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Psychiatry at HCMC

So, I've now completed two out of six weeks of my psychiatry rotation at Hennepin County Medical Center. So what's it like? Well....

- The patients are much sicker than those found in the community. In general, the vast majority of psychiatry is handled by primary care doctors, with the more complicated patients seeing psychiatrists. And of those that require a psychiatrist, only a few require hospitalization. And of those that require hospitalization, it's the sickest that tend to end up at HCMC. Most psychiatrists tend to see way more depression than schizophrenia, with full-blown psychosis rare. Not at HCMC.

- Of the patients I've followed so far, the major problems have been pseudo-dementia (dementia secondary to severe depression, in this case secondary to bipolar disorder), poorly controlled paranoid schizophrenia, relatively newly diagnosed paranoid schizophrenia, residual-type schizophrenia and substance abuse (alcohol and crack), schizoaffective disorder, catatonic-type schizophrenia, aggression secondary to Huntington's Disease, dementia secondary to muscular dystrophy, suicide attempt secondary to schizoaffective disorder, suicide attempt secondary to major depressive disorder, and agitation secondary to multiple strokes. Of those patients, about 75% have a history of chemical dependency, and over 90% are in the psych unit on a 72 hour hold, a court hold, or have been committed.

- The doctors who work there are special. They all have a natural affinity for the practice environment of HCMC. Some people speculate that this trait is indicative of psychopathology, but at the least it indicates a desire to work with the sickest of the sick psychiatry patients, a great many of whom are poor, uninsured, and/or homeless.

- In addition to the doctors, I also work with nurses, nurse practitioners, occupational therapists, mental health workers, social workers, and psychologists on a regular basis. Throw in the occasional consult from another service (medicine, endocrinology, cardiology, neurology), the lawyers involved in the court hearings, and mental health and chemical dependency workers from the community, and it's a full house!