Sunday, October 9, 2011

Early Impressions of the Top Floor

Posted by Eric Zhao at Sunday, October 09, 2011

I'm on the top floor of UMHS where you need a keycard to access to the unit. Two weeks into my psychiatry rotation, I feel safe in saying that I doubt I will ever experience a patient population more interesting or empathy-inducing.

A Day in the Life
7:45 am: Patient workup prior to team meeting

8:30 am: Team meeting with attending physician, medical residents/students, nurse practitioners, physician assistants, and social workers. During this meeting, we talk about the patients, their progress overnight, and our therapeutic plan. If you see any pharmacy interventions, speak up here.

10:00 am: Rounding with the medical team. Now's the time to see the patients and view how they're doing. Pharmacists make sure that the medications are working as intended while minimizing any side effects. For example, in an obese patient or an athlete, recommend an antipsychotic that minimizes weight gain and other metabolic complications; aripiprazole and ziprasidone are good choices, while clozapine and olanzapine are not. As always, consider the patient profile as a whole, but you knew that.

12:00 pm: Patients are usually at lunch or group therapy, so we spend time chatting with our preceptor about our patients, giving journal clubs, and attending grand rounds.

1:00-4:00pm: Follow-up with patients and ask any questions. This is a good time to write up pharmacy notes, visit patients again with the team, and provide therapy recommendations.

Variety is the Spice of Life
As you can guess, no two days are the same. Diagnoses may be similar, but no two hallucinations, delusions, or psychotic episodes are alike. Also, there are few things more inspiring than seeing a patient's mood improve as their medications take effect. One of the strategies used to manage severe, drug-resistent forms of acute metal illness is called electroconvulsive therapy (ECT). Tune in next time as we explore the clinical dimensions of ECT.

-Eric Zhao

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