Well, first I have to apologize for not meeting my goal. I was unable to write every single day. I think its a combination of being completely exhausted and also maybe just a lack of interest after awhile. The repetitiveness of the day was less than thrilling after you saw one case of ADHD you saw them all. However, there is much to be said about seeing the physical difference in the kids through follow up and the true magic present in one single pill that can make (or break) some parent's life.
I must admit i will be sad to see psych go, mostly because my preceptor (and his staff) was so awesome. Especially towards the end of the rotation I started feeling like I fit in. We had inside jokes and goofed around about crazy stalker patients who stalked one of the front ladies. We also teased the doctor. It was definitely a community, and I felt accepted. It is hard to leave that since I have heard bad things about my next rotation. I have to say that for those people out there who have never seen a "serious" gay man-- you have to meet my preceptor. His sexual orientation did not cause any awkwardness or impact at all on my experience. Actually, the saddest part was when his patients saw his wedding ring and asked about his wife. He always just said "she's fine" and ignored their deeper probing. There was one time when an older patient remarked that I was a "pretty one" and it was "too bad" that my preceptor was married. (talk about awkward on multiple levels).
As to whether I think I could ever do psychiatry... I don't know. I suppose I could. It is a lot of follow up and control over who you see and when. Since my preceptor doesn't do therapy (said he's not very good at it... too blunt) it was usually a day full of med checks and making sure there were no side effects. I told him I felt that he did a small amount of therapy in the med check meetings, telling parents the truth about what he thought or calling the kids on their bullshit. Its amazing what 15 minutes with him can do and... not do. I can understand how there would be less of a burnout. It was hard to see a number of parents who just wanted you to give them a pill to fix their parenting skills. But then it was balanced by the parents who were so desperate to try anything and to see something work for them.
In the end I would say its not off the list, but its not on the top, at least for me. I still want to excitement and variety that I haven't really found in psychiatry- outpatient psychiatry. I was constantly talking to the preceptor about wanting to see rare disease or unmedicated patients for the experience. My preceptor appreciated me for that. He wrote me the best evaluation and honestly told me that I'm going to make an excellent physician. I'm glad to have his support. I asked him to write me a letter of recommendation. And he agreed. I can already tell that its going to be one I'm going to use for every site, because despite our rocky start and the fact I was outshined by my fellow student-- he took the time to recognize my strengths. Maybe its because he's a psychiatrist, but i think he likes everyone.
And I suppose I need a few words in here about the psych Shelf exam. It whipped my butt. I wasn't expecting so many neuro questions. I felt like it was all about vit b12 dementia and neurotransmitters. I got at least 3 questions on theophylline, an asthma medication. I used first aid for psych and tho it helped I should have studied a bit more out of my step 1 book. I hope I don't have to retake it, but at least if I do-- I can do significantly better on it.
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