Psychiatry Rotation Lessons for Life

My rotation with Dr. Rivera has been an incredible journey.  In a few short weeks, I have learned skills to become a better clinician, but more importantly, I have learned to strive to become a better person.  He has opened my eyes to a healthier lifestyle and to a better mental state, not only to feel good, but to avoid preventable diseases and disabilities that our society increasingly suffers from.  Because of his guidance, I have changed the way I eat, and I already feel healthier and have more energy.  He has taught me “not to sweat the small stuff,” which helps reduce anxiety and stress in my life.  I have learned to focus on the present and on the positive, and to care less about what others think of me.  This has truly helped me with managing stress in my life, and has made me realize that a healthier state of mind leads to a healthier physical being.

I have also learned that patience is a great virtue.   When it comes to his interactions with residents, Dr. Rivera always sits down to talk to them, and comes off as more of a friend than a physician.  It’s amazing to see how quickly these residents respond to that, and how, in that one moment, they connect with Dr. Rivera.  Even if their thoughts are scattered and racing, there is a certain moment in time where that all stops and they make a connection.  I feel that this is an inner ability that some of us have and some of us lack, but it teaches us that if we take time and try to connect with a person, they will respond to that.  Although one can’t learn how to make connections with people, one can certainly learn how to take a moment to step into their world and give them the time of day.  This will help me as I start my journey in the healthcare field, where even though work will be busy, I will keep in mind how powerful it is to sit down with the patient and give him or her a moment of my time.

I have learned that touch is more powerful than words or medications.  These residents respond to hugs and hand holding, which is evident from the smiles on their faces.  It taught me that patients are people, and that a simple gesture such as a hand shake or a hug can truly impact a provider-patient relationship.   It doesn’t take much to shake a hand or give a hug, but most of us don’t even think about it.  It’s as if we are opposed to making a physical connection with our patients.  It was eye opening for me to see that Dr. Rivera treats his residents as human beings instead of patients and charts.  He knows their stories and they know his.

Another important lesson I learned is that dosage increase in medications does not always heal the patient.  Dr. Rivera believes that conservative therapy is best in order to avoid side effects and drug interactions, especially in the geriatric patient population.  He believes that starting small and even decreasing dosage is better for the patient, and this is especially true in geriatric patients.  His motto of “start low, go slow, but go” is one of the most important lessons I have learned as a student. Wherever I end up, I know that that mentality will help to prevent me from making mistakes when it comes to patient care.

He has taught me that there are alternative treatments to chemicals, such as music, massage, meditation, activities, and calming rooms.  His patients have responded positively to these alternative treatments, and it has inspired me to think creatively and utilize some of these tools when I become a clinician.

I have been beyond blessed to have had the opportunity to do a rotation with Dr. Rivera.  I have learned so many great lessons, and I hope to one day inspire somebody like he has inspired me.  Every day was a lesson, and there are too many to list.  Being a good person cannot be taught, but there are certain things we all can do to ensure the safety and health of our patients.  I believe that this rotation will make me a better clinician, regardless of which career path I choose.


Senior year Physician Assistant student Nova Southeastern University

By now you have probably heard from the wonderful staff at the facility that our dad, Bobby S., passed away last Sunday.  I just wanted to personally thank you for all the care you gave Dad, especially these past few months when he needed so much compassion.  It meant a lot to us that you took the time to call me, so that we as a family could provide as much support as we could from afar.  Though we visited Dad often, we are sorry that we never had the opportunity to actually meet you in person.  Thank you so very much.  We send special blessings your way.

Thank you so very much for the care you gave my father.  Your expertise in medication usage for mental illness and dementia is amazing.  You gave my father two and a half years that I could not have given him by living with me, of clearer thinking, and finally accepting when it was time to go.

It was wonderful that you used music to help him, and I will always remember the video of him conducting that you showed me.  Thank you for taking the time to come in on the day that dad passed, and helping me deal with his passing.  I was feeling very alone until you came.  Thank you for listening to me.

Recently, my family had the privilege of having Dr. Miguel Rivera, treat our mother for stroke related dementia. Her illness began in June of 2012. She had three hospitalizations at Sarasota Memorial Hospital, the last one in November 2012, requiring ten days in the Physical Rehabilitation Unit. During this time her dementia progressed significantly, and we were now faced also with the agitation of sundowning episodes when she would become more confused, angry, and at times think we were trying to hurt her. I would check on her during the night four and five times because she would get out of bed on her own. She was in the category of high risk for falling. My husband and I were not getting any beneficial sleep. She was impossible to deal with during the day because her mind was not functioning normal. Being a single caregiver I felt frustrated, hopeless, and helpless and was advised by my doctors that my health was declining, and that I needed to place her in a long term care facility.

In December 2012 we contacted Dr. Miguel Rivera to handle her case. The improvement was immediate, and over the period of six months Dr. Rivera’s treatments have been able to eliminate the sundowning, totally improve her memory, her physical strength and improve her quality of life on a daily basis. I consider this exceptional considering my mother is 94 years old. The difference from the beginning up until now, under Dr. Rivera’s care, is truly amazing. Because of Dr. Rivera we are able to still care for our mother in our loving home environment.

We are so grateful to Dr. Rivera for giving us our mother and grandmother back to us as she is such a beloved member of our family.

I have a patient, early onset ALzheimer’s, escalating pretty fast.  His wife tells me he is more depressed, lethargic, mood swings, restless, wandering at night.  She is only 47 years old w/ a 15 yr. old daughter.  Her husband is only 54!!  I took the liberty of giving her your number in hopes that you can assist her in some way. She is barely hanging on.  She came to the support group at Arden Courts last Wednesday and fell apart every time she opened her mouth.  The rest of the group all yelled out your name to her.   Mike said, if anyone can help your husband it’s Dr. Rivera…..I hear those kinds of remarks all the time.   Thanks for what you do.

I’m the Sarasota County Alzheimer’s Association Program Specialist and thought I’d drop you an email since my favorite Doc, Miguel Rivera, will be in your neck of the woods over the next few days.  I believe you have already had the pleasure of meeting him at the Harvard conference last year.  He is my magic medicine man for all of my difficult patients and has been instrumental in implementing calming rooms in many of my facilities.  He presents at the local and national forums and plans to do the New Orleans conference for the chapter there in the next couple of weeks.  His perspective and philosophy on dementia care, medication management, and caregiver rescue hold any audience spellbound.

It seems there are no words to express the depth of our gratitude for supporting our dad with the gentlest of hands.  You’ve given him back to us in his true essence, one that spreads joy to all.  Hoping to see you soon – with our heartfelt appreciation.

Two years ago I attended a lecture by you at Manor Care in Venice.  While I did not totally adopt a vegan lifestyle, as you recommend, I went part way on that journey, and added turmeric and many of the foods you recommend to my diet.  I have lost twenty pounds. I attend a TOPS group that meets at the Senior Center in Venice, and I give those great ladies full credit too.  I heard you speak again today, and am ready to take the next step, and to lose another 20 pounds.

Thank you for being a holistic practitioner who believes in preventive medicine and gives sound research-based advice.  I wish everyone could hear you speak.  I’m a believer!

I can’t tell you how much I have enjoyed your presentations, and how much I have learned. I have lupus and a multiple of other autoimmune conditions, and my husband has big time heart disease, so over the years we have each made lifestyle changes that have truly made a difference in our health and how we feel. Now we are incorporating many of your ideas into our daily routine. I just put together a “cognicity” notebook of your handouts, and my notes. You truly are a gem, and I hope you write that book so both the medical and lay community can benefit from your ideas and expertise. We all need to rethink and take responsibility for our own medical well-being.

Thanks so much.

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