September Update

Well it's been almost two weeks now since I've been back in Pocatello and have started my first rotation in my training as a PA. For those of you who don't know my second year of PA school will not consist of classrooms, or long, boring lectures, but will be based off of five week rotations to different sites where I can get "on-the-job training" and practice. There will be eight rotations in all and they range from outpatient/inpatient, ER, surgery, OB/GYN, etc. I will be doing a few in Pocatello and, if things go to plan, my last few will be down in Ogden.
My first rotation is at the Idaho Department of Health and Welfare working in an outpatient psychiatry setting. Luck has shone down on me because it is the same place where I have been doing an internship since January and so I was already prepared for the environment and what I would be doing. I felt bad for some of my classmates because they had surgery first thing Monday morning and have never been in that situation. However, ask me in three weeks when my second rotation is about to start and I will probably feel the same way they did. I go in Mon-Fri from 8am-5pm, weekends and holidays off, and have participated in a variety of things. The majority of my time is spent seeing patients who are clients of this clinic and managing their medications, but when there isn't another provider there with me I have to find other ways to fill my time. I've decided to use that time to gain a better knowledge of the resources these patients have that don't pertain to the medical part of psychiatry; individual/group therapies, crisis evaluations, and so on. These are all different parts of psychiatry but they all are involved in the armamentarium that is used to help maintain these patients stable or to help them improve their situation. Literature has shown that medication alone isn't sufficient for most of these problems because it's not always just a "crosswiring" if you will of the brain. Patients with these problems need to learn skills to help them adapt to their situation, and medication just won't do it. It's been said, "...therapy solves problems, medication treats symptoms." I've enjoyed what I've learned by sitting in and participating in these different treatment options. I've even taken notes and am trying to apply these principles in my own life, not just use them as suggestions for my patients.
I've also had and will have the opportunity to work in child mental health. What a completly different setting from adult mental health. Many of the disorders present in adult mental health cannot be diagnosed in childrens mental health so it's like going to a whole new specialty.
Today I had the opportunity to attend a court hearing of a person who is going to need institutionalization. I was asked if I wanted to attend to see how procedings went and what the courtroom setting was like. The psyhcologist that I went down with was called as a witness because of a screening that he did on this individual over a year ago. I read through his report and it was quite detailed. He was asked about certain situtations that he talked about in his report and what his opinion was as to the outcome for this individual. While on the way home he took time to explain this persons history in a little more detail so that I would have a better understanding of why he put in his report what he did. He also used this opportunity to stress the importance of careful, and judicious charting. He told me that a year ago when he was writting this report he "knew" that this case would eventually end up in court and that he might be subpoenad for his testimony. With this forsight he said that he detailed his report so that he could remember it later and to also leave no room for ambiguation as to his findings. Now this was something that I've been taught all year long, "chart everything!" but sometimes it really doesn't sink in until you experience its importance for yourself. I'm just glad that I saw it in this context and didn't have to live through it myself.
So I've been able to see a lot of patients in these past two weeks. Some of them are stable and have mild problems, while others aren't so stable and have some pretty amazing stories to tell. It takes a lot of self control to not react to some of these situations, even when deep down your thinking "Really? Are you kidding me?" There are so many diagnoses that overlap eachother that sometimes it's hard to diagnose on the first visit. I've had the oportunity to give initial examinations to a few patients and I have had to sit back and think "how do can I differentiate between these three possible diagnoses?" Sometimes patients can have co-ocurring disorders but you have to be really careful to get all the information that you can so can give an accurate diagnosis. The wrong diagnosis will lead to the wrong treatment, which will not only lead to prolonged suffering, but can also be dangerous depending on how the treatment works.
I'm grateful for the staff that I work with and that take the time to help me learn and understand. The chief psychiatrist is very knowledgable, patient, and willing to take time to give me little pointers here and there. She also acknowledges fairly constantly when I do things well, which is always appreciated from a young PA. All the staff that I've worked with so far have been very helpful in helping me understand the way things work and give pointers here and there.
So that's how my rotation has been going so far. I feel that I've learned more in the past two weeks then I learned all last year sitting in class. Class room learning is important but acutal experience is when things really start to sink in.
Not much else going on around Pocatello right now. I haven't gone mountain biking since I've been back, mainly because of time but hopefully I can get a couple of rides in before the weather gets too cold.