Monday, 28 January 2013

What is PC for midget?


A pretty snowy week, as I am sure everyone else noticed, but it sadly messed up my week of rotations. I usually cycle to the close events, so I made some clinical placements (where I managed to accidentally insult a 'little person' - read on...). I did miss the placement I was most looking forward to this week, though, which was a 'forensic psychiatry' placement. It was run at a secure psychiatric hospital for criminals with psychiatric conditions. Sadly, it is a long way away from my medical school and house, and I couldn't drive there because of the snow. I was really looking forward to this placement, as I had been there one before in my third year. It was set in the grounds of an old asylum (very creepy and deserted looking) and the patients had been very interesting, so it would have been very interesting, and I could have got some cool looking pictures!

As I am in a bit of a rush (work, play, constantly late submitting my blog) I will just briefly talk about things. As usual! The 'little person' incident was the most embarrassing, and hence probably the most worthwhile talking about. I was helping out in a scheme for adults with learning difficulties, mental health issues, and such like, where they met several times a week to do things like art and cookery courses. This isn't very medical, but I was working with a social worker and it was a lot of fun, making paintings and collages and so on. I was working with a small group of people, making a collage to take back to my flat, while chatting to them about their problems. Very informal, but I think the main reason for this scheme is social. I was talking to a person with abnormal growth, meaning he was less than 4 foot high; he was telling me how he got a lot of insults because of his height, and I was asking him what the correct term was for a shorter person. [He told me he calls other shorter people midgets, but didn't think that was PC for me to use, so I should say 'little person' (which I think sounds a little bad), or shorter person. Anyway, during my talk he was telling me how he was very good at collages, and showed me a very large, A1 sized one that he had been doing over some weeks. He was telling me how the difficulty was in the size, and keeping it homogeneous, and I (for some reason) just blurted out "well, they do say bigger is better"... We had quite a good relationship by that point (before, not after) and I was not even thinking about his size when I said it, just about the mural... Needless to say it didn't go down all that well (though we did patch things up by the end). Very awkward. I won't be making that mistake again.

Famous actor suffering from dwarfism - Warwick Davis.

Monday, 21 January 2013



A new week in psychiatry, though ruined a little towards the end by the ubiquitous snow which meant I ended up having to cycle through a blizzard! This week started with a mock test (to prepare us for finals), and had a selection of clinical placements and lectures through the rest. Sadly, one of the clinical placements I was most looking forward to, a placement based around people with HIV who had psychiatric problems, was cancelled. I thought it would be very interesting, as some psychiatric problems lead to people having much higher risks of contracting HIV (such as hypersexuality in mania), while addictive problems such as intravenous drug use, which are also covered under the psychiatric remit, can also lead to higher rates of HIV. As well as psychiatric reasons for contracting HIV, HIV infection can itself lead to psychiatric problems, such as anxiety and depression (from having the illness) and HIV dementia. The breadth of possible cases here could have been very interesting, but I suppose I will never know.

The mock clinical examination we had at the start of this week was sold to us a good chance to practice some of our history taking and examination, to help us start to prepare for finals in a few months (Finals in only a few months... Oh god...) but I thought it was more of a chance for them to scare us witless into revising really hard, so they don't have to explain why so many people have failed. It consisted of a range of stations, and the feedback I got from them seemed to conflict. The consultant running the chest pain history station told me that, while I got in all of the relevant questions [things like shortness of breath, and family history of cardiac disease] (one of the few to do so!) -I was too abrupt, and needed to be more personal towards the patient. The next consultant, in a station where the patient was suffering from weight loss, told me that I was too 'chummy' with the patient and I needed to me more formal and direct. While this does show that I need to change the style I use for examinations (and towards patients) it also shows me how objective some of these exams are - as I was being the 'same' (as far as I could tell) for each of these. I suppose some consultants prefer a much more friendly approach, while others may want you to be more efficient. I am sure that, whatever they prefer, they won't fail you on what they think of your style. At least I hope so!

Other than in the exams, I also saw some patients this week in a visit to the secure ward in the regional psychiatric hospital. I have been here before, during my third year psychiatric placement, though I can hardly remember that far back! I number of keypad and camera-operator opened doors let you in in an airlock type fashion into a rather nice ward. It is a far cry from the images of asylums in film!

Nothing like this at all.

In there I have some interesting talks with patients, whose circumstances were quite unique, so I will not go into them too much in the interests of confidentiality. There was an undercover policeman who had become so guilty at his work he had become a serious suicide risk and had to be supervised 24 hours a day, and an immigrant from the eastern block who had been in this country for years before trying crack cocaine, becoming psychotically confused and throwing bread all over a M&S supermarket, after becoming convinced that the people were seagulls. Once admitted to hospital, this man had become involved in a number of fights with other residents of the psychiatric hospital, though when talking to him myself, I thought he seemed very measured and in control, and he seemed to have great 'insight' meaning that he now understood that he was ill, that the hallucinations were not real, and that he needed to take these medications. The synopsis? Don't try crack!

Wednesday, 16 January 2013



I'm back, after a nice relaxing Christmas, and ready for my last set of rotations as a medical student - an exciting (and very scary) thought! I am starting back on a 4 week psychiatry rotation, something that I haven't done since my 3rd year (3 years ago!). It looks to be a really interesting selection of things planned for me, mostly based in the community, but with some short stints in psychiatric hospitals. This week, I have to brave all of the introductory lectures, have a very interesting session in a 'Substance Misuse' clinic, have a few psychiatric clinics, and have to section a patient and admit them to a secure psychiatric hospital.

The introductory lectures were more interesting than normal, as the people running them had thought up engaging games to help 'teach' us about teamwork and so on. My favourite part of this was a game where they created four groups: one made of consultants, one mixed consultants and students, one of random students, and the final one of students who had chosen to work together. They had to each look at a complex picture and talk amongst each other to recreate it as perfectly as possible. The idea was to show how people take leadership roles, how teamwork is important and so on. This was all well and good, but the fun came from comparing the sketches done by the three teams with students in with the one which came from the consultant group. I am not sure if they were meant to do very well, as they are all used to working in teams, but their picture looked as though it had been drawn by a child who couldn't be bothered to play. Despite it being a grid-based-robot-like figure, they had just scrawled a shape onto it. Perhaps their brains are attuned to recognising difficult diagnoses, to the extent that their art skills have regressed to pre-primary levels.

Most people's pictures looked a bit like this

The consultant's image looked more like this

Well, I digress away from my clinical experiences. The best part of this week was attending a 'substance misuse' centre, where people who are addicted to various substances come to receive safe doses to help them stabilise their lives. This may mean giving them methadone every day (pending an alcohol breath test), or may mean giving them other medications such as benzodiazepines to keep their addiction in check. The thought behind providing these medications is that many of these people who are addicted to drugs spend much of the day trying to beg/steal money for those drugs, then trying to find a dealer, meet the dealer, take the drugs, and then starting the cycle all over again. As the people take the drugs as a coping mechanism for problems they have had in life, supplying the drugs in a safe environment means that they have a lot more time in their day to do things like train for a job, or look for housing. Once these problems such as education and housing are more stable, the person is less likely to need to rely on the drugs, and then you can look at getting the person off of them. Just trying to take away drugs doesn't work, as it is removing their coping mechanism, which they need for their difficult lives. Talking to patients, I heard some very upsetting stories about abusive childhoods, about losing loved ones and friends, and one person had his girlfriend stolen by a pimp who wanted her to be his prostitute, and was then kidnapped by this pimp, who tried to get money for more drugs by holding him ransom for over a month. I have had such a 'soft' and easy life, I cannot begin to imagine what some of these people have to go though. Its impossible to judge people for using coping mechanisms such as drugs and alcohol when you have no idea about the torment they have to go through in their lives.

As well as this enlightening trip to the substance misuse clinic, I spent some time in psychiatric outpatient clinics where I talked to a number of patients with different psychiatric complaints, such as schizophrenia and bipolar disorder. The most interesting part of the week came when my consultant and I were called to come straight to the hospital to assess someone who had been admitted through A&E who seemed very manic. This was a 40 year old Irish lady who had come across to Britain to look for some records. It was very hard to find out anything more on top of that, as she spoke very fast (pressured speech), and was very hard to follow (flight of ideas). As well as this, she was very dis-inhibited and tactile, and was trying to stroke me and kiss my hand while I talked to her. By calling around her current GP practice, we found she had a diagnosis of bipolar disorder (though she denied this) and usually took medication for it. She could have left the pills in Ireland, though I think she stopped taking them while over there, leading to her spontaneous trip to Britain. She was clearly very unwell (though I am sure some of the 'pressured speech' just came from her being Irish), and so was sectioned under Section 2 of the Mental Health Act to be assessed and hopefully taken back to Ireland as soon as possible for proper treatment. A very interesting experience for me, though she seemed so lovely and caring - I felt very guilty being part of the team who was keeping her in hospital when she just wanted to 'go outside and do roly-polys down the hills'.