For my first evaluation, I was pleased to meet Dr. Martin on Skype. It was the shortest evaluation, I ever had, eighteen minutes. I had a six long page comprehensive history and physical with differential diagnosis, assessment and plan. Dr Martin was focus on the mental status, a section that unfortunately I did not pay much attention because in psych ER we tried to complete the mental status in one word for each element. However Dr Martin wanted me to expand the mental status in order to have a comprehensive understanding of the patient’s behavior and mental insight. Dr Martin also discussed the social issue about the patient, who was a young female with history of schizoaffective disorder but after an episode of aggressive behavior, her father did not want her back home, and eventually patient was sent to a shelter. It was discussed the negative consequences of sending a young patient to a shelter, what more could we do for this patient. For my future presentations, I would expand the mental status and understand the many resources that can help patients with psychiatric history to have better transition to society.

The final site evaluation longer because they were three comprehensive H&Ps. I made sure to broaden my mental status exam and have suitable discharge plans for according to each patient’s needs. I presented a male patient with sudden psychosis and homicidal ideation. Dr Martin taught me about Tarasoff, a case from the 70s, where most states have the law for mental health professionals to inform the possible victim about the patient’s homicidal intentions. At first I argued that because the possible victim was in another country and should  assume the family and detectives would warn her, I should not be alarmed. However, Dr Martin brought up a great point, what if everybody assume the other had done the job of informing the third party.

This site rotation had help me understand that mental illness is a complex multidimensional array that requires multiple approaches in order to cover the needs and wellness of patients and those around them.

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