How did it go? What have you learned? What can you improve? How do you plan to improve these new skills?

I did not think I was interested in psychiatry before I started this rotation, but now that I have finished, I am much more open to the idea of working in psychiatry. I was very interested in the cases we came across and I loved reading about certain psychiatric disorders along with the mechanism behind how certain medications worked. I truly enjoyed this rotation, not only because the education there was enlightening, but also because the work environment seemed healthy. The staff was respectful and made the setting comfortable, welcoming, and safe. My knowledge on psychiatric drugs and medications has increased significantly since I started this rotation.

While I am grateful for my ability to be empathetic, I would like to improve on the skill of separating myself and managing my emotions as a professional clinician. As expected, we often saw psychiatric cases that were unfortunate and distressing; sometimes during the interviews, I would find myself getting emotional while hearing patients speak about their hardships. I would like to handle my feelings in a more appropriate way for my future patients and also for myself. To do this, I plan to continue to put myself in these difficult situations so I can gain experience, and I plan to ask my future mentors and colleagues for advice, along with reading from professionals online.

 

Skills or situations that are difficult for you and how you can get better at them

One skill that is difficult for me is handling patients that are agitated, aggressive, or hostile. I have not personally been put in a situation like this before, but I know that I will be one day, and I would like to hide any sense of intimidation or insecurity in that instance. I remember watching my preceptor at this site interact with an anxious and agitated patient who was accompanied by her mother who was also anxious and agitated. He was able to answer their questions in such a direct and confident manner, while also being polite and professional despite their harsh attitude. I feel that my skill in dealing with situations like this has improved significantly since the beginning of this year, but is not at the level I would like it to be. I can get better at this by continuing to watch and take note of how providers handle difficult instances like this. I was told that this skill will come with time and experience, and not to get frustrated with myself if I need the help of my colleagues. I hope to emulate that confidence and skill the next time I am interacting with someone who may be irritable during their medical process, and I will continue to ask for advice from those I feel have perfected this skill with grace.

 

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc). 

My perspective on children who are brought in for aggressive or destructive behavior has changed. While these children can easily be seen as “bad kids” or “misbehaving,” I learned that it is important that we recognize what often leads to this behavior. Many of the children that I saw brought into the psychiatric emergency department, excluding those with depression or suicidal ideations, were diagnosed with conduct disorder or oppositional defiant disorder. After some reading and discussion with my mentors at this rotation, I’ve gained insight into the common risk factors of these conditions. Many of the environmental factors that have been seen in these children with behavioral issues include neglect, poverty, dysfunctional families, physical abuse, and many more. This lack of control over their environment, lack of impulse control due to their age, and emotional lability, should make us more compassionate towards these patients and motivated to helping them, instead of just labeling them as “bad kids.”

 

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

I found speaking to certain patients was difficult when they would provide illogical answers or be uncooperative. When patients were aggressive, I saw how providers would redirect the conversation, and sometimes validate the patients’ feelings in order to calm them down. I learned to also notify other staff/providers about certain triggers that patients may have. When patients were completely uncooperative, I learned that a good approach is to educate. By discussing your role and purpose for speaking with the patient, they may become more comfortable and willing to cooperate. When this along with other efforts do not work, sometimes it is best to give the patient some space/time and try again later. When trying to obtain history from patients who may be uncooperative or be providing illogical or incoherent answers, I learned the value of obtaining collateral information from friends and family. These are all things that will be applicable to other rotations and my career as a PA. I know that we will come across patients that are aggressive and/or with a psychiatric diagnosis in almost any field we go into. These techniques to deescalate situations and obtain information will be needed. Even if I do not end up working in psychiatry, this rotation was extremely valuable to me in this sense because I can take many of the lessons I gained here and apply them to future experiences.