Updated: Nov 29, 2020
Psychiatry is set up so that for two weeks I do outpatient and then two weeks of inpatient. So for my first two weeks I did outpatient. The psychiatry situation in New Orleans is quite the disaster at the moment. We are supposed to be considered a major US city, yet the whole city only has 21 inpatient psyc beds. This is a big difference from the 300+ Pre-katrina. Our program director steams with frustration about the current status of mental health in the city and loves to remind us of little facts like this. She is of course justified in her anger, the health care system of New Orleans is currently in shambles, but the Mental health specifically is an atrocity. With no inpatient beds there is really very little placement options for those that need chronic care. Most of these patients are the chronic schizophrenics, and most of them without any kind of state sponsored infrastructure wind up on the streets. So it’s no wonder that with the population of New Orleans only being half of its Pre-Katrina numbers, the homeless population has almost doubled as compared to before the storm.
On a side note, if you live in this city or are a frequent visitor then you will know that the nomenclature of Pre- and Post- Katrina is pretty much the rubber-stamp for describing anything that involves any sort of timeline.
My first week of Outpatient psychiatry was fairly busy, I say fairly because although we still see a lot of the run of the mill depression, and anxiety, there is this ominous black box that begs the question, where are the really crazy patients, we really don’t see them on an outpatient level either.
Every day for the first week I was at a different clinic following a different doctor, and every experience was unique, but yet the same. A typical day followed the format of me going into some office at say 830 or 900. Depending on what their schedule was like that day we either saw a bunch of patients or if they were slow got a lecture about drugs, or the diagnostic criteria of some obscure personality disorder.
The whole thing was really boring, mainly because I never actually talked to a patient, I sat there quietly like a fly on the wall, not speaking, or dictating anything. This is a stark contrast to Neuro, where I was interviewing my own patients, writing notes, etc. Now I suddenly found myself a pre-med once again, doing the irritating art of “shadowing”. What was nice I suppose is that most days I got out by 2 or 3. What was sort of annoying about getting out so early on a fairly easy rotation where not much is expected of me is that I have no idea what to do with myself for the rest of the day. I now understand why people save this rotation for step 2 USMLE studying.
This pattern continued for another week until I got to the end of the outpatient rotation which is marked by a two day stint in a substance abuse rehab hospital. Turns out this was actually pretty fun, and was the highlight of the outpatient experience. I was actually assigned a patient, interviewed them, and presented to the attending, almost like being a real third year. My patient was in her mid 20’s, came from a fairly well background, but just really liked pain pills and heroin. Over the course of two days I sat in about 4 group meetings that were a blend of AA, and NA. What was interesting is we were given the instructions to portray ourselves somewhere between being a counselor, and a patient, and to chime in with whatever we felt like.