I really enjoyed my Psychiatry rotation at Elmhurst Hospital Center! This rotation was my sixth one, and definitely nothing like any rotation I experienced prior to it. It was an excellent learning experience where I put down my stethoscope, stepped away from traditional medicine, and had the opportunity to work closely with psychologists and psychiatrists as I learned about the human mind, behaviors, verbal and non-verbal language, and a range of psychiatric issues. 

I definitely was exposed to completely new techniques and treatment strategies during this rotation. Since I was working very closely with psychologists, I got to experience treatment strategies geared more towards therapy. This included multiple types of therapy, including individual psychotherapy, group therapy, relaxation therapy/ muscle relaxation exercises, and music therapy. I got to learn from the psychologists how they engage in each of these types of therapy, and see first hand how it worked for the patients! I also had the opportunity to engage in individual therapy with several patients throughout the rotation, and help each of them on their individuals paths to identifying their issues and figuring out how to navigate them and get better. With the guidance, advice, and constant support of my preceptors, I was able to really help patients, in a different way than I ever have before- not by using a stethoscope, labs, imaging, or questioning, but merely by speaking to them. At first, it was definitely difficult, and it is often scary to only be able to help people with words, especially as a medical provider, but the more I did it the more comfortable I got with it, and I really was able to see the difference I was able to make through guided therapeutic communication. Furthermore, therapy really empowers patients, since many times I was not necessarily offering them solutions, but rather I was opening the conversation and giving them the space to talk through issues and figure them out/ come to conclusions on their own. I was very happy to be introduced to these new treatment strategies, as I anticipate being able to use them in any field I end up in.

Some types of patients that I found challenging were patients who refused treatment. On the inpatient psychiatry unit, most patients were not voluntary. Many patients did not have insight into their medical problems (ex: patients with schizophrenia), and therefore refused medications because they “did not like how it made them feel,” or they merely did not think there was anything wrong with them to warrant medication. A lot of patients, specifically with schizophrenia, also had illogical thought processes and speech, so it was difficult to understand them and get a proper story which explains why they are there, which made it even more challenging to properly treat them. I learned a few lessons through these challenges. Firstly, I learned the importance of patience and persistence- sometimes we had to speak to patients multiple times before they finally agreed to take medication, and sometimes after taking it once, they would stop and the back and forth started all over again. I also learned the importance of respecting patient’s rights. One might think you could say- “Who cares if the patient refuses, they do not have insight, we should just force them,” but that is illegal and was definitely not how we treated patients in the hospital I was at. Patient’s rights were respected, whether it was with refusing to take medication, refusing to give permission to contact family and gain collateral information, or anything else, and I was really impressed to see these rights always being upheld to the utmost level. Finally, in terms of incomplete information, when patients gave consent, it was very helpful to speak to their families/ loved ones to get more information. 

My perspective on psychiatric patients definitely changed after this rotation. In general, there is a huge stigma against the mentally ill, and in my previous rotation, the exposure I got was mostly seeing them in handcuffs surrounded by several police as they passed through the regular ER to go to the Psych ER. But this rotation, I really got the opportunity to interact with individuals, many of whom were extremely ill, and I learned that there is way more to them than their illness. The patients formed a community, they really looked out for each other, cared for each other, took care of each other, and prayed for each other. In particular, there was one patient on our unit with a developmental disability which resulted in impulsivity, and the care and love that the other patients demonstrated towards her, even when she was biting them, scratching them, and grabbing their things, was so impressive to me. Patients in psychiatric care are suffering from illness, and we are here to treat that, but that does not take away from the fact that underneath their illness, they are kind, caring, loving people, who have huge hearts and just want to help people and care for people. There were so many instances when I saw patients go out of their way to help someone else, and often patients expressed to me how much they desire to help people and be there for others. It was really impressive and definitely changed by perspective about this population in a positive way. 

The knowledge I have gained here can definitely be applicable in future rotations. I learned how to use therapeutic communication, how to show empathy, how to understand patient’s body language and unspoken words, to help frame a better picture of what is going on and help them in the best way possible. I can use this knowledge in future rotations, as well as in my career in general. Whatever specialty I end up in, there will be lots of communication with patients and many patients who need love, care and empathy. There will often be patients who come in with a medical complaint but really just need a caring shoulder and a listening ear (or often both.) Furthermore, many patients will not properly voice their complaints and it will be up to me as the practitioner to understand what is going on based on other cues, and be intuitive to help treat them in the best way possible. I definitely learned and worked on these skills during this rotation, with excellent advice, guidance, and tips from the psychologists and the whole team, and I look forward to using these skills to better communicate, and through this, better help my patients in future rotations as well as in my future career as a PA.