This rotation was definitely the most emotionally challenging of any of my rotations thus far. I had a feeling before I started that psychiatry would be a challenging rotation for me and was worried about producing the high caliber patient notes that are the crux of any psychiatric interview. Psychiatry is an area of medicine that I have always seen the importance in but have taken very little interest in in the past. I have to say my time in QHC CPEP was difficult at times, as I had anticipated, but an overall wonderful and eye-opening experience. My schedule required me to work two night shifts and three day shifts. Admittedly, the turn-around from working until midnight one night to coming in at 8:00 a.m. the next day was difficult however, I really appreciated the different perspective that I gained working the evening shifts. At night everything was predominately run by PAs with one attending on-call. There were also no other students at night besides Merin and myself which meant that we were able to see every consult or new admission if we so desired.

As with every rotation, I felt nervous and unsure for the first couple of days of my rotation. This feeling was heightened by the unpredictability of the patients. The violence that I witness could be very unsettling and I feel that at times my nerves would get the better of me, but as time went on I became more accustomed to the daily routines, was able to better listen to my own intuition as to which patients I should be aware of when in the hall and was able to see the patients for what they were, people in need of some form of intervention in order to help them function better in their daily lives. As I mentioned above, psychiatry was extremely emotionally challenging, many of our patients had very traumatic pasts or one day received a diagnosis that has forever altered their lives. One of the things I love about medicine is its ability to take a person who may not live and intervene in such a way that they are able to leave the hospital and return to normalcy or even better to prevent any such occurrences with regular screenings and patient education. While I understand that is not always the case, I like that rose-colored version. In psychiatry, many of the diagnoses are a life-long struggle fraught with an ever-changing drug regimen that often has terrible side effects and general lack of access to care.

The CPEP definitely felt like an ED. We interviewed patients and decided if their chief complaint was acute and warranted immediate intervention or if they could be managed on an outpatient basis. While I had experienced malingerers during my emergency medicine rotation, trying to tease apart what was truth, what was fabrication and any ulterior motives was difficult at times and my preceptors were wonderful at pointing out subtle clues in the patient interview that led me in one direction or another. The tricky part about the psychiatric interview was that as we were told over-and-over again, it is the guarded patients who tell you everything is fine that you as a clinician should be the most concerned about. I enjoyed the fast-paced nature of CPEP, but many of our more acute patients wound up being admitted to inpatient psychiatry and after that moment we no longer became responsible for their care. I think to get a greater understanding of continuity of care it would have been helpful to see some of our patients as they spent time upstairs and were (hopefully) able to return to their baseline functioning.

Overall, I really enjoyed this rotation. My time in CPEP did not convert me into someone who feels I would enjoy a career in psychiatry. It did however, alert me to patients that may require my assistance in accessing psychiatric services, warning signs that cannot be missed and gave me a general comfort around a patient population that I had previously been uneasy around.

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