Saturday, 6 August 2011

Motivational Speech

I used to be a child psych intern. I switched to medicine, because, well, psychiatry is not the right career for me. That doesn't mean I wasted my time with psych. I've learned skills which I use on a day to day basis still; sometimes managing things my consultants don't (or I like to think so).

Example number one: a more-or-less elderly lady is a notorious care-avoider; leading to her losing her mobility and her vision in one eye. She probably has OCD and some cluster C personality traits, maybe even obsessive compulsive or avoidant personality disorder, says my own quick psych screening. Now she's here with a diagnosis of double cancer, and she's tending to start avoiding it again. The oncologist worries about it, and after the bad-news convo orders me to go over it again with the patient and the family. I managed to get her to acknowledge her cancer and the prognosis, and a few days later she was able to tell me she wanted to fight for what she had left of her life.

Example number two: a depressed 80-something year old lady who just returned from ICU where her life had been saved a few times BUT she still has her chronic abdominal pain (possibly psychogenic) and I have to tell her -wearing this:   that we have no answer for that, but the best for her is to enter revalidation and go home in the end. Her son wasn't impressed, they want her to go to an academic centre to find the cause of it all. The reason for my pretty yellow outfit is that she's got three super-opportunistic multi resistent bacteria on her, and if I get those on my ward the ward can be closed down. She started crying, she doesn't see the light, she sees no progress in it all and she's still in pain. So here I was, dressed as a duck, motivating an old lady and her son until they both started listing tiny progresses.

1 comment:

  1. Good for you for taking the time to really talk with your patients and help them find ways to deal with and engage with their hospitalizations. All too often we as doctors think that our job is done when we make the diagnosis and come up with a treatment plan, regardless of how the patient feels about what's going on.