u/SamHouston1886

I'm really looking forward to starting psych residency in July! I’ve been fortunate to spend the last few weeks with family, friends and catching up on my netflix and reading queue. I've been journaling and wanted to focus on something I struggled with as a med student, what I named myself as "moral dissonance."

I'm not talking about clinical disagreement, but a *values-*based difference in how I think a patient encounter should feel versus how my attending or senior resident prioritizes?

Here's an example: there was a family meeting I sat in as a med student with a Korean-American patient. The family appeared confused and politely tried to ask questions – some of which admittedly were more appropriate to discuss with the aftercare provider. It was clear that the family was scared and not prepared with a mental health diagnosis in their son (what family isn’t?).

While my attending was polite, he was curt and obviously trying to speed up the meeting. It lacked a sense of empathy that a family of a patient with first episode psychosis deserves more time to process with the psychiatrist who first diagnosed it.

Afterwards, while the team went to lunch break,, I followed the social worker as we escorted the family out of the unit. The social worker appreciated the extra time I spent reviewing the discharge paperwork in terms of what a diagnosis of schizophrenia entails and the types of questions to write down for the IOP psychiatrist. I gave the amount of attention which I realize only a med student realistically had time to dedicate to their patient.

Later in the afternoon before I left, the attending chewed me out for talking with the family without him. He suggested that I undermined his authority and that as a med student I should not be doing anything without supervision. He explained that I can't give more time to one patient over another unless, for lack of a better term, a clear clinical indication. I accepted the feedback and knew better to argue and try to justify my perspective or explain that I did in fact re-direct the family that their questions were better asked with the outpatient team.

This episode left a lot of dissonance in terms of there’s a way I would prefer to handle a patient encounter vs my attending. While there is no compromise in care, I felt dissonance in how I believed we should've addressed the human aspect.

Efficiency is important, but when should I speak up with my attending/senior and advocate that I feel we should spend more time with a patient doing psychoed, or perhaps use a different motivational interviewing approach?

As a medical student I learned that accepting and applying feedback is the most important thing as a trainee. Since the aforementioned issue with that attending, I am very self-reflective of how my actions and questions may reflect on the educator-learner relationship and workplace politics.

The only reason I’m harping on this is that I anticipate this will be a source of moral burnout. As a med student I learned to “know my place,” but hell I am a doctor (in-training) and feel like developing my style, as long as it doesn't conflict with the standard of care, should be an essential part of my residency training.

August 11 Primary Reminders

Is there a trend of SW moving changing their preferred position title to “Clincian”

Moral dissonance — how do I address this in residency training to avoid burnout?