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Guest simonheyland

My 5 least favourite things about Psychiatry

9 posts in this topic

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1. Getting those crap referrals at 3am which you know are going to take at least 2 hours to sort out even though you can tell over the phone that you're going to discharge them >:( :(

2. Knowing you're the only person on-call in the entire hospital who has to trek across the car park to get to A&E to see the crap referral at 3am etc etc etc

3. Feeling slightly jealous of specialties where the sickest patients say 'Thank you' once they've recovered

(is psychiatry unique in the lack of gratitude shown to it? ??? )

4. Getting verbally abused is part of the job ('It's not their fault it's the illness doctor') when really you know it's their 'personality' swearing at you and not their 'illness' :-X

5. Yet another person saying 'So what is the difference between a psychiatrist and a psychologist?' ::)

Let's get cathartic, people............

:lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol:

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It's just occurred to me that I gave birth to this topic during a Saturday on-call....... [glb]roll on SpR days [/glb] :P

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Obviously, psychiatry is as good as it gets for the workshy doctor, but there are a few niggling problems.

1. A patients daughter brought dad in (2/52 of what sounded like hypomania), she didn't tell him why she was bringing him to A&E. Then, when she arrived, in moderate distress, she said to me:

'I feel so guilty, it's the worst thing you can do to someone'. Which made me feel like choped liver.

So the lack of trust, (non-fearfull) respect, gratitiude and understanding of what we do by the general public, is a drag.

2. The soul searching, ie do I think this patient should go home because it's clinically wise or because I don't like them.

3. Not knowing what to do, and not knowing if anyone knows.

4. Not being sure, having reviewed the literature, that we are doing the right thing.

5. The personal development needed to be any good at psychotherapy and the knowledge that I have a long hard journey ahead of me in this respect.

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1)Psychiatry as a specialty has more than 80% of trials have less than 20 patients & last less than 6 months(Mcallister Williams etal).Some interventions likePsychodynamic or CBT dont have a huge data of Randomised Controlled trials or Systematic reviews. How do the 21st century doctors use evidence when it is Garbage?(in most cases!)

Coming from India, I was shocked that in general Families,Church etc.. are disempowered here i.e they dont deal with sadness and so they are medicalised into dysthymia,Mixed anxiety and depressive disorders etc..

In India Temple, religious folks like swamijis, and elders in the family counsel,present with good social role models.I may be ignorant but where are these things here?(atleast in the inner city neighbourhoods)

Look at the way the physical health,Mental health,Substance misuse indicators are for chilldren in care.Having a child in my opinion is not a right but a RESPONSIBILITY. How does the society handle parents of ASBO children & importantly how to prevent ASBO's happening to children?

Then there is the Government, whose aim in the current day is to save money over everything else.So many people who need supported accomodation,supervised accomodation dont get it.The government also uses the NHS to offload the Criminal Justice system so that they dont need to build prisons,carry out prison reform etc.....

Then the Benefit seekers who become suicidal after GP stops benefits etc..... I believed that it was a good thing to have a benefit system as it helps the needy(not anymore), but we are now seeing families who are on benefits for generations. No work,No self esteem. How do these people spend time?Pubs,Use cannabis etc...(apologise for stereotyping)

Without changing these things I am not sure if all these Billions will ever make a difference.

just my thoughts....

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The Government wants to Hunt with the hounds and run with the hares. It wants the human rights lobby to be happy(Victimisation of doctors for every small mistake even if the defects are systemic).

It then wants to keep Middle England happy(Worchester woman,focus groups etc.)So it wants the general adult psychiatric services to deal with personality disorders & the Forensic services to deal with the so called &quot:lol:SPD'(dangerous and severe Personality disorder) a legal construct not a psychiatric one.

the Home Office starts its pet &quot:lol:SPD' project with HMP Frankland prison,Rampton &Broadmoor Hospitals(high secure care) getting DSPD units, but the new mental health bill does not even mention &quot:lol:SPD'(department of health drew the draft mental health bill)

Ofcourse it then ignores the Joint Parliamentary select commitee's views,Ignores the profession,Ignores patients(should I say Users and carers?!LOL!) and Now wants to withdraw the draft mental health bill & add riders to the current mental health act,1983 ( in England and Wales)

The Worst Thing is Psychiatrists these days are Lawyers for the medical profession, does this patient have capacity for refusing kidney transplant?does this patient have capacity to write a will? is he fit to drive?

They want the psychiatrists to make very fine judgements, some times based on case law, with the proviso thatif you get it wrong you will burried in litigation for years.

I am happy to do it, but please dont bury me in litigation if i get it wrong, I mean Good and sometimes its very hard to interpret case law or there are individual circumstances which make it impossible for me to know what is ideal when I dont have benefit of hindsight.

Apologies for my woffle !

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that was very well said and well composed. its the system taht is to blame.. and not the doctors working in it..

and the point about benefits and the youth you see everyday - its SAD...

but then again, the real power is with the law makers, who have nothing what-so-ever to do with the patients or the plight of the staff working for the NHS...

the system is so rigid, that there is no room or scope for common sense approach to work.

i do share the same feeelings and feel really handicapped that i cant voice them to others except for colleagues .

God only knows what they will come up with next...

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1) The fact that it is so minimally:

                 Taught to medical students

                 Funded, etc  

despite acounting for a massive proportion of illness in the population.

2) The public misconceptions that all psychiatrists are merely sadists who enjoy locking folk up and electrocuting them.

3) The professional misconceptions from other doctors and surgeons that we are somehow not a 'proper' medical specialty.

4) Cartesian dualism. All that mind-body stuff. Seriously not helpful.

5) Being at a party and getting those looks when you tell someone what you do for a living.

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Great post!

1. Exams - surely the others don't go through what we go through, or what I'm going through at the moment.

2. The stupid stupid calls that we get. ' Two service-users have just had consenting sex on the ward, can you please review...' Review what for f#cks sake?

3.The sheer ignorance of other colleagues. A surgeon asked me what capacity was. Doesn't he test that whenver he consents someone for an operation...aaarrrghhh!

4. How we are expected to sort out everything...mental state, past wrong-dongs, housing, the cat being sick, the weather...I mean come realistic. Misery is very hard to treat!!

5. The lack of thanks/gratitude, and no I don't mean detained patients or those who have been restrained.

Thank you.

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The five things that I least like about psychiatry:

1. The realisation that in some cases we are doing far more harm than good by even getting the patient involved.

2. That pseudoscientific claptrap that masquerades in the guise of 'psychodynamic psychotherapy'- and the complete abdication of responsibility by psychotherapists the second a patient becomes remotely psychiatrically unwell - 'suicidal' you say? Let me get in touch with your medical psychiatrist... Part of this is the 'treating' by psychotherapy of things that frankly are better treated by telling them to have a drink down the pub with their mates whilst having a good bitch about how shit life is.

3. The realisation that nurses are now carrying out most of our job- assessments/ overdose assessments etc. And really what do I do that a nurse couldn't do? I might know a wee bit more about fluoxetine than them, but they just need to pick up a book and read about it and voila!

4. The apparently completely random management of personality disorders. These people (unconsciously or otherwise) thrive on the dissent and distress that follows them around. They come into wards and like a psychic vampire drain the staff and other patients of the will to live... And The complete lack of cahoonas shown by psychiatrists in dealing with people who actually do need to be told in black and white terms that they ARE responsible for their actions.

5. REviewing absolute crap on the wards- e.g. the two consenting adults who have had consensual sex... hmmmmm.... what am I going to do about it? Put them on high dose SSRIs? A lump on their lip- a cold sore you say? Would they have seen their GP with this? Mrs X wants to leave the hospital- you speak to Mrs X, 'The nurses tell me you want to go home?'... 'Eh?', 'Yes they say you want to leave', 'Emmm... I said I was a wee bit fed up being on the ward, but didn't say anthing about leaving', compared with those who do demand to leave every two days... getting into repetitive cycles of detention/ allowing them to lapse.

Can I have a sixth one- 6. The fact that you can never admit seriously unwell patients because the beds are taken up by vicious dissocials/ borderlines who know just the right things to say to ensure they can evade their latest court case (or whatever). Tied into this is the fact that people can sit around perfectly well for over two years waiting for social work to find them a place to stay.

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