It was a very short week last week because being the last week of the rotation there were exams instead of ward rounds. That said, there was a single day in the psych hospital, which I really enjoyed. It is a shame that at the end of the entire psych rotation it starts getting good. A good combination between a proactive and interested consultant and seeing about 4 (yes four!) patients in a day showed me what psychiatry can be like.
Two of the patients we saw were in because of violent tendencies. One of the patients was in the manic phase of bipolar affective disorder and had been bought in because of their strange behaviour, and the other one was a possible sufferer of antisocial personality disorder (AKA psychopathy). Talking to both of them, they seemed relatively normal likeable people, though the latter did seem very manipulative. This was obviously not enough for the consultant psychiatrist, who decided it would be a good idea to test whether they were ready for release. He slowly started winding the patient up and saying things to aggravate and annoy them. When he started doing this to the first patient, we had no idea what he might be doing. It started off seeming like he was being a little tactless, saying things that the patient might find upsetting, then he seemed to work up into a frenzy, telling the patient how they were to blame for all of this and criticizing all of their viewpoints and arguments. All in a not-so-subtle way. We realised what he was doing after a while into the first consultation, and so got the chance to sit back and watch him try and wind up an aggressive and violent patient. It was fun in a sadistic way, but neither patient reacted violently towards the psychiatrist (fortunate, as they were both quite large men). What an odd experience, but I suppose as a consultant you have licence to do these things. You don't want to release a patient out into the community if they are still violent!
In the afternoon we were sitting in a reception waiting for a patient to show up to see the psychiatrist. This was a different psychiatrist to the one we were with in the morning, as we are swapped around doctors like a cheap Biro. Whilst we were waiting in the reception, we saw a drunk man sway into the room and wander towards the reception where he was directed to the waiting room. Soon after this the psychiatrist came down and told us that, while this drunk man was the person he was meant to be seeing, they had a rule here that they did not see intoxicated people so he wouldn't be able to have an appointment with him today. Unfortunately telling the patient this did not go down too well. From a positive mood where we was chatting away with us two medical students and hi-fiving us, he quickly turned to a very upset and angry. Refusing to leave because he had spent so much time getting here, the patient didn't see why he couldn't be seen. I can see both sides of the argument I suppose, the psychiatrist didn't see the point of talking to someone who was this drunk, as they wouldn't remember it or gain any benefit from it, and the patient didn't see why he couldn't be seen as he was there, had an appointment, and the psychiatrist was standing right in front of him. The patient was starting to get violent, pushing the doctor and receptionist around and throwing chairs around the room, so the doctor's PA came out and whisked us away to the admin room. While it was a lot safer there, I thought it was a shame that we couldn't see how the rest of the situation was handled, or how it developed. My partner disagreed with me fully, she was more than happy to be hidden away from the violent drunk. Anyway, the police were called by some of the administrative staff, and when the patient was told this he quickly fled the premises after threatening to go and kill himself. Unfortunately, because of this threat, the police had to be informed he had said this and they had to go and find him to section him for his own safety. Poor guy. I think the people who work in substance abuse are prepared to see intoxicated people, because with functional alcoholics it is hard to see people when they are not drunk.
Anyway, that is all I am going to write this week, exams went very well, thank you, and I have several essays and other things to write up now, so I should be doing those rather than meandering my way around a blog. I have now finished psychiatry and am going onto gastro medicine. I will be dealing with lots of obese people and alcoholic liver disease I am sure, and there will be plenty of poo, I just know it. I am really looking forward to being back in a hospital with the fast pace and lots of patients. I hope that this rotation lives up to its name and is varied and very hands on. I will let you know next week.