I've been busy and haven't had much time to browse SDN.
Let me just reply to this statement with an example.
My very first call as an intern (second week of residency) a couple came into the ER. It was a young lady with a young husband who was in the military. This was about 10pm, and a few hours earlier the woman cut her wrist which had to be bandaged but needed no stitches however. It was also not a very superficial cut and she had bled "all over the kitchen". I wouldn't have thought this way then, as I had virtually no experience but looking back this was most likely a borderline call for help type thing. She even told me in private that she felt like she was losing her relationship and wanted her husband to show her that he loved her.
Anyway, my backup was with me until about 11pm and I admitted her onto the locked unit. Well I get a page at about midnight and staff are saying that she wants to go home. Now I go upstairs (my back up is home sleeping), and with blood still on the bandages she requests to leave. Her husband is next to her and states she was still a little drunk when she signed the paper work and now wants to leave AMA.
A decision/situation like this usually doesn't happen in the daylight hours and when you are the only psychiatrist in the hospital situations like these can prepare you for a lifetime of critical psychiatric decisions. What psychiatrists have to deal with more so then other specialties is the uncertainty of an outcome. We will treat so many patients with severe depression or constant suicidal thoughts. I think it is these kinds of situations that really prepare you to deal with these problems. You are only in residency for four-five years, after that you won't have an attending looking over your shoulder.
After speaking with an attending over the phone I let her go.
Hmmmm... these kind of situations prepare you to deal with these problems? I sort of don't get the moral of your story, you let her go because... the attending knew what they were doing? She was just a 'drunk borderline' and thus was ok to let go? Only in your second week of residency? Obviously, the heart of spirit of your post (though not clear totally for myself) is that the in house call trains your clinical acumen for later.
Perhaps it's my home-caller yokel psychiatry silliness, but someone bleeding everywhere in her kitchen has bought herself a night away (at least) from sharp things. There's no way I need to see her in person to tell the staff she'll have to wait (until the morning to be seen). Obviously, there are many different scenarios in treatment settings, so I think this could sound as coming off harsh... but I'm still left with the feeling that something needs to be said here.
I think part of what the difference in postings is... there's a dichotomy between people on home call type residencies vs I'm in the psych ED branch of the medical hospital overnight in a downtown metropolis type residency q4 during my first two years... Nevada may be unique but does not appear to be the exclusive holder of this idea, such as my residency in the west, which possesses the idea that most major issues can be handled by phone and an appropriately trained psych nursing staff (generally better than your first week interns)...
Clearly I'm biased, I know... food for thought... I was recently called by new staff (I'm in my third year) to come in and deal with a demanding spouse of a "high profile patient"... they wanted to check out on a saturday night... after all, there was a rave in town. "Um, no." I told the nurse, "Besides that rave sucks and I'm already going and it would just be too awkward to see her there." Just kidding... it would've been okay to see her there probably...
😀
You may consider cautious determination of whether a person with slit wrists should go in the middle of the night an experience that is denied to us home callers, and I will tell you that no part of me feels unprepared (when on the many situations, moonlighting or other) for the future. Life or death decisions in the middle of the night are for people with higher insurance premiums (and more respect from the hierarchy of medicine).
...Maybe I harbor a secret jealousy to be as experienced as the q4 overnighter, those hardworking cash machines for their hospital based programs...I know I wish that for much of my first two years after medical school I'd be plagued with fatigue and irritability from a true inhouse call experience (though that's still a given on 1st year medicine rotations), ...oh well, don't dwell...
I recognize this might sound terrible and self-congratulating, thereby downplaying the hard work, sweat, blood and life some residents give towards their career, I apologize, for you do the Lord's work. Just food for thought... shouldn't we be better treated sometimes, even as residents?
also, defending yourself on the stand from lawyers seems to be an easy thing to prevent: no borderlines, live in a state where suing for suicide is difficult, and oh yeah, don't practice.
