Spring 2020 | Issue 43

Training in the time of COVID-19: an intern’s perspective

By: Laura Rosas, MD

What an interesting first year of being a doctor. If internship wasn't hard enough, we're struggling through unprecedented times. I didn't expect to get a crash course on telepsychiatry, but here it is! Uncooperative patients are still uncooperative. They hang up the phone or throw the iPad across the room. Hypersexual patients are still hypersexual. They make the same inappropriate comments but add kissy faces for the camera. Although unconventional, these interviews unlock new insights into a mental status examination and how we can still evaluate patients in less than ideal conditions. However, I find patients with psychosis, delirium, or catatonia particularly difficult to interview via telecommunication. Patients’ level of disorganization or disorientation make even my in-person interviews difficult. It’s hard to redirect a patient when you can’t pick up on nonverbal cues or the when the internet lags. And although I’ve ditched my stethoscope, patients still benefit from a physical exam to assess for things like rigidity or ambitendency. We do what we can given the circumstances and that fact of life has not changed during this pandemic.

However, it's troubling to hear that in the city where I’m training, 68% of the deaths from COVID-19 involve African Americans who make up only about 30% of Chicago’s population.1 This pandemic is highlighting the disparities and inequities in our healthcare system. I decided to become a psychiatrist because I saw the mental health field particularly affected by our broken healthcare system during medical school. This pandemic reinvigorates my commitment to fight for a system that is accessible and affordable to all people living in this city, state, and country regardless of their race or socioeconomic background.

Anxiety levels are running high not only in our patients, but our community. Personally, I’m learning about being gentle with myself and accepting that sometimes it’s ok to not be at your best. For the physical and psychological benefits, I encourage myself and everyone else to go outside, if possible, briefly each day for fresh air and exercise. I encourage staying connected through whatever means possible. My co-residents and I lean on each other for support, another fact that has not changed with the pandemic. I feel lucky to be training with my co-residents because they are a wonderful, smart, and understanding group of people. This year is an incredible time to start a career in psychiatry and I look forward to the lessons to be learned throughout the rest of my training, career, and life.

Source:
1. C Reyes, et al. (2020, April 7). Chicago’s coronavirus disparity: Black Chicagoans are dying at nearly six times the rate of white residents, data show. Chicago Tribune. Retrieved from http://www.chicagotribune.com