Blue_Arrakis

А вот кусок из "Projections" про то, как в неотложке проводится опрос поступившего пациента и как это выглядит в случае психиатрических проблем

“Psychiatrists begin as doctors of the whole body, in emergency rooms and on general medicine units, diagnosing diseases of all the organ systems, treating illnesses from pancreatitis to heart attacks to cancer, before specializing in the brain. In this yearlong all-purpose phase of internship after conferral of the MD degree, medical rituals are consolidated—including the rhythms of how to pass along all the information about a patient, in exactly the order expected by the attending physician (the senior doctor to whom the case is presented). This canonical sequence begins with the trinity of age, sex, and of course chief complaint, or chief concern—the reason given by the patient, in the patient’s own words, for showing up in the emergency room that day. The formulation of seventy-eight-year-old woman, chief complaint of worsening cough for two weeks, is stated before anything else, before medical history, physical examination, or lab tests. This ritual makes sense in medicine, establishing focus on the active issue in a way that is helpful—especially for patients with many chronic conditions that would together otherwise be a distraction.

But medical custom is not always translated easily to the reality of psychiatry, especially in the next year of specialty training following medical internship. It takes a little time for the newly fledged residents, now in a phase of resetting and relearning, to transpose this medical rhythm into the new space, since the first thing the psychiatric patient says, when asked, can be awkward to restate as the first line of a medical note: twenty-two-year-old man, chief complaint: “I can feel your energies in me”; sixty-two-year-old woman, chief complaint: “I need Xanax to cry in therapy”; forty-four-year-old man, chief complaint: “These fucks trying to control me. You can’t follow me in death now, can you. Fuck you.” We write it down anyway.
I had elicited Henry’s chief complaint with my stock opener, asking what had brought him here to the emergency room—and conscientiously recorded his response, the first line of my note:
Nineteen-year-old man brought in by police, chief complaint: “My father said, ‘If you kill yourself, don’t do it here at home. Your mother would blame me.’ ”

www.tg-me.com/br/Blue_Arrakis/com.blue_arrakis/333

2.9K viewsMarch Slashcheva, Sep 9, 2021 at 11:44

А вот кусок из "Projections" про то, как в неотложке проводится опрос поступившего пациента и как это выглядит в случае психиатрических проблем

“Psychiatrists begin as doctors of the whole body, in emergency rooms and on general medicine units, diagnosing diseases of all the organ systems, treating illnesses from pancreatitis to heart attacks to cancer, before specializing in the brain. In this yearlong all-purpose phase of internship after conferral of the MD degree, medical rituals are consolidated—including the rhythms of how to pass along all the information about a patient, in exactly the order expected by the attending physician (the senior doctor to whom the case is presented). This canonical sequence begins with the trinity of age, sex, and of course chief complaint, or chief concern—the reason given by the patient, in the patient’s own words, for showing up in the emergency room that day. The formulation of seventy-eight-year-old woman, chief complaint of worsening cough for two weeks, is stated before anything else, before medical history, physical examination, or lab tests. This ritual makes sense in medicine, establishing focus on the active issue in a way that is helpful—especially for patients with many chronic conditions that would together otherwise be a distraction.

But medical custom is not always translated easily to the reality of psychiatry, especially in the next year of specialty training following medical internship. It takes a little time for the newly fledged residents, now in a phase of resetting and relearning, to transpose this medical rhythm into the new space, since the first thing the psychiatric patient says, when asked, can be awkward to restate as the first line of a medical note: twenty-two-year-old man, chief complaint: “I can feel your energies in me”; sixty-two-year-old woman, chief complaint: “I need Xanax to cry in therapy”; forty-four-year-old man, chief complaint: “These fucks trying to control me. You can’t follow me in death now, can you. Fuck you.” We write it down anyway.
I had elicited Henry’s chief complaint with my stock opener, asking what had brought him here to the emergency room—and conscientiously recorded his response, the first line of my note:
Nineteen-year-old man brought in by police, chief complaint: “My father said, ‘If you kill yourself, don’t do it here at home. Your mother would blame me.’ ”

BY Blue_Arrakis