Michigan, Ascension Providence Hospital 

PSYCH CORE

Medical students

Hello everyone!

My name is Lana Hariri and I am a current 3rd year medical student at AUC. I was so graciously asked by Tayler to talk about my different experiences at Providence Hospital in Michigan. Psych is broken up into “inpatient” and “outpatient” for the 6 weeks (I had 3 and 3), but this is changing! Providence just hired a new Psych Clerkship director, so I think the week distribution is a bit different. I like lists so please excuse my “list-like”' take on this reflection. So, let’s get started!

 

Inpatient:

Where: In-patient psychiatry is done in the hospital. 

Who: Patients in the psych unit are admitted for the following:

  • Depression

  • Suicidal Ideation (SI) or Homicidal Ideation (HI)

  • Bipolar Disorder/Manic Episode

  • Schizophrenia

  • Anxiety

  • Other reasons that are not listed, but a threat to patient/others (delusions, etc.)

What you do: You’re paired with a resident, who is paired with an attending. 

  • Short Daily Interviews with patients. Important “Psych” questions to ask. 

    • How are you feeling today? Are you sad/happy/anxious/depressed/etc?

    • Any thoughts of SI/HI?

    • Eating/drinking/sleeping ok?

    • Do you hear or see anything? (Auditory/Visual Hallucinations)

    • MMSE: Mini Mental Status

      • Ask the patient the 3 A&O Questions - person, place, time. 

      • Sometimes you’ll do parts of the MMSE like the serial 7’s, spell World Backwards, draw a clock, etc. (not everyday, but occasionally). 

  • Encourage patients to attend Group Therapy

    • Group therapy is becoming a more and more popular and effective treatment for Mental Illness. Group therapy is a session led by a therapist and patients are given the opportunity to reflect, engage, and interact on the specific topic for the day. Topics range from positivity, overcoming obstacles, perseverance, etc. 

  • Lead a Group Therapy session

    • As part of the psych program, we are required to lead a group therapy session. Me and my partner, Tarek, did a group therapy session on Meditation. 

  • Weekly Meetings:

    • Once a week, the physician, residents, medical students, and psychiatry team (nurse, social worker, and therapist) meet with each individual patient and talk about…

      • Treatment plan (current medications, change in meds, etc.)

      • Discharge plan (discharge, stay in unit, go to a group home, etc) 

      • Any other pressing concerns with patient (Guardianship, finances, etc.) 


Outpatient: Broken up into Substance Abuse Facilities (2 places) and Out-patient Psychiatry (3 places)

 

Substance Abuse #1: Ascension Brighton Recovery Center

 

Ascension Brighton Recovery is a Rehab center. There are many components to this facility. 

  • Detox: It’s pretty much in the name! The first part of Rehab is the detox. Patients enter the facility and clean their body of whatever substance they are addicted to. Patients pack their bags and “check-in” kind of like a hotel. 

    • Some patients just choose to detox for a few days and go home.

    • This is usually not effective… because they tend to go back to their same environment and use again, and come back to detox… rinse and repeat. 

  • Rehab: This is AFTER a patient has detoxed. This is when patients go to Group Therapy, see a therapist, etc. Some patients attend Day Treatment, from 9am-5pm. Other patients attend the overnight stay treatment. 

 

Outpatient psychiatry: See patients who are following up with their psychiatrist, checking their medications, etc. 

 

Quick Facts about my rotation:

  • Older patients who were in rehab were more likely to be addicted to alcohol, younger patients were more likely to have polysubstance abuse (alcohol, marijuana, cocaine, opiates, etc. )

  • Many, many, many times, patients who were addicted to something had a positive family history of abuse/addiction. 

  • In one of my outpatient experiences, 40% of African American female patients with mental illness were sexually abused.

    • Most sexual abuse is done by a male family member (brother, male cousin, father, step-father, uncle, etc.) 

  • Many patients who had mental illness had some sort of traumatic experience or difficult upbringing: sexual/physical/emotional abuse, broken homes, poverty, etc. 

  • Some patients are “forced” to be brought into rehab by family/friends/significant other. If patients do not have an internal drive to get clean, they’re usually not as motivated to get clean and relapse. 

  • Alcoholic withdrawal is the most dangerous due to risk of seizures. These patients are monitored very closely. 

 

PRO TIP: UWorld, NBME shelves, and First Aid Psych (Not Step 2 CK First Aid, the actual 1st Aid Psych edition) were all helpful for me to do well on the shelf. 

 

Hope you guys found this helpful! Feel free to reach out to me/Tayler for any questions regarding the rotation or anything else!

-  Lana Hariri

Lana Hariri