This past month I completed my Psychiatry rotation at the Queens Hospital Center CPEP (Comprehensive Psychiatric Emergency Program). I found this experience to be extremely eye-opening, as it provided great insight into what working in the field of psychiatry entails. My preceptor, Professor Alie, as well as the other PAs I worked alongside in CPEP did an excellent job at teaching me important and valuable lessons throughout the rotation that I will carry with me throughout my upcoming rotations and while working as a PA in the near future. They taught me when to use certain medications, such as Abilify versus Invega, which are the two most common long acting injectable antipsychotics. They taught me how to approach patients who are acutely psychotic, manic, and depressed; which involves a great deal of communication skills and people skills in general. Aside from those points, I especially loved working in the CPEP at QHC, because it was an extremely PA-friendly environment. The PAs in this unit are given a lot of autonomy in treating/managing their patients’ care, and their hard work is valued and appreciated greatly by the supervising physicians. 

I also learned important clinical/technical skills during this rotation. I learned how to write comprehensive psychiatric HPIs, discharge notes, admission notes, and other disposition notes, which are very different from the notes I wrote up during my Internal Medicine rotation. I learned that in psychiatry, especially in the psychiatric ER (at CPEP), it is very important to include as many details in your note as you can. For instance, I learned the small differences between “flat” and “blunted” affect, and the significance of those details. Additionally, although every provider follows a different format in their notetaking, I learned how to properly read the Provider Notes and other aspects of the patients’ charts, and mentally highlight the most important points while doing so when writing up my own note. Furthermore, the PAs and doctors gave the other students and I the responsibility of calling patients’ family members and friends (or whatever other contact information they were able to provide), in order to obtain collateral information about the patients’ history, reason for their hospital visit, and other pertinent information to add to or confirm the stories provided by the patients. In doing so, I learned how to speak to family members, even those that were difficult to understand (due to language barriers) or those that were difficult overall to communicate with (due to being very emotional about the patients’ mental state and its effect on thier family). By the end of the rotation, I was able to call up family members and other sources of information confidently, and ask all my questions efficiently in an organized way. I also gained a lot of respect for the patients’ families and experienced a lot of empathy toward them while speaking with them. Overall, this was a big learning experience for me. 

Finally, my favorite part of the rotation was the day I got to spend with the Mobile Crisis Unit. The Mobile Crisis Unit is a team of social workers working for the hospital whose job is to respond to calls made to hotlines by patients’ family members or others who are concerned for the mental wellbeing of patients. The Mobile Crisis team then visits the patients at their homes to check up on them and to determine the help they might need, with the goal preventing the need for inpatient hospitalizations by preventing situations from escalating. When I joined the MCU, I was with two social workers who responded to three different calls in Queens. The first call was made by the patient’s son who reported that the patient (who has a history of schizophrenia and bipolar disorder) was acting aggressively toward him and not complying with her medications. When we knocked on the door to the patient’s home, she refused to answer the door or speak with us. The MCU then called EMS and NYPD who came and escorted the patient out of her home and brought her to the hospital, because she was not being cooperative and appeared to be a danger to herself and her son/family. I got to see how the social workers, EMS, and police officers play a vital role in psychiatry overall and in helping patients with mental illness. 

Overall, this rotation taught me a lot about psychiatry that I did not know about before. It also taught me valuable clinical lessons that I could apply to all fields of medicine going forward. It also made me realize how important it is to work in an environment where PAs get along well with the supervising physicians and other health care workers. Finally, I gained an extreme appreciation for the work that the CPEP does. Although not all hospitals have a CPEP, those that do are able to prevent unnecessary inpatient hospitalizations by deciding who should be discharged and who should be admitted through extended observation in the CPEP. I definitely enjoyed this rotation and feel I have done a lot of important work there.