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Hani

Don't you just hate being a SHO?

26 posts in this topic

Well after a long day at work... A morning with 5 bordeline personality ladies, a Clozaril Clinic and 3 Addiction pre-admissions... I'm on call... A couple of admissions: sweet elderly gentlemen and as I was writing the 2nd patient's chart... I get a call from the A&E of a neighbouring hospital... The smart a**e A&E SHO (Pressured speech, high volume):

I have a 39 year old lady who has been depressed for 2 years because her marraige is breaking down. She's taken an overdose of Paracetamol and then told her husband. We have no blood levels yet. I want you to assess her!

BOOM... My blood is boiling... Sorry she's not medically fit yet... 1st she needs to be medically fit and 2nd We don't do assessments at night unless there's an emergency. I am also not allowed to go to A&E. I am on-call for liaison tomorrow morning and I could see her then...

SHO: So you're refusing to see her then?

Me: No I'm not. I've just explained to you how the system works. We'll see her in the morning and when she's medically fit.

SHO: So what do you do if you don't assess patients in A&E?

Me: I have over a 100 inpatients I look after.

SHO: Well this is not a good service, is it? I'm gonna discuss this with my consultant and make a formal complaint!

Me: OK thank you. Please could you let me know where the patient is in the morning and I'll go and assess her!

SHO: No we want her assessed now (Hangs up).

Boom boom... My blood is boiling even more now... All the NATs are spinning in my head... I just hate being a SHO... God what have I done to deserve this?

Well put this into a pmp and try to answer it!

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I know exactly how you feel. My last on call at 1 in the morning, the surgeons called me up about a guy who had stabbed himself in the neck five times and required emergency surgery and they wanted me to come and assess him for depression before that as they considered that more important. In spite of my explaining the whole procedure to him, he kept ranting and raving at my liaison nurse, so I went . The guy could not even speak, and could communicate only thru writing. The assessment was obviously not possible . But it is quite a pain all the same. :(

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Believe me, I have been through a lot of these scenarios!!

There is nothing more frustrating than to listen to an A&E SHO, screaming and shouting at you, in the middle of the night, when you refuse to see a drunken chap in A&E!

There are no two opinions about the fact that somehow, most SHOs from other specialties, seem to think that they are superior to the psychiatry SHOs!

I wonder why? ::)

These idiots cannot differentiate between simple, common psychiatric illnesses, cannot take a decent history, cannot do a brief mental state, cannot do a decent risk assessment, refer the moment a patient says 'low mood' but on the other hand, expect us to have the knowledge of a Professor of medicine, demand to know 'hundred' minute details of any patient referred to them, threaten to complain about inapproprate referrals etc

I wonder why? ::)

I have spoken to a few Consultants about this but they just smile and shake their heads

I wonder why? ::)

Whenever they refer and you ask for further details, they complain that you are being difficult but whenever you refer, they think it is their birth right to ask you for a 'zillion' details about history, investigations and what not and have the gall to say 'Well - you are a doctor, aren't you - you should know'

I wonder why? ::)

Psychiatry is one of the most important specialties in this country but we are afraid to talk to them on equal terms

I wonder why? ::) ::) ::)

Somehow it gives me great pleasure, imagining myself jabbing the A&E SHO with Acuphase 150mg, when I am on my way to A&E

I know why!! :P :-X

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i agree with the above. the very audacity of some of the SHOs from other branches is shocking! given that they expect us to know a fair bit of medicine, i would say that their knowledge of psychiatry seems appalling! and the panic they show at the slightest display of agitation by one of their inpatients is laughable!!

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I think the most irritating A&E SHOs are those who not only do they think they are professors in Emergency medicine but also that they know psychiatry better than you do! Like there was this A&E SHO who was on-call (Nights) in a weekend I was on-call and he was referring all these patients with 'comprehensive psychiatric history'

First night he asked me to see a patient at 3 AM. He went through the history and I could not interrupt him then MSE (Like a part 1 candidate!) and then used all the psychiatric terminology in Sim's... Pressured speech, tangential thinking, 3rd person aud hallucinations, persecutory delusions... Command hallucinations telling him to harm himself! And I thought gosh 1st episode psychosis or mania?

I saw the patient at 4 AM. Man, 28, sexually abused in childhood, started hearing his own voice inside his head at the age of 11, knows that it is his voice, been impulsive all his life, easily gets bored and feels empty, lacks confidence when he goes out so tries not to do much outside... Was chearly distressed that he cut deeper this time... I later learnt that the patient was referred while his wound was still open and he was only sutured 30 min after I accepted the referral!! No wonder his speech was pressured and tangential!! LOL

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Hani,I share your pain and disgust at the way we are being treated by colleagues from other specialties especially A&E.I think a lot of it stems from the old days when it was policy that every one who makes or threatens to self harm should have a psychiatric assessment asap.

Most of the consultants now from other specialties saw this while they were SHO's.The problem widens even with our good old psychiatric nurses as everyone's definition of what an on call doctor should be doing appears as wide as some confidence intervals from very poor studies.

My experience is that most of our own consultants are not supportive enough and just listen to our complaint and do nothing.Maybe it's because the experienced the same thing as trainees.

It even gets more complicated because our college does not appear to be very clear on hese issues meaning the level of psychiatric care varies from one region to another.I have worked in hospitals were you not only have to be barking mad but be at immediate serious risk to get admitted whereas doing the same thing in another hospital will surely earn you a complaint as people would feel you are too dangerous.I hope NICE would take note of this.

My feeling is that it would take a longer time to earn deserved respect from our colleagues if our on call duties are not defined further.I forgot to mention also that crap GP referrals on a Friday evening.

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yup fellas,

i think we all share the same views.but hey,can we make an effort to try and change it?may be but will it work is the big question.that i'm unsure about.anyway, lets hope for the best in our future,cheers

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i am pessimistic about the change for the better in the future...as everyday medicine is becoming more and more stressful..people dont want to take any risk and passing the buck quickly to the 'Psychs' seems the easiest thing to do...

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I agree with you all. But, I would like to add few more things to this topic.

First thing is A&E sho is also like us (psych sho) they have headaches too. Especially with these new rules by government (2005 is election year) that every pt attends A&E should “done dusted” in 4 hours otherwise trusts will not get any stars. Because of that there is huge pressure on A&E shos.i know this because I worked in A&E for 18 months before joining psychiatry rotation (I am in psychiatry for 1 ½ years now).

When I was working in A&E we had so many protocols for all others specialities, like when to refer when not to refer a patient but not for psychiatry. If some one comes to A&E and says they are suicidal or seeing things ……… etc. next thing you are told to do is refer to psychiatrists. Explanation by A&E consultants for this is don’t waste too much time on one patient (remember the work load for A&E sho).

In my opinion liaison psychiatry team should make some protocols for A&E and other medical or surgical doctors about psychiatric referral.

COPD patient referral protocols were made by COPD nurses in some hospitals and everyone strictly follows them. Can’t our liaison consultants make some guidelines for psychiatric referrals? It is not A&E sho who is making our life hell but the system.

Finally wish me best of luck I am on my week of nights from 25th till 1st 2005 morning. Because it is Christmas, cold out side, my pay band degraded this month, I am preparing for mrcpsych part1 and I am psychi sho.

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i agree with you about the rigidity of the system but the fact is that the a and e sho's treat us like shit. one a and e sho told me'' i can never do your job mate''. i'm usually very calm but this irritated me and i replied-'' i can never be in that stupid green dress all day doing referrals all over the bloody place

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Yes I can understand your feelings. There are some stupid SHOs in A&E but you should keep in mind that they are not going to be A&E SPRs or consultants, Basically A&E is not their career. That job might be part of their rotation like our GP-Psychy trainees. Just ignore them.

We are Psychiatrists not just doctors that mean we know how humans behave and why they behave like that. We do not just deal with body. We deal with both body and soul. Offer that stupid A&E SHO counselling next time if he or she speaks to you like that.

Treat them like your PD patients next time.

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hey Dr.Raghu,

look at my Poll in this general discussion boards and vote. (i am sure some of A&E SHOs will be watching this message).

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1st we ave to c things frm the other side...

they keep slaggin us off because they think we are empty upstairs.

i was in general medicine for18mths b4 startin psych and also went thru the mrcp exams.

after 1 or 2 duels wit other shos frm the general side,they've learnt to give me some respect.and believe me the word does get round amongst them too.

i think our colleagues shld show more confidence and self assurance.let them no u cannot be intimidated...and learn the health service rules fast even before opening psych textbooks(!).that way u will not be armtwisted in2 seein an intoxicated fella @ 2:00am.

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hi guys...

its really good to see everyone getting into the holiday 'spirits' and indulging into some free for all bitching. hehehehe :lol::lol:

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as for the ongoing discussion 8)....

all i can say is that we ourselves are partly to be blamed for the rut we find ourselves in...

i mean wat sort of an example is our royal college setting up wen the president says that he will work towards making the royal college of psychiatrists into the royal college of psychiatry and eventually the royal college of mental health :-/...

he dreams of the day wen all the RMNs, CPNs, ASWs etc can become members of the 'college'.... :o:o

i guess this is political correctness gone mad! :-X ::) ::)

AND NO! I HAVENT HEARD THIS FROM SOMEBODY.... I ACTUALLY HAD THE HONOUR OF HEARING THE PRESIDENT`s SPEECH WITH MY VERY OWN EARS WEN I WENT TO ATTEND THE ONE DAY RCPsych CONVENTION IN BUXTON. >:( >:( >:(

I am fully in favour of multidisciplinary working and i totally appreciate the valueable contributions that our non medical colleagues put into the management of our patients... but hw can u not expect to be treated like a nurse or a social worker if thats the image ur college projects.

i really feel really sad wen i hear my college president tell me that i should see myself as a medical SW after 10 years of medical training.... :(

I AM SORRY TO SAY BUT WE JUST DONT DESERVE THE RESPECT OF OUR A&E/SURGICAL/MEDICAL COLLEAGUES IF WE OURSELVES ARE NOT READY TO RESPECT OURSELVES AS DOCTORS.

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we add to our own pot of woes by not feeling confident when we face our fellow SHOs... somehow it has become ingrained into every SHO`s psyche that we are inferior and we tend to play along.... :-[ :-[

i guess its become a self fulfilling prophecy of sorts.

no wonder that a recent survey published in 'Focus on Psychiatry' (hospital doctor) noted that only 3% of medical students ever want to consider a career in psychiatry...

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The college talked about 'changing minds' to eradicate stigma.

i personally feel the minds of our office bearers need to be changed before anyone elses... coz they are the ones responsible for attaching this stigma to us psychiatry SHOs who pay to keep them in their offices.. ;):lol:

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SORRY EV`ONE ........

IF I GOT CARRIED AWAY :);):lol:

lets hope the new year is better for all of us......

maybe we will get more respect in 2005 8) 8)

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Dear all,

I think it's shocking that so few graduates from UK universities go straight into psychiatry. I graduated from Leeds 2 and a bit years ago and am loving it!

Interesting job, time to study, part time Master's course, loads of teaching and supervision, reasonably quiet, ok really quiet on-calls compared to other specialtites, quick career progression, guaranteed job as a consultant -where you want and how much you want, good lifestyle and time to develop special interests...need I say more!

I was one of two people from my year to go into psych, a handful the year before and one or two for each year going back 4 years.

WHY?????????????????

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I dont know if anyone will agree with me, but my Professor of Psychiatry who motivated me to take on Psychiatry, used to tell me that he learnt a lot in life by simply being a psychiatrist and observing other humans. 'We all mature emotionally by working in this field. This is how some Homo sapiens are.. and just get along..AND TRY TO SHED THOSE NEGATIVE BITS WE OBSERVE IN OTHERS..'

I now realise how wise his words were...

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What do you guys use to help protect your sanity from all these abuses? My favourite tactic is to speak to the refering SHO as if s/he has a borderline personality disorder. Some do not realise it but a few suddenly 'realise' I am speaking to them as if I am speaking to a patient - does their head it! :lol:

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hi all,

i was working in the year end when my esteemed colleugues in a&e referred a patient with paranoid delusions at 2.30 am.when i went to assess him he was doped to the roof with cannabis and speed.when i decided to send him home and see him later on in the day with him sobered up the patient started being aggressive. i got some staff from the wards and he was restrained.then my clever friend from a&e came up to me and said well if you have discharged him why do you need to restrain him? i wondered what he meant by that. did he mean that it is my moral responsibility to admit everbody even if he is intoxicated because we deal with drugs and alcohol? i actually thought i was doing a great favour to all the a&e staff ? what do you think fellas? :-[

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