PGY-3 Zach Schwartz

I’m in neurology movement disorder clinic, one of our outpatient electives, on Monday morning the first 6 months of PGY-3. This morning the first patient isn’t scheduled until 9:15am, so I have time to wake up relatively late and get breakfast with my wife. When I get to clinic, I quickly chart review, go see the first patient, and then present and discuss with the neurology attending. One of the patients I see this morning has some subtle signs of Parkinsonism, so after we are finished seeing patients we discuss Parkinson’s mimics, DaTscans, and other topics relevant to psychiatry. Most of the cases I’ve seen in neuro clinic are very relevant to psychiatry, and I’m starting to wish I’d signed up for another 6 months of the elective. I head home for lunch and then drive across town (~10 minutes) to my afternoon neurobehavioral clinic. Here, I’m working alongside one of the child and adolescent attendings seeing patients of all ages with autism and other neurodevelopmental disorders. Many of these cases are quite challenging, and I’m glad for the direct supervision. I get home around 5pm and eat a quick dinner, before heading out for an evening of mountain biking in the SLC foothills with one of my co-residents.

Today is resident continuity clinic, i.e. general outpatient adult psychiatry. This is my favorite clinic of the week. We have a great deal of autonomy here, and it’s nice—after doing mostly inpatient work the last two years—to see people out in the community. I only have six patients on my schedule today, most of whom are transfers of care from graduating PGY-4 residents. These transfer of care visits are scheduled for an hour, which gives me more than enough time to get to know each patient a bit, review their psychiatric history, and stay on top of documentation. Today I see people with MDD, OCD, bipolar disorder, and ADHD. Some of these patients are quite stable and others…less so. My last appointment of the day is at 4:30pm with one of my long-term psychotherapy clients. I head home around 5:45 pm to get ready for my first rehearsal this season with the Utah Medical Orchestra. This is a group that was founded a year ago by some of the UofU medical students, and it’s really taken off, with members from across the UofU medical system. Music was a big part of my life before medicine, and it's been really nice to play in an orchestra again, especially one that’s very flexible about the occasional missed rehearsal.

Wednesday is all day didactics. Today’s lectures are on malingering, a journal club discussion of an article on microdosing psilocybin, our bimonthly resident meeting, and an afternoon of lectures for PGY3s on child psychiatry specific topics. It’s hard to express what a privilege it is to have an entire day in the middle of the week devoted to didactics, with no competing clinical responsibilities. After our last lecture of the day, I take a short mental break before logging in to the monthly zoom meeting of the UofU Bioethics Journal Club. This group is mostly students and faculty from the University of Utah philosophy department but is co-led by one of the psychiatry attendings, Dr. Kious. After a full day 0f learning/thinking/philosophizing, my brain feels pretty fried and I decide to head up Big Cottonwood Canyon with two of my co-residents, Hunter and Zane, to go climbing. I get back to town late and crash into bed, trying to get a good night sleep before what is usually my busiest day.

Thursday morning is geriatric psychiatry clinic. This is probably my most difficult clinic of the week, simply due to the severity and complexity of the cases. Fortunately, these are longer appointments, and there is generally enough time to make sure I’m doing my due diligence. Today I see a patients for severe refractory anxiety in the setting of Parkinson’s Disease, treatment-resistant depression, benzodiazepine dependence, and agitated dementia. After finishing my notes and spending some time coordinating care with other providers, I get in my car and drive up to my Mental Health Integration (MHI) clinic, stopping to get some lunch on the way. MHI is essentially an outpatient consult/referral service where we assist primary care physicians with more complex or time-intensive psychiatric cases. Fortunately, there are only three patients this afternoon and they are relatively straightforward—two new visits ruling out bipolar disorder and a follow-up visit to manage SSRI-associated sexual dysfunction. I finish up a little early, around 4pm, and head up to HMHI main campus for my weekly appointment with another long-term psychotherapy client. I get done around 6pm tonight and head back home for an easygoing night with my wife, walking around our neighborhood and getting dinner at a nearby pizza place.

Friday is my psychotherapy and research elective day. PGY-3s have (at least) a half day of protected therapy time scheduled during the week; but since clients also have their own busy lives, this often means arranging therapy sessions outside of the designated half day slot. As a result, my time on Fridays is mostly my own. I begin the day meeting with my psychotherapy supervisor to discuss my sessions with clients earlier in the week and some relevant CBT theory. Then, spend most of the rest of the day working on a paper that seems to be going nowhere fast, with a welcome break to take my bike into the shop. That evening my wife and I head to a barbecue at Westminster College, where she works, before coming back home to binge some Tokyo Vice.