The medics!

What's the common perception of psychiatrists? At a guess, it would be older male, beard (very Freudian), distant, detached, arrogant, over paid, with something approaching pressure sores for never leaving the other side of their desks. And definitely, but definitely, out of touch. A penchant for diagnosing personality disorders for anyone with the temerity to disagree with their wisdom.

There may well be psychiatrists who satisfy this description. But not that I've met.

The psychs that I've met are all young- ish. Even the consultants. They're interested, hardworking, and invested clinicians. Perhaps with a hint of arrogance. But, I must confess that if I'd studied and trained for as long as they have, I'd be a touch arrogant.

What's struck me about my RC (responsible clinician. The bloke who has responsibility for my care) is that he is always aware of the power imbalance and the ethical dimensions of detaining someone and authorising medicating them by force if necessary.

In my opinion, I was detained under section 3 in some part because I knew that if I went missing as an informal patient, I wouldnt meet the criteria for a 136, nor would a mental health assessment , outside of the hospital, have detained me. I've never believed that I suffer from a mental disorder of a degree  to warrant detention. It's the nature, and interplay, of disorders that make me detainable.But I digress!!

Ward rounds are weekly meetings between me- the patient- and all of the relevant professionals involved in your care. (This is called the MDT, or multi disciplinary team. Mental Health likes its acronyms a lot!)
 
If there is a patient alive who has not felt trepidation at the thought of their impending ward round, I'll be amazed. They're not designed (I hope) to engender fear. But they do. It's the place where the power imbalance is most keenly felt. You are the patient. They are the experts.

Ideally, everyone should have a common goal. To get you well enough to be safely discharged. Unfortunately, they sometimes end up getting 'stuck' in a discussion of misdemeanors (fag out of the window, anyone?) that don't really have anything to do with mental health or dangerousness to self or others'. Smoking in bedrooms is illegal. It's also, in general, tolerated by staff - who have more important things to deal with than minor misbehaviour. But these things can reduce a ward round to a farce, especially if tensions are already running high.

These are meetings that can get fractious.

Nerves feature heavily for me here. Even after 9 months, I still sleep poorly on the eve of a ward round. I'm often quite hyperactive afterwards, as well.

A nervous aspie is a tactless aspie. I have been known to tell the consultant that the suit he is wearing is not as nice as the one he wore last week, that he has herpes (a cold sore), that he looks better without the beard (he IS a bit of a Freudian!), that he is completely wrong for not giving me more leave, etc etc. I have seen people forcibly removed from their ward rounds, and many people 'storm' out of theirs. I have seen the doctor leave on one occasion. I have seen the nurse who is note- taking sniggering more than once. And That same nurse nod off, only to be woken up by a direct question from the doctor.

Fractiousness is often quite funny, it must be said.

 He's Italian, my RC, with quite a strong accent. He doesn't seem to like direct questions. He likes to announce that he is not working alone- he is merely one part of the team. And yet woe betide anyone who thinks they know their way around the mental health act or BNF better than he does.

In a surreal 5 minutes a while ago, he asked me how I'd like him to respond to me if he sees me out      and about. Would I like him to ignore me, or to stop and say 'hello'? My reply was that he could buy me a pint! But, more seriously, I have mild prosoplognosia (face blindness). I often don't recognise people by their face. It's their voice, clothes, build and walk that informs me about the identity of the person. So, it stands a good chance that I wouldn't recognise him, especially out of context. But I find the idea of ignoring someone who you've been legally responsible for for the best part of a year a bit of a strange one.

This is the sort of thing that modern day psychiatrists ask, and are interested in the answers to.

A lot of what goes on with the consultant is extremely serious (suicidal thoughts this week?) Indeed, it can be life savingly important. Prescribing psychotropic medication is a serious business. So is giving leave to a patient who was suicidally depressed a few weeks ago. Maintaining hope when dealing with a patient who, having just been released from jail, keeps going on vodka binges and slashing their throat, is (we may assume) not an easy task. Keeping focus, and the patients' best interests genuinely in mind,  when that  patient is delusional and aggressive,  making obscene  gestures,  swearing at you in Italian, and threatening to irrevocably alter the child-bearing capacity of close family members, is no mean feat.

It's also what the nurses deal with day in and day out. But that's another story.

I've been impressed by the shrinks here. The junior doctors (SHO's) often don't want to work in psychiatry. Most of them are GP's in waiting. The turn up en masse in August and February, and are very much thrown in at the deep end. The first task for the last SHO was to put me on a 5(2) - she told me a couple of months later that she was told exactly what to do by the nurses, as she hadn't a clue! But they learn quickly.

I think, across the board, the medics do care. They make mistakes, and I'm my experience they are very ready to apologise and move on. That's a good experience for patients, who might very well be detained and as a result have very little control over the decisions that affect them. Knowing that the people with the power are interested in collaborative working goes some way to ensuring that patients don't feel done unto.

And this can only help to facilitate recovery. It's helping me, anyway.