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About Gee

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  1. 4th station... talk to carer about patient who has history of wandering and threatening and hitting out. patient also has alzheimers link son is upset because father has been started on olanzapine. address concerns and discuss alternative management plans
  2. I am not surprised at all. The onlt thing I would add is that if you hold a british passport, things might b a bit better at the official level but not the day to day life level. Hi! I am currently working in the Gulf and the horror stories that you are recounting are urban myths, and frankly shocking. I will agree with regards to the requirement of speaking the Arabic language, but that is common sense, because what is the likelihood that a patient when psychotic will focus on speaking his second language when they can't concentrate on conversation?! With regards to the racism, as others have said it is present everywhere in the world, so it won't be any different from practicing in any other not-so-cosmopolitan city, ie. even rural areas in the West where I personally have heard "I would like a white doctor please!". These are small countries that you are talking about, which are unquestionably still xenophobic (and this you will find even when they talk about citizens of their neighbouring countries) and still blind sided to a certain extent by their histories of being colonized. The impact of religion varies greatly within them. The bottom line here is that the foundation of most of their medical systems were Asian and British doctors, and until this day the Asian doctors make up a large percentage of the working healthcare system. The laws with regards to employment are fast changing, and employers have lost the power they used to have in a lot of the Gulf countries and it is becoming illegal for them to take anyone's passport. On the subject of doctors being put behind bars, now that I have NEVER heard of. Unfortunately the practice in the Gulf has not even reached the point of respecting the patient's autonomy. Medicine in this regard, is still stuck in the days where the doctor has full reigns of power and the patient does not even question the prescription. Consent is taken loosely, and its just the medicolegal issue of having a document signed when nobody really explains anything. It is possible that the doctor you heard/read about was prescribing these benzos to drug addicts fully aware of their addiction and exploiting it, as the tendency in addiction in this part of the world is polydrug abuse and the benzos are a favourite. When it comes down to pay, you are right to say that it varies greatly. The doctors of Gulf citizenship are actually paid the least, but ANY foreign/expatriate doctor will make the same amount which surpasses what his citizen counterpart will make. The question of practicing psychiatry in this part of the world boils down to the fact that the majority of the citizens are more comfortable communicating with their mother tongue; and the cultural implications of the mental illness and stigma associated need to be mollified at all times when dealing with patients. Hope this helps.
  3. I feel your pain!
  4. Single Stations: 1. ECT explain- patient was tried on VFX and fluoxetine. 2. Early Onset Psychosis patient referred from the GP. Assess thoughts and MSE 3. Frontal lobe examination 4. Angry mother son with working diagnosis of paranoid schizophrenia, she doesn't agree thinks that hallucinations and delusions are the result of cannabis use only. 5. Firesetting risk 6. Alcohol dependence and depression 7. 15 year old OD assess seriousness. 8. Wandering behaviour risk assessment and seriousness of wandering behaviour. Good luck to all!
  5. Has this station ever come up before?
  6. I suppose cover the risks as well, not only the risk factors. Risks are fall, driving, cooker, neglect, wandering, vulnerability, exploitation, non-compliance, accidental overdose etc. In presenting complaints use information from the scenario. If you smell any risk in any of the answers given by the patient, explore it and probe it until clear. Give advice re. informing DVLA if he is still driving. Give some management plan in the end such as "I am going to talk to your wife and we'll try to sort out how best to help you with these difficulties". Cover agnosia, apraxia, visuospatial orientation, amnesia, aphasia, agraphia and alexia in your history if you can. That is not enough, ask about mood as well and also about his social activities. Also try to differentiate it from Alzheimer's so ask about the progression that did it suddenly become worse or was it very gradual. Were there any periods when your memory stayed the same and did not get any worse. You can also ask about impulsivity and Parkinsonian symptoms but main D/D is with Alzhemier's. Thanx Afterlife... that gave me better perspective. Now if only someone could help me with the Firesetting station?! Please?
  7. There was a station on the 23rd of Nov where you are supposed to take a history from a man with vascular dementia to confirm the diagnosis. You are asked not to do a cognitive assessment. Apart from: 1. Eliciting the presenting complaint. 2. Asking about risk factors : Cardiovascular, Diabetes, Hypercholesterolaemia, Smoking, Obesity, ?Family History What are we supposed to do?!
  8. Fire setting station on 20 Nov. You are seeing a 18 yr old girl.police has arrested her after fire setting yesteday. Tasks- check for any underlying mental illness -assess risks -take history with regard to risk factors. She had -childhood sexual abuse -past history of fire settings- few times,once set fire to her stepdads bedroom.police were involved but not convicted. -implsive behaviours -alcohol use -no previous police convictions -No violence towards animals/others -current nightmares. -No psychotic symptoms. What are we supposed to do here? Help please!
  9. Would you please elaborate on what you mean about him being receptive to motivational interviewing and able to generate alternatives?
  11. 1. Lewy Body Dementia – History: A 65 year old man presents with memory problems for the last 8-9 months. Also had visual hallucinations and Parkinson an symptoms. Has had scans and has confirmed Lewy body dementia. Talk to patients carer. Let her know the diagnosis. Discuss the management options. ( Big A4 sheet of instructions in 2 min. Only could register above ) Patient carer turned out to be her daughter. Role player was good .But I was anxious and not composed I guess. She asked difference between Alzheimer’s and LBD. Management and side effects of rivastigmine. Failed this one! Help please!
  12. Thats exactly how i feel. I was sure i covered all basis! But what is done is done.
  13. I understand what you are saying. But on the other hand, I thought the interview went smoothly, and the actress was very forthcoming with the information. I guess you are right maybe I'm just reaching for straws. I am not happy with the title of the station anyway... Thanks for the feedback
  14. Psychosis trumps depression! She would be depressed if she thought her son was possessed by demons!
  15. So... I just got my results letter and I am totally confused. The title of the station is Post Natal Depression. The actress clearly expressed seeing a demon in her babies eyes which scare her and make her fearful that the someone might try to do something to the baby. She has locked herself up in the bathroom fearing for the baby or from the baby or something! HOW IS THAT POSTNATAL DEPRESSION?! I failed this station. Obviously I failed the following station too. Anybody understand whats going on? Is this grounds for appeal? Will it matter if I do? I had dealt with failing and accepted and started putting my notes in order to start all over again. Now I am beyond angry!