Surgery for psychiatrists

[Messerschmitts]

What do you think a psychiatrist should take away from his/her medical school surgery rotation? Just for curiosity's sake.

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[billypilgrim37]

What do you think a psychiatrist should take away from his/her medical school surgery rotation? Just for curiosity's sake.

Learn about acute abdomens so you know when to give Miralax and when to call for a surgery consult.

Learn about vascular surgery for the cranial vessels. They're relevant to neurology, and thus relevant to psych.

Learn about narcissistic personality disorder. You'll see plenty of it.

 

[Doctor Bagel]

Learn about narcissistic personality disorder. You'll see plenty of it.

I've just received my intro email for my surgery clerkship, and yeah, wow.

One of the psych residents I worked with told me that she read about the different psychiatric complications of surgeries (amputations, heart surgeries, etc.). She had to kind of go out of her way to learn this stuff, but it might make the rotation more bearable.

 

[kugel]

Learn about acute abdomens so you know when to give Miralax and when to call for a surgery consult..

I found it useful on surg rotation to ask about times other services (incl psych) did NOT call for a surg consult soon enough.

In residency, it was near impossible to get a surg consult to the psych hospital without Int Med requesting it, except for the man who had swallowed objects every month or two. Simple CXR usu got their attention, "How many toothbrushes did he swallow?!"

 

[nancysinatra]

Learn about acute abdomens so you know when to give Miralax and when to call for a surgery consult.

And which would be which?

bearable.

This is no way to speak of your surgery clerkship! Just today I got to go back to the SICU, one of my favorite places in the hospital. I learned about a rare operation for extra large duodenal ulcers, where they borrow a technique (or at least a word, from what I could gather) from gastric bypass! A new, EXTRA expensive kind of VAC material! Four different trauma cases, including a lady with LOC after her ex-boyfriend pushed her out of bed. (The team stood and pondered exactly when he must have become her ex.) All this in about 30 minutes of rounding. See, surgery is your friend.

I once tried to look up literature on the psychological aspects of having necrotizing fasciitis (it's often left to close by secondary intention and I thought people must have some reaction to seeing their own insides like that), but I could find almost nothing. I would love to study this sometime!

 

[whopper]

Learn about narcissistic personality disorder. You'll see plenty of it.

What can you get...
Seeing the effects of opioid medications on the lungs.

Understanding why surgeons sometimes need psychiatry consults on their patients.

Knowing that Xanax has some surgical uses, and that if the surgeon prescribes it, it may be for a surgical & not psychiatric use (or so I've been told from my surgery colleagues. They claim it relaxes muscles faster. I've never yet checked this data in journals).

Dealing with patients who are closer to death, and helping them with their mortality & feeling of loss of control over their own lives.

Knowing when a post surgical patient is stable, because sometimes surgeons will try to have them transferred to psychiatry while they're still internally bleeding.

 

[OldPsychDoc]

Learn follow-up for wounds and trauma, because the jumpers, cutters, stabbers, and shooters will be shipped to our inpatient service as soon as they're hemodynamically stable.
(I think my med students have removed more staples from my patients than on all of their OB/GYN and Gen surg rotations combined!)

 

[BobA]

Learn the basic surgery stuff. It will be on the shelf. It will be on Step 2. It will be on Step 3.

Also, you are likely going to be an intern in the ED, general medicine, and possibly ICU's depending on your residency. Know what a doctor is supposed to know so that you make us all look good as an intern. (At least that's my plan!).

 

[Messerschmitts]

Learn about narcissistic personality disorder. You'll see plenty of it.

Ha ha, nice! Actually most of the attendings I've worked with have been super nice, very supportive and respectful of psychiatry. It's residents who have been telling me psychiatry is "kinda bogus".

 

[HCE]

(I think my med students have removed more staples from my patients than on all of their OB/GYN and Gen surg rotations combined!)

I'm not a doctor....would this be accomplished with a staple remover?

 

[VMSmith]

Ha ha, nice! Actually most of the attendings I've worked with have been super nice, very supportive and respectful of psychiatry. It's residents who have been telling me psychiatry is "kinda bogus".

I've been surprised by how many surgery attendings and residents have told me that they were considering going into psychiatry. And vice versa, actually.

 

[notdeadyet]

I've been surprised by how many surgery attendings and residents have told me that they were considering going into psychiatry. And vice versa, actually.

That's interesting. I would think it would be hard to find two more different specialties at first glance (patient relationship, procedures, hours, etc.).

 

[cleareyedguy]

One option is to assume that you'll need no surgery in psychiatry, but why should you bore yourself and get a mediocre grade?

I'd suggest not anticipating the need to learn specific skillsets or knowledge clusters that might help with your psych residency but instead practice being a great student/doctor. Ie, be attentive and enthusiastic, appreciate what they have to offer, learn what they teach, notice things you'd do differently and give an effort to understand why they're doing it the other way, and study the assignments as if you will be graded on the stuff--which you will. My point is that to be a good psychiatrist, you should practice being professional on every rotation and not just the ones that seem to most naturally fit the career path that you think you're beginning.

 

[OldPsychDoc]

I'm not a doctor....would this be accomplished with a staple remover?

Here's some examples for you.

 

[asmallchild]

Here's some examples for you.

This is much fancier though

 

[strangeglove]

Delirium. Alcohol withdrawal. Pain. Traumatic brain injury.

 

[marie337]

I've been surprised by how many surgery attendings and residents have told me that they were considering going into psychiatry. And vice versa, actually.

Me too. I've actually had a better response from surgeons and surgical residents than I expected. I just finished an ortho rotation (only because I needed two more weeks of surgery to graduate ) and when they found out I was going into psych they asked me to look some stuff up for them regarding post-op depression. They seemed genuinely interested. In return, they very kindly only made me go into the OR once the whole two weeks.

 

[Stillfocused]

Do a good job, learn as much as you can and have fun. A solid background in surgery is essential for being a good doctor.

 

[Thorazine]

just take advantage of the fact that this will be the only time you will get to see the insides of a human being, on purpose. its pretty cool.

 

[nancysinatra]

just take advantage of the fact that this will be the only time you will get to see the insides of a human being, on purpose. its pretty cool.

unless you get necrotizing fasciitis.

 

[Thorazine]

unless you get necrotizing fasciitis.

you can get that just by looking at someones insides???? im glad im not a surgeon

 

[Faebinder]

1) Getting a surgeon to come to the unit to put suture on a patient who cut himself on the unit (accidently or not) is near impossible. As a resident you are expected to deal with this... you better know how to suture.

(This happened to me twice this year... at one point they called the vice president of the hospital... who ended up calling the surgeon on call to go see the patient.... the laceration was on the face! This one hospital we cover has no surgery residents.)

2) Delirium post surgery... learn to recognize it and treat it.

3) Acute Abdomen.... Psychiatric patients (on psych meds) with constipation are at risk of dying from aspiration pneumonia due to their SBO. Learn to recognize the problem. This actually happens.

4) Bariatric Surgery... know it's details and follow-up.. many of those patients have psychiatric problems. You may even be asked to preop screen for them in the future.

 

[peppy]

I found that surgeons weren't always the most patient people when it came to teaching about suturing. If you don't get the chance to get enough suturing practice on surgery (especially on jagged wounds instead of neat little laparoscopic punctures), an emergency medicine elective may offer a better chance to learn about sewing up the sort of injuries you'd see from suicide attempts.

 

[nancysinatra]

you can get that just by looking at someones insides???? im glad im not a surgeon

no I meant if you got it you'd have to look at your own insides assuming you get a big debridement out of the deal. so your surgery rotation wouldn't be your last chance to look.

 

[whopper]

My point is that to be a good psychiatrist, you should practice being professional on every rotation and not just the ones that seem to most naturally fit the career path that you think you're beginning.

Very good advice.

All fields of medicine to converge & interact on some level. Yes, I do think that surgery & psychiatry don't do it as much as others (e.g. surgery & IM), but it still happens.

Several of us had brought up some very good examples that weren't coming to my mind--the post surgical delirium for example, I do now remember plenty of consults with that.

And now I remember a case where someone on our unit had acute appendicitis, and none of the psychiatry attendings were able to catch it, but a resident who was fresh out of medicine was able to catch it.

and I haven't had this yet, but I've heard of cases of such---a patient where nothing seemingly seems to sedate them, and they have to be "mechanically" sedated by an anesthesiologist. I'm actually wondering if someone here has seen a case where this had to happen.

 

[OldPsychDoc]

Very good advice.

...and I haven't had this yet, but I've heard of cases of such---a patient where nothing seemingly seems to sedate them, and they have to be "mechanically" sedated by an anesthesiologist. I'm actually wondering if someone here has seen a case where this had to happen.

We had one of these on one of our units last month--agitated catatonia.
Had to be intubated and was on propofol in ICU, getting emergent ECT.

 

[strangeglove]

We had one of these on one of our units last month--agitated catatonia.
Had to be intubated and was on propofol in ICU, getting emergent ECT.

I had a similar case of a woman who started off looking like she had really bad benzo withdrawal, was transferred to the ICU, where she ended up getting sedated and intubated with a prolonged course, and where it was later discovered that she had some sort of strange encephalitis. Even the medicine docs were perplexed by what was going on.

 

[Messerschmitts]

I found that surgeons weren't always the most patient people when it came to teaching about suturing. If you don't get the chance to get enough suturing practice on surgery (especially on jagged wounds instead of neat little laparoscopic punctures), an emergency medicine elective may offer a better chance to learn about sewing up the sort of injuries you'd see from suicide attempts.

Oh man I'd be so happy for the opportunity to suture someone on a psych ward. I did indeed do an emergency medicine rotation and got to do a good amount of suturing, and occasionally right now on surgery. I think suturing is one of the hands-on procedures I'm going to miss the most going into psychiatry, so if I ever get to do it again it'll always be a pleasure.

 

[whopper]

A particular forensic psychiatrist in the philadelphia area also was trained as an anesthesiologist. She had a reputation of being able to take down anyone who was agitated--anyone.

I've only had 1 case so far where a patient was given haldol 100mg and it didn't seem to phase her at all. She had a false (+) pregnancy test, but we didn't know it was false at the time. Thankfully we were able to redirect her to her room, and she stayed there, mostly out of fear that if she got out, she'd be put in restraints. Her paranoia added to the fear of being put in restraints.

That was the first case I had as an attending where I kept thinking to myself "what am I going to do here?" and none of the possibilities I could think of I was liking.

 

[michaelrack]

What do you think a psychiatrist should take away from his/her medical school surgery rotation?

You should take away gratitude that you are entering a specialty with a more friendly lifestyle

 

[CarleneM]

A new, EXTRA expensive kind of VAC material!

That sort of thing is exactly what I hated feigning interest in during my surgery clerkship, but hey whatever floats your boat!

But seriously, I was able to rotate through bariatric surgery, transplant and neurosurgery during my surgery clerkship and all those have direct ties to psychiatry. Surgery is not for me but I definitely got a lot out of the time I did have during the clerkship. I don't miss carrying around the bucket of dressing changes, saline, etc on rounds which involved running up and down flights of stairs to keep up with the team and not drop the bucket at 5 AM.

 

[nancysinatra]

That sort of thing is exactly what I hated feigning interest in during my surgery clerkship, but hey whatever floats your boat!

This new stuff was apparently so impressive it would float anyone's boat. But yeah, talking about it would get dull before long though.

I loved trying to perfect certain skills. I got to be an ace at suturing up laparoscopic port holes and then putting the bandages and gauzes over them all in one direction, so it looked like a real pro had done it. I was really territorial about those port holes! I also prided myself on retracting like a machine, toughing it out for hours at a time, sometimes. I know it is measly work but I loved being the bottom person on the totem pole and trying to shine!

I also thought surgical illnesses were very interesting and with every patient there was something to learn. You get patients of all ages with surprising conditions quite often. The two coolest surgeries I ever watched were probably a whipple and a coronary bypass. I ended up thinking some otherwise gross body systems (GI) were way more interesting after seeing them operated on as well. I followed a peds surgeon into the NICU where they were considering operating on a tiny premie (can't remember how big, but close the smallest viable) who had free air due to a poorly formed intestine as well. Kind of like with psych, you get to be involved in situations where you realize most people will never come close to seeing these things. And you're part of a team as well.