Thursday 15 April 2010


How do you practice psychiatry in hospitals, and clinics, as folk in the USA mostly do, with folk who have dementia?

I ask in the spirit of genuine inquiry since I find visiting folk at home to be a core and wholly necessary part of work. The bit that's most useful is, of course, the patient's fridge.

It's always good to look in a fridge, I find.

There's the opportunity to see what food and drink's in it. One once was stacked full (so full you couldn't see the fridge light at the top) of beer. An opportunity to talk about alcohol use and the amount drunk.

One had nothing in it but milk for tea and plasticky cheese slices. An opportunity to talk about diet and opportunistic health promotion.

One today had a mix of things. Greens, mostly. But not in a good way. The fridge was filled with food that was covered in green fur. Or, on some of it, black mould. In addition to the varied diet of mouldy food (the food long since obliterated so I've no idea what it originally was), was what Withnail and I would call, "matter."
Just semi solid stuff, composting down, with dark greenish black fluid seeping out of the bottom.
An opportunity to talk about a suboptimal level of function.

You can look in a fridge and see if food's out of date. "What is the date today, is this in date?" An opportunity to test orientation and decision making, without abstract instruments irrelevant to our patients but instead with tests of ecological validity.

Using fridges works too. "Fancy a cup of tea, doc?" "Why yes, thank you kindly, I rather would." Do they go straight for the tea or hunt around several cupboards for it? Do they sequence with cold water in the kettle, then heat it, then mix hot water with tea, leave it to brew (but not for too short or too long a time), place the hot tea in a cup, add milk, all in the right pace and order? Is there a tremour? Do they get muddled? Is the milk in date? An opportunity to talk about organisation and sequencing.

Seeing someone at home, seeing what's in their fridge and how they use it, beats 20 minutes of questions in clinic any day!


XE said...

Very interesting to hear your perspective, thanks Shrink!

Mark p.s.2 said...

Great detective story!
Absent mindedness and depression let things go downhill.
No one minds the store.
Attempting to keep people functional must be a difficult job.

Unknown said...

Very good :).

Before drinking the tea, you need to check the milk is in date.... mind you off milk tends to disintegrate on hitting tea anyway.

Off milk makes me barf, as a student I got very good at sniffing any carton before pouring from it.