Dr. Nurse at Work

After months of board exam preparation, applications, interviewing, and soul-searching, I recently accepted a position as a hospital mental health consultant, or as I like to call it, Mighty Mouse. I start Monday.  I am excited to get to practice and am ready to meet the challenge of what I see as an enormous responsibility to ensure patients are followed by the correct services to meet their immediate needs.  When working as an RN in Emergency Psychiatric Services, I saw first hand how having "bipolar" or "schizophrenia" on one's chart would often result in being immediately shipped from ER to EPS, even if chest pain or severe headache was the primary complaint.  This stigmatization (or perhaps clinical laziness) can lead to disastrous outcomes for patients with mental illness who are actually having an emergent physical issue.  Psychosis, delusions, and mania are not exclusive to a DSM diagnosis and are often a secondary symptom to a primary medical problem.

In preparation for my new position, I have been reviewing many of my favorite references from school - Stahl, Carlat, Caplan. Most recently, I picked up the Massachusetts General Hospital Handbook of General Hospital Psychiatry. Since the bulk of my work will involve consultation in an emergent and acute-care setting, it is important to bone-up on all things psycho-somatic.  The book reviews essential skills  with a breakdown of assessment, diagnosis, and treatment by symptom and medical disease process. I particularly appreciate that while this is a physician-focused text, much of it is devoted to holistic assessment and communication, mindfulness, and follow-up beyond the initial evaluation and disposition. It also addresses ethics, legal considerations and collaboration issues, such as disagreement over diagnosis and interventions.  As with most Elsevier publications, you can activate the expert consult online, which includes a searchable text feature.  All that is missing is an integrated app!