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Week in the Life - PGY3

by Chris Hellekson

Third year is all about meeting the developmental tasks of providing outpatient psychiatric care in different settings. The frequency of clinics with different work-flows was a daunting transition at first, but once I got the hang of it I really appreciated the variety. There is a lot more flexibility and autonomy in terms of how you manage your patient interactions and structure your workflow. I love the continuity and relationships I am building with my panel. It really makes the week fly by and it’s never boring! Days this year always started around 8:00-8:30am and usually finish around 4:30-5:30pm.

About me: I grew up in Billings, Montana, and am passionate about pursuing a career in psychiatry in a rural or small urban (population <30,000) setting. I’m still figuring out exactly what I want that career to look like, but I do have a passion for medication-assisted treatment (MAT) for addiction, serious mental ilness, and rural health disparities. I hope to return to Montana after my training. Spokane’s location provides the opportunity to care for socioeconomically diverse populations and implement creative solutions for access to care for both underserved urban and rural populations.

I currently live and own a house in the small town of Medical Lake, which is 15 miles west of downtown Spokane. My commute is only about 15 minutes to the hospital and clinics (Spokane Teaching Health Clinic and Frontier Behavioral Health) we rotate at. I am less than a mile away from the site of our state hospital rotations. I love getting home and hearing the peace and quiet of a small town even though my commute is so short. I spend about an hour nearly every day working in my garden or on my big back yard that overlooks the lake. I love walking the trail by the lake with my wife and our two dogs. If I get off early, I take the opportunity to walk out my back door 50 yards to fish, paddle, or swim in the summer. Spokane is an outdoor paradise. Sometimes I’ll float the river from downtown with co-residents after work. In the winter if you get off early you can book it up to Mt. Spokane for night skiing after work. You can do a lot with a resident salary in a place as affordable as Spokane!


Monday mornings I do telepsychiatry with patients in Colville, WA, based out of the rural critical access hospital and clinic up there. Patients tend to be high acuity in terms of mental health as well as medical complexity and substance use issues. They have very few local options in terms of psychiatric care due to their remote location so it is gratifying to fill that void.

In the afternoon I have psychotherapy at the Gonzaga University student clinic. We do supportive therapy and CBT with the students there. They tend to be high-functioning, problem-oriented, and respond briskly to the therapy which can be a gratifying break from the predominance of higher acuity patients in other clinics. Right now visits are all virtual but it was fun to be on campus during simpler times.

Evening: I hit up my garden for harvest and afterwards visit my garage gym to get a quick lift in then walk the dogs by the lake at sunset with my wife.


Direct outpatient clinic at STHC all day, seeing a variety of complaints. I am in the process of feeling out which patient I want to take on for psychodynamic psychotherapy this year. Lots of bread and butter cases and also more rare pathology mixed in.

Over lunch I have a 30-minute meeting about my QI project on provider education for inpatient treatment of opioid use disorder implementing a clinical pathway throughout the Providence Eastern Washington system.

Evening: Hit the garden, then walk around the lake with the dogs carrying a heavy loaded backpack. Gotta get in shape for elk hunting season in Montana!


This is a full day at Frontier Behavioral Health, the local public mental health safety net organization, working with children and adolescents. Two recent fellowship graduates just started and are eager to teach. It is very useful to see the phenomenology of pathology as it evolves since a predominance of our adult patients have suffered adverse childhood events that have contributed to the development of mental illness or substance abuse. By the end of the year I will have a strong foundation if I end up in a rural community where I may treat a significant population of older adolescents.

Evening: Garden, lift, and actually have time to take my one-man pontoon boat out on the lake behind my house to chase rainbow trout. Nothing biting tonight, but the sunset was beautiful.


Thursday mornings I do collaborative care, providing indirect consultation to patients who follow with an LICSW care coordinator. We make recommendations to the PCP who can choose to implement them, or escalate patients to direct psychiatric care as needed. The goal is to provide support to the PCPs for management of mental health issues within their scope of practice, and also to liaise with the PCPs to increase their knowledge and comfort level treating psychiatric complaints.

Thursday afternoon is didactics at the hospital or virtually via Zoom/Teams. I start a weeklong block of outpatient call, and received one call requiring crisis triage management of a suicidal patient that I had to step away and handle.

In the evening I watch some Thursday Night Football, and walk the dogs at sunset.


Morning is more Gonzaga psychotherapy clinic.

Friday afternoons we do addictions clinic and addictions learning collaborative which is my favorite! We have a robust motivational interviewing curriculum, and lots of high acuity patients. I love the nonjudgmental approach of MI, meeting people where they are, and nothing is more rewarding than someone returning to a meaningful life with the help of medication-assisted treatment. We have a really dynamic Suboxone program and working with Dr. Burns is so fun!

Friday evening I finish off any notes I need to for the week and get ready for the weekend.

I have the outpatient call phone so I need to be within cell service areas and have access to the EMR via my smartphone. I take my motorboat out on another nearby lake on Saturday and fish for tiger muskie. I get one call about a pharmacy error in a patient’s Suboxone that I am able to manage by calling the pharmacy. Sunday is more football and R&R.