Thursday, June 28, 2012

Ending with the Crazies

Ya know, I could say how I've been busy and whatnot.  But that'd be a lie this time.  I've just been lazy.  The year has been winding down for some time and I just couldn't be bothered, lol.  And as it is, I end the year with the crazies (aka, psychiatry).

It actually wasn't a bad rotation.  Spent 2 weeks on child/adolescent psych, 1 week on eating disorders, and 1 week on adult psych.  As the director of the place told us several times, "Most of these patients ain't dumb, they ain't crazy, they just have had crazy things happen in their lives and couldn't handle it, and that's why they're here."  On about day 3 I realized how true his words rang.

The vast majority of psychiatric patients I saw aren't crazy.  Most of them aren't schizophrenic, they don't hear voices other people don't hear, they don't see things other people don't see, they aren't foaming at the mouth or anything (that said, the couple of schizophrenics who weren't taking their medications really were sometimes kinda scary crazy).  Most of the people I saw actually had mood disorders - anxiety, depression, irritability, etc.

The best way I can describe most patients' situations is that crazy things happen in their lives - a kid is witness to domestic violence or is abused (verbally, physically, emotionally, and/or sexually), a teen feels out of control when her parents divorce and start restricting her eating, an adult couldn't handle the pain from multiple surgeries and turns to drugs - and their minds just can't take it.  Something inside breaks and they snap.  These people try to resolve things and find an outlet for the trauma of their minds and find themselves repeatedly bashing their heads against a proverbial wall.

And when they're at their lowest, when there's not much further down to go, they come to us at an inpatient psychiatric hospital.  Here we control the environment, take the responsibility out of their hands for a time, talk to them, counsel them, prescribe medications.  And these medications often work (it may take some fiddling around to find the right drug and dose for the right person, but it works out more often than not).  They kind of reset the imbalance in the brain and allow people to think clearer, calmer, and more rationally.  They smooth out the edges of emotions so one doesn't soar as high or dip as low.

Mental health.  It's a real thing.  Sometimes all one needs is some counseling, and sometimes it requires medication.  In that regard, it's not really any different than diabetes or hypertension.
Oh yeah, I'm 3/4 of an MD now!  :-D  Unfortunately the other aspects of my life have been less interesting than the things I witness when I'm in the hospital.  Still a few things here and there worth blogging about in posts to come.

Oh yeah, PPACA (aka, Obamacare) survived the Supreme Court ruling.  Thoughts?  Also for another post, lol.


fan of casey said...

Overall I'm glad Obamacare survived -- I've talked to a couple of doctors who are opposed but they seem to take primarily their own economic self interests into consideration instead of the larger fact that a segment of the population can finally get some decent health care.

I'll admit Obamacare is not perfect but it is start. Look back at the Bush 1, Clinton, and Bush 2 years and no one could make much headway with the issue. The republicans talk a good game of repeal and replace but that's just smoke and unlikely to come to fruition even if Romney is elected.

I give credit to Obama for making the effort and advancing the ball forward but I expect there will be more tinkering to smooth out some of the rough edges. Bush 2 had 8 years to do something but did nothing -- NOTHING! Until the republicans start working towards a bi-partisan solution, I don't see much chance of some of their good ideas happening.

And remember -- the mandate (which really isn't one -- you don't have to buy insurance, you can always opt to pay the penalty) really was a republican idea to begin with, with everyone supposedly contributing their fair share and not burdening those with insurance to carry those who decide or cannot afford coverage.

SCalRF said...

Did you notice any sort of "stigma" about psychiatry from other doctors?

naturgesetz said...

It's been interesting reading about what you've seen in the hospital, and I'm sure the other items worth blogging about will be interesting as well.

Aek said...

SCalRF: Hmm, not really? I mean, other services are often annoyed at neuro and psych because they tend to be really slow with consults (though this may be hospital specific). But I wasn't on a psych consult team. The one thing that kind of frustrates me with all services is that as soon as something is even remotely outside their field, they reflexively call a consult before doing an initial evaluation.

I mean, just because you're a psychiatrist doesn't mean you shouldn't know your patient's cardiac status and just because you're a cardiologist doesn't mean you shouldn't know your patient's mental health status. Things like that. Or on peds, sometimes as soon as it's something gyn-related, they consult adolescent or ob/gyn so fast you'd think the patient was struck by lightning or something.

Biki said...

im glad obamacare passed the court safely. i hate the whole preexisting condition mandate that most insuranses have. or they penialize you for being sick in the first place by restricting the amount of care you can get for some illnesses. the whole system of insurance is to keep their profit margines as high as possible for their stockholders.

I was on a mental health board for quite a while, and there still is quite a stigma around the idea that many of us need help now and then. espeically with men. im glad you got to see up close and personal the crazy way our mental heath care is worked. ive seen what you mean about not wanting to touch anything that is out of the mental health field. drove me to abstraction several times.