Why medical students should go through a psychiatry rotation

“Psychiatry consult, returning a page,” she said, cradling the phone between her left ear and left shoulder. Digging around in her pockets, she eventually pulled out a half-sheet of paper that wasn’t already covered in barely legible writing and boxes marked with Xs. Her right hand clicked the pen and prepared to write.

“Hi, this is Cardiology,” the male voice on the phone said. Doctors tend to lose their names when they are calling consults. “Thanks for calling back. I could use your help.”

“Okay,” Psychiatry said.

“The patient’s name is Montgomery Ward,” Cardiology said. “He’s a 47 year old guy with a past history of high blood pressure, high cholesterol, and diabetes. He was admitted yesterday with a chief complaint of chest pain. We’re treating him in the coronary care unit for a heart attack.”

“Uh huh,” Psychiatry murmured, scribbling notes onto the scrap paper.

Cardiology took a breath and then said, “He didn’t sleep at all last night and won’t stop talking. He keeps asking to leave and says something about having to end the war overseas, that he’s the only person who can do it. I think he’s manic.”

“Huh,” Psychiatry said.

Cardiology asked for help with diagnosis and treatment. Psychiatry said she would see the patient within half an hour.

“Great,” Cardiology said. “Here’s my pager number, but I’ll probably be at the nurses station, charting.”


Psychiatry walked into the unit and immediately heard a man talking loudly. She guessed that this was Mr. Ward.

“If I don’t go there the war will never end I know the generals I taught them everything they know They will listen to me and stop They all know who I am The President will get upset if the hospital doesn’t let me go No one wants to make the President upset The President once gave me a golden heart—”

A nurse, recognizing Psychiatry, pointed at the talking man and commented, “He’s yours.”

Before Psychiatry could respond, a man in a long white coat and blue scrubs said, “Hey, are you Psychiatry?”

Psychiatry nodded.

“Hi, I’m Scott, the coronary care unit resident,” Cardiology said.

“Jennifer,” Psychiatry said, waving hello. “I’m guessing that’s Mr. Ward?”

“Yeah,” Scott said. “He’s been talking like that ever since he got here. He might have slept for an hour last night—if that. Let me introduce you.”

Scott led Jennifer into the room. He rolled a stool from the corner and sat down.

“Mr. Ward—”

“Dr. Scott, the President will be upset if you—”

“—I want to introduce you to Dr. Jennifer, who is a psychiatrist—”

“—don’t let me do my job The military is counting on me to be there and I have the secret codes—”

“Mr. Ward—”

“—and without the secret—”

“Mr. Ward!” Dr. Scott said loudly… and calmly. He waved his right hand in the air.

Mr. Ward stopped for a moment.

“I know you’re concerned about the war and your dedication is admirable,” Dr. Scott continued. “But I want you to meet Dr. Jennifer—”

“I once met a woman named Jennifer who said that she would help me get messages to and from the battlefields and she—”

“Mr. Ward,” Dr. Scott cut in, smiling. “Let me finish, please.”

“Sorry I just have so much to do—”

Dr. Jennifer watched the conversation and smiled to herself. Though he couldn’t finish a sentence, Dr. Scott was gracious with Mr. Ward. The patient was noticeably not put off with Dr. Scott’s interruptions. She was impressed. Not all doctors she had worked with in the past demonstrated this level of skill with patients—particularly those that were difficult to steer, for whatever reason.

“—so I hope you’ll talk with her so we can all help you get better soon,” Dr. Scott finished.

“Okay Dr. Scott whatever you say but the military needs me—”

“Hello, Mr. Ward,” Jennifer said, taking her cue. Scott stood up and Jennifer took his seat.


“… so that’s what I would recommend for you and your staff. Hopefully, that will help keep him here so he can get proper treatment,” Jennifer said to Scott. “I’ll put all of that in my note.”

“Thanks.”

“By the way,” Jennifer said, “you did an excellent job in there with Mr. Ward. Given his current state, it’s not easy to interview him. Nice work.”

Scott chuckled and looked down. “Thanks,” he said. “When I was in medical school, someone taught me how to talk to manic patients.”

“Oh, really?” Jennifer asked.

“Yeah. I was on my psychiatry rotation and the chief resident gave a talk on interviewing techniques. It was really useful.”

“And that’s why all medical students should go through a psychiatry rotation,” Jennifer said, smiling.

Maria Yang is a psychiatrist who blogs at In White Ink.

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  • http://hokiemd.blogspot.com Christopher Bayne

    My psychiatry rotation was great. I was assigned to the consult service. I wish I had seen more inpatient psych, but the variety of cases I saw on the consult service was a truly invaluable experience.

    I didn’t know there was any debate on this–the rotation for students. No brainer to me.

    • http://www.dialdoctors.com Dial Doctors

      Many people, especially medical students, consider psych rotations as unnecessary. Sort of like how a high school student who plans to be an art major views math

  • http://www.dialdoctors.com Dial Doctors

    This post is the perfect example why med students should definitely go through a psych rotation. Psychiatrists are trained in different skills which will come in handy through a doctor’s career. About a month ago I read a post somewhere on how can doctors evaluate potentially dangerous patients who could become violent and thought how a psych rotation could help. Besides even if a person isn’t clinically depressed or manic, it can help doctors be more empathic and avoid losing their cool while managing difficult patients.

    • http://hokiemd.blogspot.com Christopher Bayne

      I’m not sure a psychiatry rotations trains anyone in empathic skills. Maybe it can teach you to be a better communicator. Maybe a better listening. But empathy, no, not specifically. Unfortunately, empathy is a buzz word in medicine, and we have no idea what it means.

  • http://drsamgirgis.com Dr Sam Girgis

    A psychiatry rotation is a required third year core clinical rotation and should remain that way. If not to teach you how to talk to a manic patient, than to give you an understanding of the very broad field of psychiatry. Not having a psychiatry rotation, would be like not having gross anatomy in the first year of medical school. Psychiatry is an integral part of medical education.

    Dr Sam Girgis
    http://drsamgirgis.com

  • Leslie

    I enjoyed this post, thanks.

    I know it’s a buzzword issue in medicine, and I know there’s a limit to how much training can help, but I am still somewhat struck when I come across a medical professional with limited bedside manner**. I know people are drawn to practice medicine for many reasons, but that’s a frustrating career choice for someone who isn’t up for dealing with many types of people.

    **Not the issue with Cardiology.

    • buzzkillersmith

      You really don’t learn bedside manner in a psych rotation. You learn it in all your clinical rotations, mainly through trial and error in combination with your own intrinsic emotional intelligence (” I said this and hurt the pt’s feelings; hmm, I won’t say that kind of thing in the future.”) Now if you have no IEI, you (and your pts) are in trouble.

  • buzzkillersmith

    Psychiatry is very important, at least in primary care. Not much to do with learning empathy, but rather how to diagnose and treat anxiety, depression. PTSD, mania, psychosis, adjustment disorder, personality disorders, etc, etc. We see this stuff daily ,usually together with physical disorders in the same pt. The brain and the body are hooked together (somewhere around the base of the skull, I think ) and the mind is a manifestation of brain function. That said, my psych rotation in med school was suboptimal. The psych attendings and residents took too long and seemed to fool around too much. A concise presentation with clear diagnosis and treatment plan was the exception. Kinda “maddening” to a type A med student. Serenity now!

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