You won’t believe the stuff I saw today

February 5, 2008 at 7:13 pm (Clinical rotations)

I started inpatient psychiatry this week, which is already turning out to be one of the most ridiculous clinical settings I’ve ever been in—for a variety of reasons. My very first patient of the day was a 40-year-old man who claimed that he was 10 1/2 months pregnant. He was fairly certain that he was going to give birth in the next two weeks, claiming that he was carrying 50 babies. He was very adamant that he was the mother of the children and that his cousin was the father, prompting my attending to say, “That’s the craziest fucking shit I’ve ever seen in my 20 years in psychiatry.”

I certainly expect odd behavior from my patients. However, I’m sorry to see that many of the psychiatry residents and attendings also exhibit severe personality flaws. Already in my second day, I’ve diagnosed my intern as being manic. He told us on the wards that he was a player, and then proceeded to hit on a social worker, two pharmacy students, and was even flirting with several of the committed patients. I’m pretty sure that he’s going to be one of those psychiatry residents who ends up marrying a patient.

He talks incessantly. He tells us that he’s such a wonderful teacher, and then proceeds to read to us from a PowerPoint slide. While the med students are diligently writing notes and filing them away in patients’ charts, he is idling his time by surfing Facebook.com and telling us, “This is such a hard rotation. I can’t believe the amount of work I have to put in.” I wonder how a person who lacks insight and judgment got put in charge of managing a dozen patients who also lack insight and judgment.

Probably the most offensive thing I’ve had to witness so far on this rotation is the dress code. Nothing seems more out of place that a psychiatrist who wears a white coat. As if they’re real doctors! The pockets are typically empty. There is never a stethoscope, a reflex hammer, penlight, or anything else that might make a person believe that psychiatrists practice any kind of real medicine. My service consults out for every medical problem: diabetes, hypertension, shin pain, and pregnant men. Then, the shrinks all get upset and offended when other specialties state that they aren’t real doctors.

But I think I may have found a woman for my intern. I was sitting in on an interview today when the patient stopped addressing my partner, turned to me, and said, “Hey handsome, if you give me 69, I give you 69. You can get me pregnant.” Seems like a perfect match to me.

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5 Comments

  1. anonymous said,

    Thank goodness you aren’t working with social workers. Persons in that profession stand around and laugh at clients (your patients) and then proceed to bitch about how little they get paid, how retched their lives are, etc. They are good at complaining as they started back in college and have at elast four years up on getting started to be jaded.

    What is the purpose of the white coats? So you look sanitized? At least those clowns aren’t wearing scrubs. There is nothing like a doctor wearing scrubs all day– I had an OB do that and it grossed me out, “Did you just get out of surgery or medical school?”

  2. MSG said,

    I posted something recently related to this idea of psychiatrists having to go through medical school when they’re clearly not “doctors”. I was thinking that it may have been just my school, but I’ve heard that this is actually more the norm (at least in teaching institutions) than originally thought.

    I love the white coat bit…like they’re going to do anything other than be all crazy with their patients. SOAP note? WTF is that?!

  3. social worker said,

    not all social workers laugh at clients. there are some that do and then there are those of us who take our job seriously and treat our patients as they should be treated–with dignity and respect.

    and a lot do bitch about what they get paid, but in the hospital setting, a social worker shouldn’t complain about what they’re making because hospitals probably pay the most in the field outside of private practice.

    here’s a question: if psychiatry is not “real” medicine, then who should be prescribing psychotropic meds? internists? just something i’ve wondered since i’ve heard a lot of internists say they’re not comfortable prescribing psychotropics.

  4. Danielle said,

    Of course psychiatrists and psychologists have personality flaws!
    That’s a given! Who is brave enough to go to work everyday and deal with senseless, psychotic, gross, dangerous,and disrespect from everyone. Mental health providers have to have a problem themselves, or some sort of affinity to delve in misery everyday, for years.
    Did it ever occur to you “real” Dr’s. That the white jackets arn’t to express Their “doctorhood” but for other reason.
    _ A lot of mentally ill are paranoid and very scared. A white jacket symbolizes that they are the dr. = ceasation of pain.
    _ They do get all sorts of objects and substances thrown at them. Would you like to get your clothes stained with feces?
    - to be immediately recognized in case of an emergency. Orderlies arn’t allowed to give Haldol.
    They are dr’s! The brain and mind are soo complex we only know little about a small portion. How can you expect someone to specialize in mystery and expect them to know the whole body as well?
    If there were no psychiatrists we would have a lot of monsters roaming the quiet contryside, now wouldn’t we. Psychiatrists also treat the public!

  5. Dave said,

    Someday you’ll be glad there are people willing to do this job……someone you can “dump” your patients on.

    As a Family Doctor I deal with a lot of my patient’s psych issues, but there’s only so much I’m willing to tackle without the help of a psychiatrist/psychologist.

    I have to agree that the wierdest docs I’ve ever met were psychiatrists.

    Half M.D.: I’m certainly glad they’re there, too. That doesn’t make them any less odd.

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