Monday 29 June 2009

Girl on Girl Action

We reviewed a lady in a care home. She was, "causing a disturbance."

She was holding hands with other ladies, talking suggestively, then at times cuddling, stroking and kissing them. She and the other ladies all have advanced dementia.

The care home sought advice on how to manage this.

Knowing my foibles, they'd already looked for delirium, considered diet and fluids and constipation, arranged for a district nurse to do bloods to exclude infection and common physical causes for acute on chronic confusion and sussed out and documented what the circumstances of this behaviour were.

A life long heterosexual woman, with an active libido throughout her life, she sought companionship and intimacy with accessible men.

Her dementia cued her in to selecting men through one principle determinant, which of a fashion makes sense. She'd progress amorous overtures to anyone in trousers.

I don't have a pill to stop that one.

Tuesday 23 June 2009

Continuity of Care

Do patients like continuity of care? Or is it that folk favour a fresh pair of eyes and a new team looking at things?

There's been an irritating practice of late, in my corner, that as soon as someone turns 65 years old, they're referred from their existing working age adult mental health services, to mental health services for older people, and to me. It's flagrantly outwith our Trust's graduation policy, they're all read, shredded and filed carefully in the bin with a succinct letter back to the referrer, but it got me thinking.

Locally, patients we asked favour staying within existing services and didn't want to move on the basis of age alone.

Happily, 2 local audits of working age adult patients (well, they were called audits, but they were surveys) found that patients feel the same way that I do. If they've clinical reasons for being under my care, with stuff that I can do better, I'm keen to snaffle them on over to my corner. If they've no reason to transfer care, I'm keen for them to stay with their existing team.

Surely transfer of care on basis of age alone, not clinical need, is flirting dangerously with age discrimination, no?

Monday 22 June 2009

Complementary Therapy

I work as a psychiatrist. Having trained as a GP and delivering all liaison psychiatry, I've a bent towards folk presenting with physical comorbidity. In my patch if you're physically unwell and have mental health problems, it's common that someone refers you to my door, or invites me to a case conference to throw in my 2p worth.

It was at just such a fortnightly meeting at the local district general hospital that I was delighted by the succinct, acerbic quip 'bout local independent practitioners.

A young lady had long term back pain, with a degree of sacroiliac and hip pain. Practical treatment had been of some benefit, but the crunch was that she'd knackered joints and a frenetic lifestyle/busy family so couldn't pace herself at a comfortable level. She'd seen a someone about her back between appointments (a chiropracter) who I'd not known, so when the Consultant was describing her care over the last month and mentioned this name, and I asked who this clinician was, it was with great candor that a physio chirped up, "Oh, he's the local quack. Rub you anywhere if you cross his palm with silver."
The lady was no better from seeing him. Apparently, few folk ever are. Ho hum.

The very next patient had problems after a below knee amputation after trauma. Again, discussion on practical and psychosocial and pharmacological management of his care. Young bloke, bad motor bike accident, loss of job and self esteem and social life, not doing too well. He'd also seen someone to help him, an osteopath to, "get him moving again" and sort out, "back spasm" that was, "stopping him walking." The name of the osteopath was not known to me. I asked who he was. It went quiet as medical collegaues tried to think how to frame it, but a physio who knew him well interjected helpfully that he was, "A charlatan."

Clarity of information, I love it. One of the perks of working in old pit villages, people call a spade a spade. As one old man said to me today, when I was asking about diagnosis and how much he sought to know of his dementia, "Tell it like it is, lad. Just tell it like it is." Complementary therapy better deliver meaningful outcomes, because if it doesn't, local folk sure get the measure of it pretty sharpish. And to date, results in my corner are woefully shabby . . .