Monday, February 06, 2006

Now I know why I became a medic

After reading Shiny Happy Person's comment about her name being the link for Random Acts of Reality's blog, I attempted to change it. Only to find that when I accessed the template page I had the links up for both Shiny Happy Person and Random Acts of Reality on separate lines and in separate links. So now I am confused (and it does not take a lot really). So instead I have decided to leave it be for the moment and apologies to anyone who gets taken to the wrong webpage but I did try and attempt it later in the week when my brain may be functioning slightly more. Technology has never been a strong point of mine (well at least not computer technology). Anything other than medical equipment tends to fail on me, although I was known on the ward when I was a medical PRHO for having an amazing ability to make a 12 lead ECG machine go totally haywire. Luckily though over the years I have perfected my technique and now only have small problems with infusion pumps and only then because I forget that half the one's in the hospital actually have no battery life anymore and have to remain plugges into a mains electricity supply. Never mind, it's all a learning curve.

What do you all think of the new layout? Personally I prefer it, if only because I can read it more easily without having to grovel around in my bag/coat pocket to find my glasses! I am that blind, which is shocking really and I need to invest in contacts but the mere though of them makes me squearm. In other news I have moved jobs (again) back to critical care. For the next 6 months I am based on the clinical decisions unit and observation ward attached to the A&E department but am accountable to critical care (that is intensive care and high dependency, where I will also spend some time). There is more on the use of CDUs and obs wards here in an article from the BMJ. Personally I think they're just a "push the patient out of an A&E cubicle" solution and in the case of CDUs just an incentive to get patients out before they breach the 4 hour rule. I'm not complaining though, it means I'm going to spend a better 6 months than I did in admissions where I felt my sole purpose was just to stick drips in people, write up painkillers, look at ECG results and tag around with the consultant at ward round writing up his notes.

I'm sure it'll be hell for the first few weeks, although I'll know a lot of the nurses from the rotation I did in A&E earlier in my career so that should be fun as a lot of them are hilarious to be around. It means longer hours which my fiancé is not too impressed with as he's already doing enough hours (as a surgical registrar - mad soul) and thinks that I should become a GP. I hate that typical male sexist view that just because I am a 26 year old woman who has done her basic medical training I should now pack up and move into general practice because it's seen as a more female environment. I don't want to be a GP (no offence to GPs) because I like critical care and emergency medicine, I like the variety it brings along with the adrenaline which you don't get in primary care. You may get the variety but not the adrenaline and no where near the buzz from working in that environment. Plus, I won't just be seen as a female medic who will get married, settle down and have children and become a part-time salaried general practitioner. The whole issue of it annoys me.

There also appears to be a spark of interest in the media at present with self-harm. The Times covered two stories on the issue on Saturday in the health section and on the front page of Sunday's edition. Maybe it is because the government realises what a crisis the NHS is in when it comes to self-harm and many mental health issues in general. I found a large proportion of self-harm when I worked on admissions in the case of overdoses as the patients are admitted overnight and I expect to see a lot more of it now I'm back in critical care through overdoses and self-mutilation. It scares me to see the figures of self-harmers admitted to hospitals these days. I know that when I trained to be a doctor hardly any emphasis was put on self-harm in psychiatry lectures and rotations and a nurse I worked with once who had been an A&E nurse for 18 years said she couldn't remember the proportion of self-harming previously that is seen at present. I took a special interest in it during my mental health module, probably because of my history, and when I worked in A&E I always offered to treat the patients who were in the department because of self-harm or who were deemed to need psychiatric intervention by the triage nurse.

Many doctors take a dim view of self-harmers and I know a lot of my colleagues will be "tut-tutting" at the idea of giving them clean blades to use as it may encourage them to self-harm and therefore they will clog up the emergency departments even more (their views, not mine). It is true that there is a proportion of patients that will attend an A&E unit on frequent occasions having self-harmed but this is symptomatic of the nature of it, it is habitual and often increase in severity the longer it goes on. For the same reason this is why on admissions we had patients who had 6 or 7 piles of notes for previous admissions to the unit following overdoses. However, in the case of clean blades it could be said that prevention is better than cure and preventing infection is paramount, along with education into how to cut safely, thus avoiding major injuries.

Maybe you have to have been there to show the sympathy and empathy that these people need. It is a very vicious circle that I think needs a lot of specialist training to comprehend and unfortunately many NHS trusts don't have the resources (despite the National Institute for Clinical Excellence's guidelines stating all clinical staff should be given training if they come into contact with self-harmers). In the trust I work we are lucky that we have a deliberate self-harm team who assess people admitted following acts of self-harm but that is the end of their remit, they can discharge people, refer them to community mental health teams/psychiatrists, or have them admitted to an acute psychiatric unit, most of which is not what the self-harmer (in my opinion) needs. They need short-term intensive intervention when they are discharged, followed by long-term support. The former to prevent them from self-harming so badly again and not feeling as if they have been rejected and left and the latter to help them understand the condition and any triggers behind it.

Then again I have the experience, I self-harmed, and therefore think I am more aware of the needs and I know NHS trusts are overstretched already and are doing the best they can.


Anonymous said...

i have sh for since i was 7 (i'm now 24) so i am well known to my local a&e. depite there being a psychiatric liason team in the hosp i go to on my last few visits i have been informed that i will be referred (i'm always out of hours) then hear nothing.

MJ said...

I can relate to this problem as I have heard patients here say the same thing. I think the liason psych team are there as a short-term intervention and have a habit of promising referrals too often. You do know that if they say they are going to refer you and you hear nothing that you can chase the referral up through your GP.
Hope things are OK,

NuttySurvivor said...

As someone who used to cut (self harm-free for over a year) I found that the problem was completely ignored by the mental health team looking after me, but on the one occasion I went to A&E for stitches, they were marvellous, and I haven't cut since.

What I do find amusing is that having tried to kill myself three or four times by overdose, on each occasion it has been written off as self-harm, presumably because self-harm looks better in the stats than a suicide attempt.