Psychiatry 110

I'm doing a month long psychiatry rotation at San Francisco General Hospital. We get to pick between working in the inpatient wards and the consult liaison (C/L) service. Interestingly, the inpatient wards are ethnically separated with focus groups in Latino health, women's health, African American health, Asian American health, and LGBT issues. I'm not sure why they do that. The inpatient wards deal with acute psychiatric symptoms in patients who don't want to be there: schizophrenia, depression, bipolar, personality d/o, PTSD, substance abuse. The consult-liaison team responds to psychiatric consultations from other services. The patients are medical and surgical patients who develop or have psychiatric problems that the primary teams can't handle. C/L assesses conditions like depression, delirium, dementia, personality d/o, substance use, and assessment of capacity for informed consent. I decided to work with consult-liaison; though the really interesting stuff is inpatient, I figured learning how a consult service works would be very useful since I'm leaning toward a medicine-y field. Differential diagnosis is tougher with C/L because you have to consider all the organic stuff too.

The instruction is awesome; the attendings on my service are completely dedicated to medical student teaching. They take a lot of time out of their day to help us get as much as we can out of the rotation. There are some formal didactics: psychopathology, pharmacology, adolescent and child psych, grand rounds, case presentations, and humanities conferences (one of the attendings enjoys reading psych-related literature). But a lot of it is learn on the job also.