First month on rotation

Two weeks ago I switched from psychiatry consult/liaison to inpatient psychiatry.  It felt like starting all over again from scratch, but not in a good way. Instead of being excited and thrilled to try something new, I felt like I was just watching people get work done around me—that is, when I wasn’t in their way.  I feel like switching teams is a little bit like moving apartments.  The basics are all the same (your couch, your desk, your bed, your silverware), but they’re organized differently.  And it takes a certain amount of time before you stop looking like a doofus walking out of the elevator not knowing which direction to turn.

My consult/liaison team consisted of three med students, five residents, two fellows, and one attending.  As each new patient came, he was assigned one resident and one med student, whoever was next up in the queue.  The residents came in with us and watched us as we conducted the interview.  Once we said all we could think of, we glanced at the residents so they could ask all the questions we knew we needed to ask but just forgot to.  We quickly discussed the assessment and plan together, then went off to see the newest consult patient.  We discussed all of our patients as a team over lunch (sometimes after a student-led presentation) then visited them together.  At the end of the day we would write our notes, call collaterals, and set up patient appointments. It was all very safe, encouraging, and structured.

My inpatient psychiatry team consisted of two med students (myself and someone who had already been there for two weeks), one resident, one attending, three nurses, and one social worker.  On my first day, I arrived 30 minutes too early due to a paging fiasco and took the elevator to the eighth floor.  I stepped out and stopped dead in my tracks, looking left and right and left and right, seeing only unlabeled doors and empty offices.  Luckily, a few minutes later another student came and led me down the seemingly convoluted path into the workroom.  I waited about 30 minutes until the resident came in, then waited quite a bit longer because he had nothing for me to do.  He finally found a task that even an unfamiliar, foreign med student could do—get consent from a patient to discuss his care with his sister.  I started in on it, but the patient did not want to sign the release.  And I failed at the one task I had all day long to do.  I felt meager and out of place; the resident must have sensed my defeat because he let me go home at 3pm.  I felt more tired than all the times I stayed in the hospital on consult/liaison until 7pm.

But I got used to it pretty quickly.  But this past Monday I moved again.  I hope it won’t take me very long to figure out the right way to turn after exiting the elevator.