I think I now could do a psych eval (new patient) in my sleep. I can cover your entire life in 40 minutes. Even if you're a talker. That's going to be painful, I'm going to be redirecting you a lot and it will absolutely exhaust me, but I can do it. I've been doing it. And I now have little lists in my head of what meds to pull out for what disorder, and how to tailor them to specific presentations. Are you depressed, sleepless and losing weight? You need Remeron and Celexa! Are you Bipolar II, don't want to gain weight and your manic periods weren't excessive? You need Lamictal! Are you only anxious and it's not too bad? You need Buspar and yoga! The other disorders (schizophrenia, ADHD, OCD, PTSD, etc.) are not as frequent so I don't have those right on the top of my mind. And yes, I know so many acronyms it's kind of ridiculous. You should hear Dr. Smith on the phone with other providers. It's just an exchange of 3 or 4-letter abbreviations.
Reassuringly enough, just in the past week I've started to feel that I could effectively handle most patients that we've seen if they were coming to see just me. But we had a doozy the other day that left me feeling like I was totally out of my league. I'm going to modify details to preserve privacy, but this was a teenager that had a long history of untreated mental illness, two specific disorders that are often co-morbid (meaning they occur together), and now finally, after flunking out of first semester of college, it's time for treatment. Never mind the fact that having one of these disorders untreated has likely resulted in brain damage according to the neurology report. I had to wonder - who was advising these parents? How did they feel about that now? The parents were very into alternative treatments, very against any medication at all, which is something we see frequently in Austin. The problem is that the alternative arena has a wide variety - yes, some things are new and work, but others are downright harmful. They are unregulated. And if you put all your chips on an alternative treatment, that's a big gamble. We didn't have time to cover everything, and we went 20 minutes over anyway. After this complex, difficult patient, I was pretty shaken. I thought to myself, if this teen came to me for help, I honestly would not know what to do. Dr. Smith said that when you're unsure on a complex case, don't make any decisions in the first meeting. Maybe you need another hour with the patient, and that's OK. She said tell them that you need to consult and do research - and that's OK. Call all the other providers that the kid has seen - previous psychiatrists, neurologists, therapists, psychologists, primary care. She said that usually by the end of that, you'll know what you want to do. But if not, call your mentor(s). She said there are a couple of guys that she trained under in town, and she still calls them once in while. I felt oh-so-much better after that.
I have a job interview this week. It's for a psychiatrist in town that works with three NPs in his office. I talked to two of them and both said great things about working for him - he's very available to consult and he enjoys teaching, he encourages work flexibility in terms of hours. Oh, and here's THE most important thing-- there is a yoga studio within walking distance. Can you say noon-time OM? I just want to see if it could be a good fit for me. He does see kids, so the fact that my license allows me to see them as well (not all Psych NPs see kids) is a plus. I knew all that time on the kids unit at Austin State Hospital wasn't a waste.
My friend Kathy is moving to Colorado. We had lunch and talked about old times working together at the psych hospital here. I will miss her a lot, and I learned a great deal from her. She's one of the best at establishing rapport with very, very ill psychotic patients. Here we are, having lunch together at Hyde Park Grill (a great classic Austin place).
