Med Student Presents With New-onset Confusion

Anna Burkhead -- Chief Complaint: "confusion"

History of Present Illness: This is a 20-something year old female medical student who presents with new-onset "confusion" over creating her schedule for the final year of medical school. This state of mind has been slow and gradual in its onset for months but has been most evident and distressing since the patient’s required class meeting for planning. The bewilderment is characterized by indecision, staring spells, and detail obsession. Aggravating factors include conversations on the topic of 4th-year planning with peers and the rapidly approaching schedule due date. Alleviating factors include sleep and red wine. There are no associated physical complaints other than those already mentioned.

Review of Systems: As in HPI.

Past Medical History: No significant medical problems. No medications. No allergies.

Social History: The patient is a third-year medical student currently in her 3rd year surgery clerkship. She thinks her main field of interest is dermatology. Non-smoker, no drugs, occasional social alcohol.

Family History: No medical problems run in the family.

Physical Exam:

VS: Afebrile, vitals stable and normal

General: Well-appearing petite female with bitten nails, sitting on examining table and clutching surgery review book.

Neuro: Grossly intact.

Mental Status: Alert and oriented x 4. Calm with periodic psychomotor agitation including toe tapping and hair twirling. Good eye contact. Speech has normal rate, tone, volume. Mood is "sometimes anxious". Affect is congruent. Thought process is linear. Denies AVH, paranoia. Language is fluent, cognition is within normal limits. Recent and remote memory intact.

Assessment and Plan:

This is a young female medical student presenting with stress over 4th year scheduling. Suspect that this is due to the immediate issue of unclear process and intimidating paperwork, as well as the larger issue of major decisions about the future, including applying for residency, that need to be made soon. Will encourage positive actions such as researching electives, discourage obsessive arranging/rearranging of options, and prescribe consulting meeting with career goal advisor, as well as sleep when possible. Return to clinic as needed.