A Little Spark of Madness.

Hello Women in Medicine,

I’ve just completed my Psych/Behavioral Medicine rotation and have many thoughts to share. Warning: it’s a doozy.

First: I loved psych.

  • This was not a complete surprise to me, but I didn’t think I would seriously consider going into this; I’m not Frasier.
  • I really enjoyed interacting with the patients. After just a few short conversations with this patient population, I was quickly endeared to many of them. Their honesty and realness and the challenges they face truly set them apart from the general patient population. Plus, I’ve always had a soft spot for quirkiness.

Second: I was able to see mental health care in a variety of settings

  • Outpatient visits at long-term housing locations and outpatient clinic:
    • Patients in a long-term facility were especially prone to being taken advantage of by the staff, their families, or sales persons. Many of the patients had difficulty forming safe networks and were often subject to being indebted to the likes of their family members, the facility for snacks, or Avon sales ladies. To be clear, these patients don’t have a lot of money, they are either on Medicaid or Medicare and have never held full-time jobs or lived independently in a safe space. It’s really sad.
  • Court hearings at Western State hospital:
    • Patients would be brought before a judge to assess whether they need to stay longer in an Inpatient setting (Western State) or can return home under a court order (Less-Restrictive Alternative – aka LRA). Patients on LRAs are required to take their meds and see their docs/ARNPs on a regular basis and this is often a really helpful option for many of them… until they are off their LRA, which often has devastating consequences.
  • Crisis Intervention team.
    • Waited for phone calls from patients that were immediately suicidal or struggling with their mental illness. The first patient we saw was suicidal but without a clear plan and it was essential for her that we established care for her with a Counselor. However, in order to meet with a Psych doc or ARNP she was required to see the Counselor at least 3x. If she was acutely psychotic or suicidal w/ a plan, she would go to the closest inpatient unit.
  • Mobile Health Unit:
    • See regularly scheduled appointments for patients with mental health illness that need care by a PCP.
    • Many of the anti-psychotics, anti-depressants, and mood stabilizers have serious side effects to the body and it’s important for a PCP to address these as managing their side effects can be much less complicated than changing the dose on their anti-psychotic.
  • Outpatient care for Cambodian and Vietnamese refugees:
    • Many of these patients had PTSD and major depression from being in refugee camps or seeing many of their loved ones die needlessly under ruthless government regimes.

Third: This is a topic close to my heart.

  • I think my mom has been grooming me to go into Psych since I was 8 years old. She is a Psych ARNP and has helped me to understand how psychosis shapes a persons life and what the expectation for their rehabilitation can look like.
  • Mental illness has touched both of my younger siblings, my former foster siblings, and recently one of my good friends. I spent the last half of my rotation trying to help this close childhood friend through a very rough spot in his life. Battling major depression and unaddressed bipolar disorder, he has been living out of his car and in despair for the past few weeks. There’s not much I was and continue to be able to do for him besides offer support, resources, and encouragement. It is devastating to watch someone you’ve known for your entire life succumb to their mental illness and refuse to accept mental health assistance. I drove home crying way too many nights.

Lastly: working closely with my favorite preceptor yet: my mom. I know we don’t look alike.  She has always told me, “If I didn’t laugh, I’d be crying.” This mantra, though not always funny, is very true and indicative of the constant challenges faced by many of those in the mental health profession. behav me and mom

Challenges in Behavioral Medicine:

  • Limited Resources.
    • Funding in behavioral health is consistently being cut, leaving practitioners and patients without resources or motivation to seek help.
  • Convoluted system and patient management.
    • There are a lot of players involved in the management of a single patient and depending on the patient, can get really involved.
  • Many patients in this population do not get better.
    • It is a sad reality and is one of the reasons that psych can be so challenging.
    • My mom has had a lot of the same patients for 25+ years and they will continue to need her support and social services for the duration of their life.
    • Continuity of care is essential to the long-term maintenance and well-being of these patients and understanding this can help make sense of your role in their lives.

COMAT Tips: 

I found that doing COMBANK COMAT questions + UWorld Questions was pretty adequate. The test itself felt much more relevant and specific to psych than the Family med COMAT.


  • Case Files: Behavioral medicine
  • UWorld Q bank
  • Onlinemeded.com: sign up for free videos and lectures, very helpful.
  • Clerkship Review compliments of the University of Texas Health Science Center.

Glimpse through how psychosis can impact someone’s life: Mad Medicine. Enjoy! 🙂


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