Mental Health: What’s the deal?

Wow,

I am terribly behind with my regular blogging! 😦 There’s no excuse, but it’s been busy and blogging about our recent vacation took a lot longer than usual.

So what’s the deal with school now?

Well, I’m 5 weeks into my Mental Health rotation, and yes, I’m quite enjoying it! By random luck (or is it bad luck? Haha), both Mike and I got placed as the only 2 students at a private mental health hospital in Brisbane.

The experience so far has been very enlightening. We found it initially daunting and awkward learning to take a psychiatric history from patients and formulating our thoughts. The feeling is quite similar to being in first year again, learning how to take a medical history and talk to patients. Fortunately, we’ve gained a lot more confidence in the last few weeks. Taking a medical history is like second nature to us now, hopefully taking a psychiatric history will, in time, feel the same.

We are humbled and grateful every time a patient agrees to talk to us or allows us to sit in during a consultation. If you think about it, these people are sharing with us, complete (not yet qualified) strangers, the most personal aspects of their lives. Some people have been victims of sexual and/or physical abuse, others have gone through great losses, some struggle with their spouses having affairs, while others have thoughts of self harm and have even tried to kill themselves. Every single patient we’ve met has taught us something, in some way, that we could never learn from a textbook.

Every patient we’ve met has a different story and is fighting a different battle. One of the first and biggest challenges for us has been, “How do we talk to these patients? How do we approach sensitive topics in a way that will not be upsetting?” We quickly learned that despite all the differences, these patients are all still the same in one way: Like you and I, they are people too.

Talking to patients with mental illness or a difficult life/past can be hard. But it’s not necessary to over-think how to talk to them. As long as you are patient, empathic and a listener, most people will be more than happy to talk to you and share their stories with you.

We also get scheduled teaching time with 3-4 consultants every week, which has been great. They have all been great teachers and we’ve learned so much already! Not just in terms of knowledge aspect, but also plenty of real life stories and experiences – something you can never learn from reading a book.

Have I mentioned we have a great Registrar? Yes, thank goodness! Most of our day is spent with him and the patients. He’s pretty awesome with them and definitely a good role model to try and emulate. As one of our profs said, “Shamelessly steal!” Adapt the styles, sayings and techniques from your seniors and colleagues that can make you a better doctor!

The most scary aspect of Mental Health at this moment? The fact that we are approaching the end of Week 5… only 2 more weeks until final exams. Absolutely crazy. It’s insane how quickly time has gone by!

GP: Coming to an end

Friday will be my very last session at the clinic for my GP rotation. How quickly 6 weeks have gone by!

We will having our final exams next week:

A multiple choice question exam on Wednesday and 2 oral exams on Friday. These are 13 minute stations (with an additional 5 minutes perusal) where we will have to perform a diagnostic case and a management case.

For the diagnostic case, we will have a patient come in with a presentation where we will have to take a history, talk through the physical examinations, provide our probability and differential diagnoses and lastly, provide a list of problems that should also be addressed.

For the management case, we will be giving a patient the diagnosis of their illness and will be working with the patient to manage their health. This will include assessing the patient’s knowledge, educating them on the diagnosis, coming up with short and long term management plans, taking the opportunity to discuss preventative health issues, providing resources, planning to follow up and safety netting.

Am I scared? Extremely!

There’s lots of time to study from now until then. I will definitely continue to practice cases and make sure I actually know how to manage diseases! I think the worst thing that could happen is to walk into a scenario where you have no idea what the disease is, let alone how to manage it!

And after next Friday – ONE WEEK HOLIDAY – YAY!

Note to self: Buy a stop watch for exams. Managing your allotted 13 minutes for oral exams is impossible if you have no idea how much time you have left.

GP: “I can tell when my BP is high”

The last patient I saw the other day was, according to my preceptor, a “heart sink” patient. The kind of patient you see on your list that makes you sigh and hang your head in frustration.

This man had uncontrolled hypertension (high blood pressure – BP) simply because he is extremely non-compliant with his medication. He’s visited the clinic numerous times in the past but doesn’t agree on the importance of his medication, despite detailed explanations each time.

He came in with his wife, who said he still hasn’t been taking his medication and when we asked him why, he said, “Because I only take it when I feel my blood pressure is high.”

We asked, “Do you feel that your blood pressure is high at the moment?”

He responded, “No, because when my blood pressure is high, I can feel it in my ears.”

So we measured his BP, it was 190/80 – which was high, and we told him that. And for the umpteenth time, he was told about the importance of maintaining good BP and that he was at risk of having another stroke – apparently he’s had 3 already, one which took 3 years to recover. He’s also on Warfarin (blood thinning agent) so if he were to have a hemorrhagic stroke (burst blood vessel in the brain), it would be a big one that could potentially kill him or cause major complications.

He laughed and said, “I’ve already had 3, I will just have a big one then!”

His wife chirped in, “If you don’t control your BP, you might die tomorrow! You can’t leave me, I need you!” He replied with another laugh.

Needless to say, the consult ended up a waste of time because the patient refused to take the doctor’s advice. On the way out he apologized with a smile and said, “I’m sorry for my… indifference regarding my treatment.”

Perhaps one of the most difficult aspects of GP for me – knowing that your patients know their behaviours (smoking, not taking medications, etc) are putting them at risk of serious illness but despite your continued efforts, they simply don’t want to change.

MIS: Coming to an End

After an amazing 6 weeks at Prince Charles Hospital learning so much about Geriatric Medicine, my Medicine in Society rotation is coming to an end.

You would not believe how worried and anxious I was to begin working in the hospital this year. The thought of constantly feeling stupid and not knowing enough was enough to get my heart racing. Luckily I was proven wrong. Every staff member I have met at The Prince Charles Hospital has been welcoming and kind. Not only have they taught me so much, but they trusted me and provided innumerable opportunities to apply and broaden my knowledge and skills – I couldn’t have asked for a better experience!

Here’s a review of what happened:

I spent my first 2 weeks in the Fractured Neck of Femur  (#NOF) Service (01/21 to 02/01). All patients in this ward had broken their hip and required surgery and rehabilitation.

Then I moved on to the Geriatric Evaluation and Management (GEM) Unit for 2 weeks (02/04 to 02/15). These patients can have any sort of health problem, and were in GEM for further rehabilitation or waiting for home services to be set up before going home.

Fifth week I spent in the Cognitive Assessment and Management (CAM) Unit (02/18 to 02/22). This ward is more long-term and all patients have some kind of dementia. CAM was an especially unique and enjoyable experience. I got to know all the patients on a personal level and it was admiring to see how the staff take care and handle patients when they are being difficult.

During my last week (02/18 to 02/22), I spent a few days with the Geriatric Referral and Liason Service (GRLS) and some days back in the CAM Unit. The GRLS team takes referrals from all different wards of the hospital to see if patients would be appropriate for transfer to the GEM unit or elsewhere. GRLS was especially beneficial because I was able to learn how referrals work and got to become more familiar with other wards in the hospital.

We now have this week off to study for our exam on Thursday! And also have to finish up our health projects. For mine, I’ve created a medical information brochure for the Fractured NOF Service. I’ve received patient/family feedback and it’s now in the final stages of editing before being submitted to the forms committee.

Overall, I’ve extremely enjoyed my Geriatric Medicine rotation. I have had so many encounters with patients, their families, and health professionals that have taught me more than any textbook could. Thank you TPCH for a wonderful experience! 🙂

MIS: You look good today!

I had a chat the other day with a patient who’s been with us for over 2 weeks now. He’s had ups and downs since his surgery, compounded by the fact that he has severe interstitial lung disease.

He was looking better so I was happy to say, “You look good today!” He replied with, “Yea! But what you don’t see is that I’m a broken person on the inside.” Too much talking takes his breath away so he went quiet and started writing in his notebook. I let him write in peace and a few minutes later he handed me what he had written. A list of nearly 10 other medical issues (that we already knew of course) currently affecting him and his quality of life. A reminder that every patient’s story and definition of “doing better” is always more intricate than the current issue at hand.

This man is a palliative patient. He knows his condition is end-stage and will continually worsen over time, which made it even more heart touching to hear him say he was fighting to stay with his family and grand daughters. How much of an inspiration your loved ones can be…

Vietnam Week 3: Nov 7-9, 2011

Third week in the hospital!

Interesting observation… many attempted suicide patients are admitted into the Tropical Diseases department on a weekly basis. Most popular poisons are: paraquat, paracetamol and other herbicides/insecticides.

Unfortunately, a lot of patients don’t make it back home, especially those who have used paraquat. In Vietnam, paraquat comes extremely concentrated, so treatment cannot be given fast enough and patients end up dying. The family is consulted and then they can decide whether or not to bring the patient home to die.

Many people, however, are fortunate enough not to have taken a lethal dose of poison, or are given an antidote in time. Sadly, VN has not reached the standard of care as in Australia/Canada. There is no mental health/psychiatry aspect to health in VN and attempted suicide patients are sent home as soon as they are better. Doctors do make an attempt to understand why patients tried to take their lives and to persuade them not to do it again, however, it does not extend any further than a short conversation in the public environment of a patient room with at least 10 other people within hearing distance.

It’s really too bad because some of those patients will definitely attempt to suicide again, and will most likely succeed. This was one of the biggest differences we noted within the Vietnamese health care.