Thursday, 19 September 2013
Somehow, in the Western world, the worst offence to a patient seems to be to ask about their mental well being when they present with physical complaints. We live in a disembodied, beheaded society, I think. Patients are more likely to understand your untranslated explanation of the pathophysiology of shistosomiasis than they are to understand you if you explain to them in plain simple English that their mindset and the amount of stress they're under has a negative impact on their bowel symptoms, but they're not physically ill. Rats experience bowel discomfort when stressed too. The one enjoying his bath doesn't poop in it (unless you manage to put him in there right as he was going to poop anyway). It's not just 'patients'. Just look at the massive gap between mental health and other specialisms. Doctors don't get it either. Funny, because the 1 in 4 prevalence of psychiatric illness affects them too. Sad, because if doctors don't understand it, how will others? And why? Fear? Fear of what? Being human? A result of the Enlightenment? Culture? Belief systems, usually the beliefs of those who insist they don't believe? Science? I've noticed that psychiatric patients are treated differently sometimes. I've noticed that people think I have some kind of superpower, just because I landed myself a psych job. I've also notice that I am somewhat disqualified in the eyes of somatic health care providers because I work in a 'soft' specialism. Sometimes, they even go as far as to assume I know nothing about the Holy Body, forgetting about the M.D. behind my name. A few examples: Dispatch: Ambulance services, how can I help you? Me: Hi, this is dr Blondie, doctor with the acute psych unit. I'd like an ambulance to send in mrs Pams, who turns out to be in the process of an overdose w... Dispatch, irritated: riight... with what? Is she conscious? Me (half interrupting): with diazepam and risperidone in unknown quantities, possibly up to 60 tablets of diazepam and around 20 risperidone between yesterday and just now. She's haemodynamically stable and her consciousness is slowly deteriorating, she's becoming somnolent. I have already informed the emergency department and will be staying here but I have no equipment at hand Dispatch: OK, so that's orange triage then, they're on their way. I'll also note there's a psychiatric nurse present. me: I am a doctor.... (Thinking: what part of the above made you think I'm a psych nurse?) Or,upon noticing that the patient with a psych history acting funny, who has been seen by the GP out of hours service and referred to us due to acting funny with a psych history being the main finding, actually is suffering from advanced liver disease and needs to get to hospital TONIGHT: Dispatch: but does she WANT to go? me: No, but she doesn't really have a say in this right now dispatch: Does she have a mental health act order then? me: No, she doesn't need one...she is unable to make any decision dispatch: But I need a mental health act order to transport her me: No, you don't. I am sending in a physically ill patient to the Emergency department, this has nothing to do with mental health. dispatch: I'm not sure I'm allowed to transport her, I'm going to discuss this with my manager Apparently all symptoms in psychiatric patients are due to their psychiatric illness? Apparently working for the acute psych unit renders me incapable? Our team has had multiple clashes with two different GP's over this patient, and I had the long version of the above discussion with the dispatch for a patient who went on to spend weeks in the hospital with an hepatic encephalitis. This is not intended to bash other health care professionals; but had this woman not been in the same house with an alcoholic and had she not had any psych history, she would have been in hospital days earlier. People get thrown off by 'psych'. Luckily the Emergency department had no issues with me. This is sometimes different. The following situation is more likely to happen if you're dealing with a junior doctor. Them: ... and they're medically ready for discharge.. me: What were your findings? Did you check this-or-this? Nothing special, and no, I needn't check this-or-this. me: May I see your discharge letter please? We need that info. them: -giving me that you-won't-understand-it-anyway look- I already told you, but here me: -glancing over labs and results- Look, I still need to know this-and-this This-and-this usually refers to something related to neurology, specific lab results such as CK or delirium related information. The worst was when I had to have my supervisor intervene in order to get a neuro consult for an elderly gent with a recent head trauma. I don't think it's about hating psychiatry. I think it's about fear. It's also very much about the mainstream Western belief system. Secular individualists who have faith in science and rationality, believing that they are -or should be- in control of their own lives. Physical illness is easier to deal with, because it's something that 'happens' to you. This type of control is seen as 'strong'. 'Strong' is the surgeon, not the psychiatrist. Health and happiness above all, and success is important. Strong people have their shit together, mental health issues mean you're 'weak'. And stress causing physical symptoms threatens this 'control'. They immediately assume I am not taking them seriously if I am asking about 'stress', and in their minds it's a weakness. This is another interesting example of how the body gets blamed for doing what it does when it gets pushed past it's limits in terms of stress: Adrenal Fatigue. Essentially it comes down to this: you are so in control of everything and can do so much and can handle stress so well that you start having symptoms of exhaustion. You then kick up a fuss and let everyone know you suffer from adrenal fatigue. Victim. You even get angry because the medical world doesn't take you seriously. And I know this way of putting it isn't fair. Dr Wilson's adrenal fatigue really comes down to a medicalised explanation of what is bound to happen when a person is just plain overstressed. And he then wants to make money out of it, but all in all: there's nothing medically wrong with explaining what happens when a person has had more than they can handle. In fact, I too 'suffer' from 'adrenal fatigue'. The thing is, this is what happens when you name it a 'condition'. I would not be taking myself seriously if I were to blame 'adrenal fatigue', or even call it that. I would not take my patient seriously if I were to go along with their wish to treat the body, blame the body and such, without even exploring who they are and what they're dealing with. There is also a drive towards 'balance'; mindfullness and and the like. Balancing your chakras, living mindfully, becoming a buddhist, etc. The above image really brings out the associations we have with the 'Connection between body, mind and soul'. More associations: alternative medicine, holistic approach (such as sticking needles in your foot?), yoga, whole foods, energies, certain types of schooling, detoxing (not talking about an admission to rehab here) and the like. I think you get the picture. I also know many 'logic' people who do not want to be associated with that. Neither do I, actually, because I see just another way of trying to control, trying to find health and happiness for oneself. See, I don't get it. Why is it so hard to find an in-between? Where has common sense gone? Why the all-and-nothingness? Why this obsession with health and happiness? I see people as multi-dimensional creatures, IN their surroundings. Mind, body, soul are all connected, of course. Mental health is health just like any other, after all, the brain is an organ, and your psyche did influence that heart attack. You can't control everything, but you should take responsibility for what you can. I won't prevent myself from getting sick if I do everything I can to stay healthy, and statistics are statistics. But it would be pretty stupid to not take care of myself (body, mind, soul AND spirit), and then feel sorry for myself if something happens. I can't prevent getting cancer, but I can refrain from increasing my risk to a certain degree. The clue being: balance. It will never be perfect, and happiness can not be found, only experienced. Being human is an all-in-one experience. It's not that floaty, and actually pretty simple if you think about it. And now, I am going beyond, for those who DARE. Body, mind, soul... and spirit. I believe there is more to being human than what we can grasp. No, I KNOW this. I am a believer, a Christian, in a secular world which looks down on believers. Because faith is for those who are weak, cannot think for themselves, the unenlightened, the lazy, the broken. Religion limits, humanity has evolved past religion. How can any self-respecting, intelligent person be a Christian? Simple. Really simple. Faith is for the weak, the thinking-disabled, the broken, too. Faith IS enlightenment. The lazy? Not so much. Religion does limit, and is not the same as faith. Humanity apparently has not evolved past ego, but God takes you past ego, and I don't even have words to describe that. It allows me to fully understand self respect and I am intelligent enough and educated enough to know we're not as smart as we think we are. I don't understand how anyone, after discovering Christ, can NOT believe. I can not understand how anyone can be satisfied with a secular life. But, that's up to them. We can agree to disagree, in all respect.
So, things are rolling still. I should be hearing about my application next week. The University Medical Centre (UMC) was kind enough to inform me that I can expect a letter in week 39, but receiving and envelope with the UMC logo a week after the closing date almost put me in cardiac arrest. I mean, that could NOT be a good sign. I am still just doing my job and it still is a lot less fun or safe to write about. Remember the Paracetamol Girls? Three years on, and they've become the run-of-the-mill of my daily (nightly, weekendly, eveningly) job. Three years on, and I do not view them any differently than back then. I know more about them, it hasn't changed my view. Interesting. To be honest, 'I want to die' becomes less impressive after hearing it a few times. You learn to listen to what they really want... and some really want to die. Not the Paracetamol Girls, mind you. The ones that chill your spine are the really sick ones: severe depression, booming psychoses... roughly in that line. On this job I've been called 'names I can not identify myself with'. I've been threatened... and I've had someone who threatened to kill me come up to me and apologise... and thank me. I've phoned 112 for acute police assistance. I've had to pull a police officer off a patient who was faking coma to prevent him from resuscitating her... (of course, only to figure out she was faking and then regretting not being able to witness the resus... she wouldn't let him!) I've had to deal with the snake pit of gossip. I've dealt with other doctors and the ambulance service who don't take psych seriously. According to some at work, I would be able to become a psychiatrist. Thanks. Really. I just don't want to. I am really psyched about the prospect of becoming a GP!