Thursday, April 5, 2012

Common errors on psychiatry rounds as seen through Sylvia Plath's "The Bell Jar"

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The above excerpt copied into my notebook is from Sylvia Plath's The Bell Jar (1971) with my annotations.

Plath presents her protagonist Esther Greenwood's initial evaluation by the rounding team. She describes the unsettling feeling of suddenly being addressed by a "troop of young boys and girls" with an older gentleman, presumably the attending physician. I've circled Esther's statements to her treatment team in blue

In sum we see the following problems:

1) No introduction to the patient by the treatment team delineating the names or various training levels of the crowd (medical student? intern? resident? attending?).
2) Practitioners forcing a cheerful smile as if patients can't suss out real from fake.
3) The need to appear pensive when evaluating psychiatric patients (the 'Hmm...').
4) The desperation of medical students/residents to appear correct in the eyes of their superiors fostered by the current style of clinical medical education (a trainee going so far as to correct a patient regarding her own sleep habits).
5) Neither the students nor the attending address any of the four issues she raises regarding feeling lousy, being unable to sleep, feeling unable to read, and experiencing a lack of appetite.
5) No discussion of the plan with the patient who is swiftly turfed to another provider.

Overall, I think this passage serves as a simple resource to teach third-year medical students some common errors found on psychiatry rounds as seen through the eyes of a patient.

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