tag:blogger.com,1999:blog-8489009971732520747.post9053790581616130148..comments2024-03-24T07:19:28.136+00:00Comments on Lake Cocytus: Continuity of careThe Shrinkhttp://www.blogger.com/profile/10009039342346247138noreply@blogger.comBlogger15125tag:blogger.com,1999:blog-8489009971732520747.post-52049769908144578212008-09-02T22:24:00.000+01:002008-09-02T22:24:00.000+01:00Oh Shrink, please can I come work with you?!The BI...Oh Shrink, please can I come work with you?!<BR/><BR/>The BIGGEST complaint I have from my patients is that they just get used to one Dr then they are off and they have someone new. Our Consultant sees patients once in a bright pink with purple spots on moon. <BR/><BR/>Your example about inpatient wards was spot on - I've had patients admitted in teh past and the wards discharge them with no consulattion with the community team...<BR/><BR/>The only continuity of care patients in our team get is from the CPN's, and I'm not saying that with a big head, it's the truth.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-60943568757126859372008-09-02T14:59:00.000+01:002008-09-02T14:59:00.000+01:00Perhaps the answer lies in patients actually choos...Perhaps the answer lies in patients actually choosing their psychiatrist - like they do their GP or their mechanic - rather than having one foisted upon them.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-29064372945055854022008-09-02T02:41:00.000+01:002008-09-02T02:41:00.000+01:00Hmm, I ballsed up the link. Sorry about that. :-)Hmm, I ballsed up the <A HREF="http://abysmalmusings.blogspot.com/2008/08/new-psychiatrist-same-old-same-old.html" REL="nofollow">link</A>. Sorry about that. :-)Davidhttps://www.blogger.com/profile/08250441382312532991noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-49349533182803565322008-09-02T02:39:00.000+01:002008-09-02T02:39:00.000+01:00Excellent post. Absolutely spot on bang the nail b...Excellent post. Absolutely spot on bang the nail bullseye.<BR/><BR/>I remember your positive input when I bemoaned this situation:<BR/><BR/>http://abysmalmusings.blogspot.com/2008/08/new-psychiatrist-same-old-same-old.html<BR/><BR/>The thing about the "therapeutic relationship" is that it often takes months for people to open up, and blimey, I for one still haven't told any of the professionals any of the worst stuff, and the same goes for blogging. You have to feel you know and trust a person, and that they have a feel for you, and a trust in you and your own judgement. Otherwise it is all stone-walling and misery.Davidhttps://www.blogger.com/profile/08250441382312532991noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-39824002770977747942008-09-01T20:20:00.000+01:002008-09-01T20:20:00.000+01:00(is there an e-mail where I can reach you?)(is there an e-mail where I can reach you?)Ms-Ellisahttps://www.blogger.com/profile/14222338450219683633noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-3654159900943849522008-09-01T12:21:00.000+01:002008-09-01T12:21:00.000+01:00As I said in my blog - I think that is a better wa...As I said in my blog - I think that is a better way of working for everyone, patients and staff. Gives us doctors a sense of knowing our patients a lot better and I think a better therapeutic relationship is achieved. I know most psychiatry teams working with older people still work in the geographical model - as I said before, kicking myself for not having got a SpR post in your field! Have decided to harrass deanery and try and dual train....Anna O.https://www.blogger.com/profile/18362595466004699101noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-68258396751064763262008-09-01T10:06:00.000+01:002008-09-01T10:06:00.000+01:00I agree with your post but thought I'd add a few r...I agree with your post but thought I'd add a few ramblings, I think the idea of a hospital and community consultant system is awful and ghastly, but in some areas this is the way the consultants wanted to work. Personally, I much prefer the mixture of both so that consultants retain skills for both inpatient and community work and the obvious continuity for the patient. <BR/><BR/>Which brings me on to my other point. Apart from early intervention, other teams, eg crisis resolution teams etc should be an addition to the existing care package. In areas I've worked in, the existing consultant, CPN, SW etc remain involved and a short term plan is agreed with a crisis team to provide additional support, for example to try and support patients at home rather than in hospital. If admission to hospital proves necessary the care co-ordinator (who may be a SW, CPN or the RMO) and team remains involved again to provide continuity.<BR/><BR/>The point that screams through your whole post is that sometimes none of these different parts of mental health services communicate with each other, which is a problem highlighted in many mental health inquiries. <BR/><BR/>I think the other contributing problem in acute psychiatry is that in some areas staff turnover is rapid and the use of locums and agency staff is high, this really hinders any continuity for patients. The other difference in adult secondary care as opposed to primary care is that much of the follow on care for relatively settled patients falls on junior doctors, so if you have a review every six months you will never see the same doctor each time.Quacktitionerhttps://www.blogger.com/profile/11117889732244151208noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-56204241567990561122008-09-01T08:00:00.000+01:002008-09-01T08:00:00.000+01:00It certainly seems a better way of working. We hav...It certainly seems a better way of working. We have currently, a unified system of care for older people (and probably in CAMHS too but I don't know about them too much) but that's mostly come about because our community consultants have their 'own' wards and the crisis team doesn't work with over 65s.. I think there are far more different services in 18-65s that need to meld together - but I don't think anyone can argue that continuity of care is a good think all round.Cathttps://www.blogger.com/profile/12652768793937457682noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-72432856819475298852008-08-31T23:38:00.000+01:002008-08-31T23:38:00.000+01:00It appears I'm too late. Following what appears to...It appears I'm too late. Following what appears to have been a sham public consultation, loaded with tendentious "Would you like a really nice, new place, full of loads of doctors and nurses so you won't have to trek all the way to hospital" type questions, OldPoshshire PCT is about to open its first "Extended Hours Health Centre". But diplomatically not calling it a Polyclinic.Socrateshttps://www.blogger.com/profile/12525104555859213125noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-58762172496947162162008-08-31T23:19:00.000+01:002008-08-31T23:19:00.000+01:00This is for the most part true - where I live ther...This is for the most part true - where I live there are community MHT and then there is the hospital team - I don't think they talk very much. My Psychiatrist is a Community Psych when I was admitted I had a different one (God complex he had) and when I saw the Crisis Team it was a different Psych (pompous pratt) again. Now I won't see anyone but the Community Psych (who is brilliant) and the Social Worker (also brilliant) and guess what they actually talk to each other. <BR/>My GP is brilliant (salaried partner) too as in the Nurse Practitioner (salaried partner) and the Practice Nurse.<BR/><BR/><BR/>Ill be there on the barricades not for Doctors but for me and the care I want.InExhttps://www.blogger.com/profile/07519339413883688386noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-72302592292752269352008-08-31T20:11:00.000+01:002008-08-31T20:11:00.000+01:00Cellar Door, that would probably worked better as ...Cellar Door, that would probably worked better as "I'm a pretty nurse, please". Point taken Shrink, heading over to the PCT's website to look for signs of malignancy...Socrateshttps://www.blogger.com/profile/12525104555859213125noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-46601535559443547452008-08-31T19:10:00.000+01:002008-08-31T19:10:00.000+01:00I couldn't disagree with you!Continuity of care bo...I couldn't disagree with you!<BR/><BR/>Continuity of care both helps the patient and the physician.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-87493564508843651092008-08-31T16:51:00.000+01:002008-08-31T16:51:00.000+01:00Can I come and work for you when I'm a nurse prett...Can I come and work for you when I'm a nurse pretty please?cellar_doorhttps://www.blogger.com/profile/09829516373761878813noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-67701952340891346752008-08-31T16:39:00.000+01:002008-08-31T16:39:00.000+01:00I have to agree with all that you have said in thi...I have to agree with all that you have said in this post. I have been lucky with my GPs over the last 15 years (two different practices, the change being necessary because I moved from Cambridgeshire to London; three GPs in total). I feel that continuity of care is important for all, but particularly those with chronic problems, and especially those with mental health problems. I have also been lucky with the two members of staff who I have seen at my local Mental Health Trust. <BR/>I need to feel comfortable with the person that I am talking to about my problems, that is not possible if I have to see a different person every time. There would be no opportunity for the doctor to get to know me and to be able to properly determine my state of mind. He would be unable to determine whether I was entering a period of depression, coming out of it, or just muddling along from day to day. More importantly he would not know what signs to look for in me, to ascertain whether I was suicidal or not. <BR/>I have in the past had a nasty encounter with a locum, whose only suggestion was that I be admitted to hospital. Fortunately, the practice nurse who was familiar with me and my depression saw me as I was making a hasty exit from the consulting room, and was able to tell me to come to the surgery on the following morning (this was in the days of regular Saturday morning surgeries at the local GP's) when my GP would be on duty and he would know how to deal with me. She even left a note for my GP telling him what had happened so that he knew what sort of state I would be in when I came to see him the next day. She also phoned some friends of mine, explained to them that I was in a bad way, and asked if it would be possible for them to take care of me that evening, so that I didn't do anything silly.<BR/>Hospital would have been totally wrong for me; my problem was caused by the fact that in a few days it would have been my 25th wedding anniversary, so what I needed was a bit of company and TLC. Familiarity with me and my problems meant that I could be cared for in a way that did not make me feel worse than I already was. Polyclinics wouldn't allow this to happen and that is why I will fight against them in any way that I can.madsadgirlhttps://www.blogger.com/profile/02406362172304786268noreply@blogger.comtag:blogger.com,1999:blog-8489009971732520747.post-65585375825256720632008-08-31T16:28:00.000+01:002008-08-31T16:28:00.000+01:00I am quite jealous of your style of practice. Here...I am quite jealous of your style of practice. Here, all care is equally fragmented as you describe.Sarahttps://www.blogger.com/profile/15606922510495018342noreply@blogger.com