Tips for Psychiatry Intern Year
Written by Derek Wolfe, MD
It's a bit surreal to be sitting here in June realizing that my Psychiatry intern year is coming to an end. It feels like just yesterday I was anxiously awaiting the beginning of my residency career. Looking back and reflecting on the patients I've cared for and my overall residency experience thus far, I truly feel I have grown immensely as a physician. I hope through this blog post I can impart a few bits of helpful advice to the new cohort of Psychiatry residents that will set you up for success. With that said, here it goes:
View chart reviewing as a skill to be worked on. Many of the patients you’ll be caring for will have an overwhelming amount of previous notes and encounters in the chart. Obviously, it’s not feasible to review all of it, so your review process should be intentional (for me, this is still a work in progress). For example, if your patient presents to emergency departments frequently, pay attention to aspects like what they are presenting for and how they presented. Are they coming by themselves and asking for basic needs to be met like housing or medication refills? Or were they brought in by police? This information may impact your assessment and noticing these patterns will take time to develop. Also, as an additional tidbit, if you can use an EMR like Epic, take advantage of filters. In my account, I’ve set up filters that allow me to exclusively see previous psychiatry encounters and prescribed psychiatric medications. That has been a huge help!
Learn to trust your assessment. Even though I just spent the last paragraph discussing the importance of chart review, it’s also critical to be mindful of the field you are working in: psychiatry by its nature is quite subjective, and many factors may have impacted a previous provider’s psychiatric assessment and subsequent diagnosis. With that in mind, patients may carry with them a diagnosis in the chart that does not appear consistent with the individual sitting in front of them. That’s ok! If you have gathered convincing evidence through your patient interview and, if possible, collateral information that supports a different diagnosis and treatment, be confident and know you’re doing right by your patient.
Prioritize understanding the Mental Status Exam. Not only should you do this because the MSE is the “physical exam of psychiatry” and you may encounter attendings who prefer a formal presentation, but a fundamental knowledge of the MSE also helps you focus on what to be mindful of during your patient encounters. In addition, learning common descriptors for components of the MSE like affect or thought process (Kaplan and Sadock’s Synopsis of Psychiatry was helpful for me) will help give you more precise language of how to describe what you are observing in your patient.
Never ever forget your patients are human. It can be easy to get fixated on diagnosis and labels, and that’s understandable. But also, don’t lose track of the fact that patients are people. They are someone’s friend, partner, child, or family member. If we are doing our job right as psychiatrists, then we are trying to give our patients a chance to continue living a meaningful life.
Lastly, never ever forget that you are human too. Do the best you can to be kind to yourself during Intern year. You’re going to be working a lot and learning a lot. You are going to be tired. You may make mistakes. When times are hard, take a breath and know you’re doing the best you can, which by the way, is probably pretty great.
To all the Psychiatry interns, good luck! The more experienced residents are rooting for you and of course, are here to help. Always feel free to reach out!
Derek Wolfe can be found on Twitter @derekw518.
