My Psychiatry Rotation at Mindful Urgent Care was a unique experience. Psychiatric Urgent Cares are a relatively new phenomenon, but the demand is certainly there. Patients often cite difficulty or long waiting times in scheduling an appointment with a Psychiatrist as one of the reasons that they opt to seek care at Mindful Urgent Care. The patients are satisfied with the clinicians whom treat them and the care they receive, as evidenced by their establishing care with the facility and returning for follow up appointments. This clinical experience, though educational and high-volume, has led me to believe that Psychiatry is not a specialty I am interested in. Prior to the rotation, I was unsure whether I would enjoy Psychiatry. One of the main reasons I cannot see myself pursuing a career in Psychiatry is because I found it difficult to hear about some of the tragedies/traumas that have afflicted others in their life. While it felt good to be helping the patients regarding medication management, making the appropriate referrals to psychologists/social workers, etc., it was still difficult to think about some of the situations that have afflicted them. Despite the fact that I don’t wish to pursue Psychiatry, this rotation, and what I’ve learned from it, was invaluable.

Memorable experiences and patients I’ve had included working with patients in a variety of life circumstances. Many patients I’ve seen were elderly and were diagnosed with Persistent Complex Bereavement Disorder. Seeing these patients as “intakes,” or for their initial visits, certainly shed light on the power of listening. One of the aspects of the rotation that I really enjoyed was the fact that patients were given sufficient time for their appointments, rather than having them feel rushed. For the intake appointments, patients are scheduled for a full hour. During this time period, especially in the case of patients later diagnosed with Persistent Complex Bereavement Disorder, the patient has the opportunity to share how they are feeling, the reason for their visit, and a lot of critical psychosocial information. Many of the elderly patients I would see would recount their life experience with their partner, describing how many years they were married, what they’ve accomplished together, etc. For these patients, utilizing active listening, as we reviewed in our Interviewing and Counseling class, was essential. At the end of their appointments, if medication was prescribed and certainly after a referral for psychotherapy was made, the patients often thanked me for listening to their story.

I saw multiple patients that were either not domiciled or recently found placement in a shelter. Seeing these patients certainly shed light on the impact of ones environment on the various aspects of their health, including medical and psychological.

Several patients also struggled with various addictions, including alcoholism, crack cocaine, opiates, etc. Learning about these patients, their stories and often their struggle to stay sober, was important in that it shed light on how depression and other diagnoses can lead to substance use and subsequent addiction.

During this rotation, I was exposed to performing and documenting a Mental Status Exam. This was a skill that certainly took time for me to get used to, though after seeing several patients I eased into it. Furthermore, I was exposed to a lot of medications that previously I did not see so much of in my other rotations. For example, learning about the use of Hydroxyzine (first generation antihistamine) in the treatment of anxiety/sleep aid and Gabapentin in the treatment of anxiety. Furthermore, I had a lot of exposure to mood stabilizers and mainly second generation antipsychotics. Pharmacology was certainly an important part of this rotation, and my preceptor, Nick Obertis, often would question me about when medications were indicated versus contraindicated (excellent review!).

The clinicians with whom I worked, mainly Nick Obertis PA-C, asked mainly board-style review questions in order to keep myself and the other PA student on our toes. We reviewed contraindications for medications like Bupropion (as it lowers the seizure threshold), Lithium (can cause Ebstein’s anomaly in pregnancy), and Valproic Acid (if prescribed in pregnancy, must supplement with additional folate to prevent neural tube defects).

Some challenges that I had to overcome were adjusting to the Psychiatric interview. It is very different from taking a history and performing a physical exam in other specialties. Performing the Psychiatric interview involved listening and often utilizing open-ended questions in addition to saying things like “Tell me more.” in order to get a complete picture. This can, however, lead to the patient talking about irrelevant topics which sometimes requires gentle redirection – this is a skill I’m continuing to work on. Another challenge I had to overcome was presenting the patient to my preceptor. Interviewing a patient for 45 minutes to an hour involves collecting a lot of information, and it is my job to succinctly present that to my preceptor so we can discuss what is ailing them and how best to manage them.

This rotation was a great review of primarily mood disorders and their management with occasional exceptions. As I am currently thinking about practicing in Pediatrics, Emergency Medicine, or Family Medicine, it is evident how important this rotation will be in my future career. In all specialties, you will see patients that have psychiatric diagnoses, and I feel that this rotation has reaffirmed my emotional maturity and preparedness in discussing these diagnoses and treating my future patients.

One thing I would want my preceptor and colleagues to notice about my work was the fact that I was punctual, that I chose to come in on days that were not required (for the sake of education), and that I was always eager to see the next patient. I also would hope that they recall the fact that my patients would tell them what a good job I did and how comfortable they felt with me.

For the following rotations, I wish to improve on my skill in gently redirecting patients when we get off topic. I recognize how important and therapeutic it can be for patients sometimes to just talk with someone, and as such, I often feel bad having to redirect the conversation. My last rotation, Family Medicine, will certainly see the incorporation of the listening and interviewing skills I’ve gained. Furthermore, it will see me emphasizing the “Biopsychosocial” view of medicine. For example, in the event that I have patients that screen positive for depression, I will discuss with them the options for referral for psychotherapy and describe how emotional well-being and physical well-being are intertwined. I also seek to de-stigmatize mental health symptoms and illnesses.

Overall, my experience at Mindful Urgent Care for Psychiatry was highly useful. I know that what I have learned here will be applicable throughout my career. I’m thankful for my preceptor and the rest of the staff with whom I worked.