Residents' Corner: Good Medical Care for Our Patients Imperative

By Poulsen, Raul J. | Clinical Psychiatry News, May 2015 | Go to article overview

Residents' Corner: Good Medical Care for Our Patients Imperative


Poulsen, Raul J., Clinical Psychiatry News


The first year of residency came faster than I had expected and concluded just as quickly. At times, it felt like medical school, with different rotations, adjusting to newly formed teams, dealing with the pressures of getting the right diagnosis and treatment, managing the unrelenting speed of rounds, and trying to make a difference for the better. I must be honest --there were times when I was counting down the days for the rotation to end so that I could begin focusing and working directly in the mental health field.

Now, in my second year, the pace has improved, and the rotations resemble the work and patient population that I chose during the match process. Nonetheless, I am thankful for the time spent and the knowledge gained during my intern year, because it is only now that I understand the true value of my first-year experiences and the need to continue getting a well-rounded medical education for the benefit of my patients.

During my second year of residency, I have come across multiple instances of health disparities for people with mental illness. While working in several inpatient units, I have witnessed delayed time of visit from medical/surgical or ob.gyn. consults, shorter evaluation times from visiting consulting personnel, and postponed follow-up appointments for general medical conditions. I remember one occasion when a patient with urinary incontinence waited 3 days until internal medicine completed its consult. These experiences remind me of the conversations I had in medical school. Some of my colleagues would say, "Psychiatric patients are difficult." Others were honest in admitting that they were scared to even enter a psychiatric inpatient unit.

Medical comorbidities

During one 24-hour shift, I was paged to the inpatient unit. A new admission from that afternoon was complaining of "toe pain."

The patient had been admitted for suicidal ideation and alcohol withdrawal. He reported tripping over a concrete step 2 weeks prior to admission. Under examination, he had an open laceration with purulent, foul-smelling discharge, erythema, and edema around the wound. The patient had signs of cellulitis, had a possible fracture of the phalanx, and was at risk for osteomyelitis.

He had been medically cleared at another facility prior to his admission, where he also had complained of toe pain. At that time, however, he was told, "You are not here for that," and the extremity was not examined during the medical clearance, f ordered a referral, imaging was completed, and antibiotic treatment was started for his infection.

Unfortunately, this is not an incidental or isolated case; situations similar to this one have become more frequent than we would like for those with mental illness.

Often, psychiatric patients are overlooked and undertreated. We frequently are the only physicians who evaluate the patient and help improve their quality of life. After reviewing the literature, I found countless studies concluding that patients who have a psychiatric diagnosis often have increased medical comorbidity and even increased mortality. …

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