Psych halfway point

This Psych rotation is so different from what I expected. For starters:

-We have clients (not patients) and providers (not practionerers)
-Psych meds are much more complex than we learned and GPs generally don't do well in this area
-Nurse Practioners handle most of the outpatient Psych meds (I don't think it's just WA either)
-Psychologists handle most of the therapy
-It's 1% housewives seeking valium and 99% IVDAs needing antipsychotics (that's only a slight exaggeration)
-No couches

I only spend one day a week with my psychiatrist 'preceptor' but she's awesome. She's a German neurosurgeon turned psychiatrist after marrying a Turkish neurosurgeon and relocating here since neither one could speak the other's native tongue!

Then I typically spend one day a week with NPs on meds management; one with psychologists on therapy; one at a homeless shelter we're contracted to provide for; and one shadowing our liaison to visit clients at inpatient hospitals after they've been picked up for going off Meds or onto street drugs.

Peds is the most interesting and tragic part I've seen. One young man had a high fever requiring resuscitation that led to seizures at 10 and psychosis later. A family understandibly had the mom in counseling after three of her four kids acquired mental health issues and the father is an uninvolved soldier recently returned from Iraq. Being near Ft. Lewis, we get many less extreme cases related to the war in Iraq. Besides PTSD, soldiers' families frequently have major depression, ADHD and other mental health issues.

Next week I hope to get more directly involved. I'm supposed to spend a day working on wound managment for medicaid clients which will mostly consist of I&Ds on drug injection abscesses. Then I'm going to use my laptop to write my own client notes and scripts since everything here is computerized. Monday I should get to see some really interesting clients committed at Western State just a few miles away. That place is fascinating and scary. It's an old Civil War era Army base the size of some towns converted into one of the country's largest mental hospitals. The hospital has 983 beds! It has a jail for the criminally insane. It even has a farm that inmates used to raise crops on. It also includes a lake and park for the public to use.

The fact that the boys and I have to enjoy the sunny weather, greenery and 75 degree temperature doesn't hurt either :-). Becky is back in Phoenix working and understandably jealous.

This is going to be a great year, regardlesss of the Board scores I get this week. I just love learning with realy patients. Textbooks do not teach the craft of healing.