What is your best patient success story

[postbacpremed87]

As a prospective applicant in the upcoming Match, I am curious about your successes (your best one) with difficult patients. Thanks!

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[Shikima]

You've got to have your own anecdotal stories to tell. Go see more patients and less in the books.

 

[OldPsychDoc]

I'll give you the benefit of the doubt, and assume you want encouragement to enter the field, and aren't looking for anecdotes to pad your personal statement...(but if I see this story in a PS next season, well...be warned.)
Oldie, but goodie--and still the Best Day Ever.
Every now and then, psych just blows you away...

 

[postbacpremed87]

I'll give you the benefit of the doubt, and assume you want encouragement to enter the field, and aren't looking for anecdotes to pad your personal statement...(but if I see this story in a PS next season, well...be warned.)
Oldie, but goodie--and still the Best Day Ever.
Every now and then, psych just blows you away...

This thread was meant to be uplifting for those of us finishing up 3rd year and looking to application season. There is no way I could replicate your awesomeness OPD. I haven't even thought of my PS yet.

 

[singasongofjoy]

I'll give you the benefit of the doubt, and assume you want encouragement to enter the field, and aren't looking for anecdotes to pad your personal statement...(but if I see this story in a PS next season, well...be warned.)
Oldie, but goodie--and still the Best Day Ever.
Every now and then, psych just blows you away...

Wow. That's going to be a really hard one to beat! That's awesome!

 

[digitlnoize]

As a prospective applicant in the upcoming Match, I am curious about your successes (your best one) with difficult patients. Thanks!

I've had a few good success stories.

I caught a case of hemochromatosis as a medical student on my family medicine rotation that had been missed by the PCP, cardiologist, nephrologist, neurology, and GI. He was young enough (late 20's early 30's) that most of the damage could hopefully be averted. That one felt good.

I had a case during 3rd year adult outpatient with severe depression with mild psychotic features, who was refractory to treatment...until I put her on Remeron. Went from non-functional wandering in the woods and multiple hospitalizations to very functional and back in college and loving life. She did gain weight but refused to get off the Remeron and I agreed with her that the benefit outweighed the risk.

During child fellowship, I had a great case who came to me with a dx of psychosis NOS on Zyprexa 20 mg (which is a huge dose for a teen) and Zoloft 200. Talked to him and figured out that he wasn't psychotic, he had just gotten social phobia (which a prior doc interpreted as paranoia, but it really didn't go that far). Got him off Zyprexa and on Wellbutrin and he did fantastic and really turned around great. They're really grateful ("I feel like I have my son back" type stuff) every time they come in and are just the nicest people.

Had a very difficult case during child with reactive attachment disorder, pica-like behavior (but not quite because he didn't actually ingest), lots of compulsive behaviors, skin picking. He didn't get as dramatically better, but improved slowly and steadily to the point that he got adopted and it is going well. Risperdal+NAC really, really helped his skin picking and compulsions.

Just a few of my favorites.

 

[notdeadyet]

I was working a rotation in residency in which I was junior attending on the jail inpatient psychiatry ward. There was a psychotic patient who was frequently there and notorious for not cooperating or speaking to psych. I had him for about two weeks during a low census lull and spent a lot of time getting to know him, talking to his family, and not being overly psychiatric. I utilized a technique demonstrated by one of my favorite faculty members in which he made an exercise of seeing how much of an intake he could get done without asking a single question. I built up a rapport with the patient and he ended up starting an antipsychotic for the first time. There was some improvement in symptoms when he was with me, then he was transferred out of inpatient and I didn't see him again.

About two weeks later, I was getting hammered at work with a lot of rough patients. As I was leaving at the end of the day, a woman was speaking with deputies and as I passed, they were accepting something from a woman and one of the deputies said loudly for me to hear, "I'll let Dr. NDY know you stopped by to drop this off." I actually almost kept walking (one of those days) but ended up stopping and coming back.

It was the patient's mother. She had made a cake and was very tearful. She explained that her son had continued taking the antipsychotics and while he still had vague delusions, he was much less paranoid, not hallucinations, and was able to re-engage socially like he hadn't since his first break. She grabbed my hands and made sure I was looking at her and said, "Know that whatever you do with the rest of your life, you will always have a place in heaven because of what you did because you saved my son's life and saved my family."

It was a moment. And it reminded me that for those of us who do emergency or acute services psychiatry, we don't always see the downstream effect. The updates we get tend to be the bad outcomes and repeated reminders of those we haven't been able to improve that keep coming back. It was nice to have a reminder that we tend not to hear about the ones that we really do great things for. I've always kept this one in mind.

 

[clausewitz2]

It was a moment. And it reminded me that for those of us who do emergency or acute services psychiatry, we don't always see the downstream effect. The updates we get tend to be the bad outcomes and repeated reminders of those we haven't been able to improve that keep coming back. It was nice to have a reminder that we tend not to hear about the ones that we really do great things for. I've always kept this one in mind.

One of my faculty mentors splits his time between emergency psych and working in our outpatient chronic psychosis clinic. That seemed to me to be kind of an ideal set up for being able to due higher acuity psych in the long run without becoming totally jaded and crispy, because you will actually get to see some folks when they are not having the worst day of their lives.