Law

Hi,

A shorter blog this week, partly because of all the work that is going on a the moment limiting time, and partly because not as much seems to be going on in psych meaning I have less to write about. Law plays an large role this week, I meet a psychiatric prisoner and someone under the witness protection programme. I also meet an androgynous feeling male.

Psych seems to be a very laid back speciality, with outpatient doctors having about 5 consultations per day, compared to the 30+ that GPs seem to have to deal with. Despite these consultations needing to be substantially longer, due to the complex needs of the patients, many of the patients do not turn up. Of those that do turn up, unfortunately only about half of them consent to have medical students sit in. This means we can go through an afternoon seeing no patients, just sitting and chatting with the psychiatrist. While good for learning, as we are being taught pretty much on a 1:1 basis, this is a real shame as we see less patients. So far, my impression is that psychiatrists have it very easy, but perhaps that is an incorrect initial feeling. Anyway, we saw 3 patients this week, but all interesting so I shall continue.

On Monday we visited a medium and a low security psychiatric hospital site. Set between the remaining shells of the buildings from an old asylum, this was a very apt backdrop. The broken panes of the fenced off old buildings seemed to emanate some kind of menace. How can a building give you that sort of feeling? Anyway, we talked to a patient who was diagnosed as schizoid affective disorder. This patient was admitted because of a series of GBH, ABH and the like offences, a degree of very high mood (mania) and hearing voices talking about him. He is likely to have some form of antisocial behaviour personality disorder (so could be otherwise known as sociopathic or psychopathic). He had just been moved down to low security from medium security he was in before. He seemed polite and charming to us, but that is just one factor that hints towards psychopathy. A very well known drug dealer in the vicinity, and an intelligent criminal, the feelings of the psychiatric staff was that he came off of his medication in prison in order to exacerbate his schizoid affective disorder and thus be transferred to the psychiatric hospital, and now to low security. Patients can be cunning.

On Tuesday we went to a ward meeting in the inpatient psychiatric hospital, where we just discussed patients who were currently resident. This was a disappointment, as my partner and I thought it was a ward round and were hoping to get the chance to talk to some patients. It was interesting hearing about all of the patients and the treatments they were on, but it is not the same as actually getting to talk with them yourself.

Friday involved seeing, shock horror, 2 patients! One of them was a man who had been depressed for much of his life, and wanted some medication adjustment. With a lot of gender issues, he was dressed very effeminately and was softly spoken and polite. Gender is interesting, how people can be born with the male genes and hormones, yet still feel they should be female, or visa versa. Interesting, but not quite enough to make me want to do psychiatry as a career.

The next patient we saw on Friday was very interesting. Not because of the symptoms, which seemed pretty ordinary, but because of the patient's situation. The patient seemed to be suffering from PTSD and depression after she had been attacked. Due to this attack she had been placed under witness protection and moved here from another part of the country. I won't say anything about the circumstances, as anonymity is obviously of utmost importance here, but she could only tell doctors (when relating to her condition) and the council her real name and situation. It seemed that she was exceedingly upset with the witness protection programme, which seems to strip you of all your civil rights, and this was adding to her problems. Taking her away from a successful job and large group of friends, she had been put into a strange town in a council house and expected to make a new life. After this consultation the psychiatrist went through techniques he uses to 'persuade' patients (read manipulate) into feeling the way he wants about certain things. He uses little things, such as offering to get them a glass of water when they get upset, to give them the feeling he is at their service rather than they are coming to do what he wants, as many patients do when they come to the doctor's. Anyway, makes you wary of yourself when you are around psychiatrists - he did tell us he wanted us to do certain 'exercises' for him, such as telling him about ourselves in 5 sentences so he could tell what sort of people we were from what we said. Psychiatrists are cunning, and patients lives can be cruel.

Anyway, that will have to do for this week, mainly because I have a lot work to get sorted out and I should really be working on that rather than writing this blog. Don't expect anything amazing here for the next couple of weeks until I leave this rotation and move onto one I find more interesting. I will still keep writing though - who knows - I might change my views completely.