome in trying to explore a different population - it's going to be very helpful for my future career in family medicine, and I think in other parts of my life experience as well.

 

[notdeadyet]

I'll have to search around this forum (if there was a link to a popular thread similar to it, let me know) for my other goals in this rotation - figuring out when and what drug class and specific drug to use for a particular indication or probable diagnosis based from positive criteria that was revealed during an encounter...

One book I really liked was Psychopharmacology Made Ridiculously Simple. It's only about 80 pages and is easy reading.

What I like is that it starts from 0 and walks you through the basics of psychopharmacology and why what is used where and when. Rather than memorizing a bunch of meds for a bunch of conditions, it gives you a good grasp on the basics of what the medications actually do. I really liked it.