Sunday, November 7, 2010

A Return to Physical Medicine

My psychiatry rotation was a month of patient or family interviews that provided very little physical examination. The dialogue was our exam. I may have used my stethoscope one time during the entire month and realized at the end how much I really miss medicine.

Mental vs. Physical Medicine

To me, medicine incorporates both the mental problem solving that finds physiological pathology and having physical contact with a patient. This is commonly done as we build our differential diagnosis while performing a physical exam. I feel like a medicinal detective being able to read the various clues from the body to solve an intricate puzzle. Interpreting how a sound, feeling or observation plays into a patient's health is intriguing as well as rewarding.

This month may be a little different. I have started my obstetrics and gynecology rotation. Assuming the patients are comfortable with my participation, I will certainly learn more this month than if I were to wait outside the exam room. Their permission aside, as a male it is difficult to empathize with them, since they experience symptoms that I will never know. Nonetheless, it is a unique specialty including surgery and clinical medicine. It promises to be a fast paced month with plenty of procedures and opportunities to learn. And I can once again use my stethoscope and all the other tools in my pocket.

Of note, both Life as a Medical Student and The Differential (another blog with my contributions) have been featured in this article, "Top 50 Health and Medical Blogs by Graduate Students." Although I don't think there is any meaning to the numbers assigned, it is nice to find blog included among the bunch.

Question of the Week

A 40 year old Caucasian male with a chronic history of paranoid schizophrenia presents to the mental health clinic. He tells you that his wife stole his bottle of risperidone, which he believes caused him to experience more frequent and intense auditory hallucinations. He says the voices tell him to kill his wife because she cannot be trusted. He admits to having homicidal thoughts about his wife but denies any specific plan for harming her. He requests a refill of his risperidone. What is the most appropriate next step?

A. Admit the patient to the psychiatric ward
B. Call the patient’s wife before filling the risperidone prescription
C. Increase his dose of risperidone
D. Refill his prescription of risperidone and call his wife after he leaves
E. Refill his prescription without calling his wife as he does not have a plan to harm her

Answer & Explanation


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