Case of the Crazies

I've started Psychiatry. I was lucky enough to get my first choice placement for the rotation, which was child psych, and the two classmates I'm working with are great. This first week kind of sucks, because we had lecture all day Monday and all afternoon every other day, but from here out I guess we only have lectures on Thursday afternoons for a couple of hours (although this still seems like an inordinate amount of lecture for a rotation that, while important, is just NOT that big of a deal compared to, say, internal medicine or surgery).

The difficulty of starting every new clerkship (it seems, since this is only my second one) is figuring out the routine and getting into a pattern. On OB/Gyn, we switched around a lot between labor and delivery, gyn/onc, private practice, etc., but usually there was a pretty clear routine to start the day--see a patient or two, write a note, wait to present or go to a meeting. Here on child psych, the people have been great--our attending is funny and personable and actually talks to us, the two residents are friendly and helpful--but it's so much more laid-back than OB that we still haven't quite figured out what we're supposed to be doing. Our day starts with rounds at 8, where we sit around a table with the whole team and discuss each kid, what happened overnight, their plan of action. Usually, after such an event I would expect everyone to get up, go see patients, write notes, and generally get to work. Instead, this morning we were basically told we could "go wander around" or follow one of the residents to see patients. I was assigned a patient yesterday, so I was going to go visit her again this morning. But right as we got done with rounds, her mom came in for a visit, so I first sat in on the meeting with the social worker. Then I chatted with everyone while she and her mom had some alone time. Then I went in and asked if I could talk to her for a minute and began asking what I thought were some basic questions about how she was doing, at which point one of the psychology interns interrupted to come play cards and ask her the same questions over again. Then I went back out and chatted with the other students and residents for a bit, and then it was time for lunch--none of us ever wrote a note or anything, and no one really seemed to give us any reason to. I mean, don't get me wrong, I don't mind having very little work to do, but I also hate not knowing if what we're doing is ok, or if everyone will think we're slackers simply because we were never told specifically to do something. Ah well. My kid is cute, and has a lot fewer issues than most of the other patients on the floor, so at least she's fun to see. Maybe tomorrow I'll actually do something productive with my morning.