All liaison referrals from the acute hospital come to our liaison team. The nurses (who do almost all the work) discuss every patient with a Consultant Psychiatrist (erm, me). This matters to me. The nurses are excellent at mental health assessments. It's what they do. More, they're excellent at sharing with nurses and managers on the acute wards how to manage their patients.
My input is sometimes into the psychiatry, but usually into the medicine. They are, after all, so medically/surgically unwell that they're needing hospital in-patient care in a hospital that never has enough beds. Medical problems often contribute to presentations, medical interventions can contribute to solutions.
So, a mental health nurse and I explore the issues of every referral.
This results in odd side effects. One side effect is that my nursing colleagues know me well enough to know how I think and the sorts of things I think of and what I like to sleuth out.
A patient was referred last week with low mood and onset of mild confusion. I'd not normally accept such a referral but won't disclose the reasons why we did. Suffice to say, my nursing colleague picked it up and sorted it out. We discussed the referral, she saw the patient, she met with me to discuss it and explained her thinking. The patient was weary and low because they were in hospital (and didn't want to be), were in severe renal failure (and didn't used to be) and critically was digitoxic.
Her high digoxin levels, presumably either caused by changed renal function, or by staff administering it to her regularly (when she'd been less compliant at home) had resulted in dangerously high blood digoxin levels, which explained her symptoms she was referred with along with other symptoms which she had. A previous patient, on digoxin, had resulted in me checking their levels (which were normal) so my nursing colleague had learnt from this and considered the digoxin in this case. The medical team hadn't noted that. They'd not even requested digoxin levels, my nursing colleague had.
A good pick up.
I think my nursing colleagues are very clever :-)
Working with a doctor who actually acknowledges their intelligence and contributions would also help, I think. It is interesting how motivating it can be when you feel like you can make a contribution by thinking and not just going through the motions. :)
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