My mental health

Image

I’m really sorry that I haven’t been discussing my own mental health very much at all. I started this blog with the intent of documenting my experience of working in mental health and being treated by mental health services. It seems I am being let down by my local mental health services who have failed to find me appropriate talking therapy sessions that do not require too much time off work within 6 months of turning up in at the GP not being able to cope. I wasn’t shy about my inability to cope with my distressing intrusive thoughts either. I was told the service aims for a one month turnover time.

As I have spoken about in a previous post I am lucky to find that my job provides relief to my symptoms (though can also often trigger thoughts and neutralising behaviours). However, it is sadly too common for people to hang about at the end of seemingly limitless waiting lists and I feel very peeved now I am another digit added to the statistics.However, because I have a lot riding on my side that let’s me get on with life and bottle up the unwell bit of my head I feel guilty demanding to be seen. I demand that if you are having trouble accessing services that you try extra hard to play for your own team and contact the service providers to see what is happening instead. I joke about the demanding part but I can’t encourage enough.

I really want to share my experiences overcoming detrimental thoughts and behaviours rather than detailing my symptoms. I think blogging about mental health is very important and the support it provides helpful and I want my blog to focus on recovery and how I will stop being a secret anxious wreck. I talk about my thoughts on OCD and some of my experiences in a previous blog post ‘Oh yeah, I’m definitely a little bit OCD’.

Please stay tuned. 

Image

Advertisements
Standard

Reading between the lines with Professor J Meirion Thomas

Image

A few days ago the Daily Mail (UK) ran an article by a professor of surgical oncology about the ‘feminisation’ of the medical profession damaging the NHS. It’s own title considered it a powerful argument. I have a number of thoughts on this.

As with almost all sensationalist articles in the Daily Mail it is not the headline theme that is the most concerning but the actual writing and ulterior messages hidden in plain sight. But I will get to that in a moments thought.

Like a lot of generalised bigoted statements there is, somewhere deep down, a tiny shard of something resembling truth. Like a lot of generalised bigoted statements the article I am discussing is a rather crude argument. It seems that doctors who are women choose to have jobs that have been traditionally associated with flexible hours such as GP. The writer states his opinion that women who choose to train as a GP and who choose part time posts do not earn the £500,000 the tax payer handed over to the NHS to train them all those years ago as medical students. The NHS is having to train multiple doctors to fill one post and is, therefore, depleted on vital funding.

What is not  discussed or illustrated is how many of these GPs are part time and how many part time doctors (no matter what speciality) are male and how many female. It is also handily ignored that the same data that shows high numbers of women in GP land (equal men and women) and low numbers in surgery and orthopaedics (genuinely low numbers) appear to show equal numbers in paediatrics of men and women and comparatively low numbers of women in psychiatry. Both of these latter jobs can be equally community based and flexible or acute admissions and very taxing on time and emotion. Why would women who are supposedly, according to the writer’s opinion, after flexibility and low hours choose paediatrics over psychiatry? It may not be because one is more flexible than the other as psychiatry is often seen the cushier career in medical circles. There must be something else that puts women off. That is of course speculation. Now I am not implying here that the author of the article in discussion was reading data how they wanted to, I just can’t see what that particular data set shows about the numbers of doctors in part time work.

It is also never mentioned that men also take part time posts, or that people take part time posts to care for private patients (the article predictably only cites child care as the reason). Nor is there statement that of all medical students trained more than 70% need to become GPs to fill essential posts. At no point is there a hint that for many specialties in medicine there are a scarcity of consultant posts particularly in extremely niche specialities such as surgical oncology which are generally filled by the old hands who are largely male. It is also not mentioned that the NHS is in dire straits for a multi factorial mire of reasons. It is mere presumption that women fill these naughty part time positions. There are no facts here.

Image

With the headline message so easily toppled I will move on to what really concerns me. I find it odd that the writer describes themselves as a feminist, however goes on to thoroughly disprove that. Professor Thomas has chosen to write an article about women in a newspaper that famously degrades and is appalled by women for a start. He also speaks about these doctors (women) who wish to be part time as though they are faceless, spectral phantoms, hardly corporal in the fog of GP land and as they are so un perceptible they read as so much more terrifying! What are their motives?! Well, Professor Thomas also describes these but can only dream up rather two dimensional concerns for these women he has presumably never met, being a hospital doctor. They want to breed. They want to raise their children. But they also want high paying, part time careers. I was hoping whilst reading that the writer was going to reference the qualitative study of female doctors of reproductive age career choices because I am not familiar with the current evidence.

It also appears that he blames women for these reproductive desires. I would have thought, being a feminist, the suggestion that both mother and father take responsibility and society work to accommodate this would have featured in the argument. Women have protected rights to maternity leave and pay that men just cannot rival. Perhaps we should remedy this in British society is a suggestion not made by the professor. It is lucky that there is a short sentence dropped in to the end of the article imploring us to persuade women to ‘lean in’ and aim for career fulfilment otherwise I may have accused Professor Thomas of not being a feminist at all! I would also think a feminist would be aware of how disastrously underrepresented women are in science, medicine, politics, economics and business worldwide but I will forgive that slip from general feminist ideology as the article stipulates that it is NHS doctors on the block, not the rest of ’em. Also, why would any feminist feel a group of adult, intelligent women should be told what to do by a socially formidable man at the top of his career? Sorry I may have read as slightly snide there.

My next point is actually something I consider genuinely sinister and is endemic to what I can be referred to as sensationalist Daily Mail articles. Around two thirds of the way through there is a subtle change to the meat of the discussion, becoming rather anti GP and anti BMA for no apparent reason and with no actual justified explanation. As with the writers explanation of what is wrong with an imminent female majority of doctors it is all a lot of hearsay and generalisation. Worrying stuff as the Daily Mail is well known to hide the real take away message away in the main body of a bigoted load of guff so that it gets reposted everywhere (with mandatory scornful caption about the anti women, feminist surgeon) and nobody really realised it. Is this article targeted at GPs and the BMA? All is fair in discussion, especially in the NHS, but shouldn’t such a powerful figure make clear what is fact and what is rumour and opinion?

anyhoo, in an ideal world (my ideal world), Professor Thomas would consider the above and other criticisms of his article and rewrite. I suggest a new title of: Concerns as female doctors vastly underrepresented in surgery for unknown reason: NHS funding in distress for multi factorial reasons.

Image

Yeah, Power!

Standard

Happy Wednesday

Happy first holiday off from work for me. A lucky instance which surely will not happen again! Happy day to all 🙂

I have fortunately felt well over Christmas possibly because I am very lucky in the support I have now. If you do find nothing but guilt, loneliness or obsession please don’t stop and sit still and stew on it and let symptoms get the better of you. Talk about them and seek out some support (even to anonymous people on the interweb). Spinning the yarn about my symptoms was the best thing I have ever done for my own well being.

Standard

Lunch break and self reflection

I’m sitting in the doctors mess on my own for lunch thinking about the effect work has on my symptoms and vice versa. Mainly because I am also flicking through the BJPsych and reading an epidemiological review article about suicide by occupation. Pleasant lunch time reading.

I find my work a very protective factor against my symptoms and my ability to cope with intrusive thoughts. True it keeps me incredibly busy and I have little time to focus on them but I also suspect that the vast responsibility of my role and the empowerment of finally fitting into a sociological slot where I can preform a functional role and preform it well helps the underling anxiety that perpetuates my OCD. I feel more confident than I have done in years. And in fact the worst that this OCD has ever been was just before I started work. When all the the responsibility was bearing down on me with none of the benefits of action and being rewarded with the knowledge that you have acted correctly. That was at its most unbearable and it was then that I had intrusive thoughts about harming others and intrusive thoughts of a sexual nature.

At the moment I am back to my usual intrusive thoughts of monstrous paper cuts that saw through sinew and tendons and blood vessels. Probably because now I have moved to psychiatry I’m handling more paper than electronic notes and resources. But it may also be because I contemplate more about mental health in general as its a subject that fills the hours of 9am to 5pm every day that I work. I also make less fundamental decisions about a patients treatment as psychiatry is quite a senior lead field. And so less responsibility.

My symptoms do also affect my work a bit. I am not able to leave a job undone. i had always assumed i was very lazy and just able to let go of a task with ease. I can also worry excessively and into the night about decisions I have made but I am working on that.

Bottom line is I feel work is protective not just because it fills my time and fills my thoughts but because I feel satisfied and productive and empowered.

And the article I am reading; the meta analysis suggests that people in low skilled professions (they quote labourers and cleaners) are at higher rates of suicide than age matched controls of people in work. This is also the group least investigated in current research on the subject. This risk appears to reduce with skill level and lowest risk in occupations with a managerial role. Though the classifications of occupation used in the study were no more specific then that.

Anecdotally people talk about certain professions being associated with high risk of suicide due to access to the tools of suicide such as farmers, veterinarians and doctors and those with jobs that have high levels of stress. Perhaps, and this is just pure supposition, there is also an element of lack of fulfilment and disempowerment.

The article I have talked about is in this months issue (December 2013) of the British journal of psychiatry:

Milner et al
Suicide by occupation: systematic review and meta-analysis

Standard

What’s happened to my talking therapy?

Hmmm it has been 6 weeks since my first talking therapy. Unfortunately I couldn’t return at the same time the following week because of work so I have had to get back in the queue and it is the only appointment I’ve had so far.

I had originally waited 4 months for that appointment too.

This is a real problem in the UK and is the reality of treatment here.I am a bit bitter about it. It’s difficult to kick up a stink though when you know for a fact it’s the same for everyone.

Standard

‘Too right you should stop smoking!’

smoking

Having just moved from a rotation in medicine a small amount of my work related conversation has centered on an issue that has piqued the interest of the UK media. Smoking on hospital grounds. Unfortunately for me this is a shuddering boring topic. Smoking is currently banned in public places in the UK including hospital grounds but is rarely enforced. There is an almost permanent gang of staff uniformed, dressing gowned and saline drip in situ smokers just within arms reach of any hospitalized dwelling. No I cannot condone smoking on hospital grounds and yes perhaps it should be enforced. Smoking is exhaustively terrible and causes irreparable damage to the body in a large number of cases.

A few questions last week that have made me think a bit more about something pretty dull. A consultant I worked for who knows about my psychiatry aspirations asked about my opinion on public health and psychiatry and why on earth do we not emphasize smoking cessation to patients in mental health services. A medical student on our ward also asked me why, why, why do people keep smoking despite severe health detriment? And in the Guardian Clare Allen wrote about the thoughts she had about enforcement of smoking cessation in inpatient psychiatric units in an article titled ‘There’s worse things than patients smoking outside hospitals’.

Allen talks candidly about her experiences of being a smoking inpatient in a psychiatric unit and describes the evolution of the pretty abstract concept of the ‘non smoking room’ to what she refers to as ‘the lung’ (a hilarious name for a smoking room) and then to the scheduled and escorted outdoor smoking gangs that I am used to.

Unfortunately smoking has its benefits in the world of inpatient psychiatry. It is a social activity that doesn’t involve much effort or strain, is a freedom in a world of limited choices and a literal and not so literal breath of fresh air off of the ward. Allen describes in her article the isolation and tedium of being cut off from this scheduled interaction by the decision to stop smoking. She also highlights the ‘good thing too’ attitude people have to the call for the end of smoking privileges and the blight of smoking on the therapeutic environment but she also points out these same voices often have little to say about what is essential to a therapeutic environment such as ‘decent, healthy food, for example, access to fresh air and exercise, talking therapies, even massage.’

I agree. Smoking should probably be banned on balance but we need to provide adequate therapeutic replacements to the fairly shoddy semblance to choice and interaction that smoking provides.

Public heath in psychiatry is a complicated issue as people with mental health issues are at greater risk of many physical health problems and have overall poorer access to public health information. It is also the role of the team involved to preserve a persons right to make unwise decisions when they have the capacity to do so, however. It is also worth considering that there is more to public health then just smoking and we should be discussing those issues as well. I will sit on that thought for a bit.

And that is my answer to my consultant. My answer to the medical student was a lot less measured; I got a bit carried away with trying to appear cool.

Standard

Overheard on a medical ward: an FAQ of sorts

Even medics says things without really thinking. In our most unguarded moments we say things to each other (and patients, nursing staff, relatives etc) that is just plain guff.

Here are some FAQs from my colleagues on the subject of psychiatry.

(authors note: I have said some blinders in my time but that is for another post)

Psychiatrists don’t need medical knowledge to practice so should it really be a medical speciality? Wouldn’t making it a separate degree subject help solve the recruitment crisis?

Any psychiatrist worth their salt requires general medical knowledge. I shall prove it to you.

1. Psychiatric patients suffer from medical issues. Like all of us. Some patients with mental health problems are even more at risk of certain illnesses eg heart disease. A psychiatrist should be able to deal with emergencies such as an asthma attack, a heart attack etc as well as general issues like reflux. If someone is acutely admitted you are the only doctor around and people can’t pop out to visit the GP.

2. Psychiatric medications have complex medical side effects. Including some emergencies that can be fatal (though thankfully extremely rare). Older medications can cause movement disorders, newer ones can lead to weight gain, diabetes and heart disease. A psychiatrist has to know how to treat these complications.

3. Psychiatric patients can have poor motivation and complex lifestyles and may have very poor contact with health services. These patients need treatment for chronic health conditions as well as inclusion in public health campaigns eg cancer screening, smoking cessation Etc. A menral health specialist may be their only health service contact.

4. The mortality figures in psychiatry show that currently people with mental health issues generally die of problems related to heart disease. (Not suicide / homicide).

The converse is true as well. Medics need psychiatric knowledge. Remove psychiatry as a medical speciality and it will swiftly drop from the curriculum and people’s priorities. Like it or lump it mental health is extremely common and pops up everywhere. When was the last time a medic learnt about dentistry?

If it is the brain that interests you why not neurology?

I get a lot of people trying to turn me to another profession. The theory of neurology is interesting but its just a bit dry for me. It’s like learning about the circuitry of a computer rather then getting to play it. It’s too dry. All it seems to be is about anatomy and I don’t think I could learn anything about what it is to be a human from that and I feel like I owe it to myself to pursue that interest. At the end of my career I want to feel like I slightly understand human creatures better.

There is lots of psychiatry in GP. Why not become a GP?

Because I want to specialise. Like you did Mr respiratory consultant.

Psychiatric patients don’t get better. Won’t you find that frustrating?

A lot of people do get better particularly with anxiety problems and depression. Some people’s lives re extremely improved with help. Some people become worse and worse yes. There is no medical speciality without its chronic illnesses that cannot be ‘cured’ eg diabetes, COPD, heart failure .. I could go on. No doctor can tell you they have no patients that fail to improve despite everything thrown at them. Or patients that don’t engage.

I will not find that anymore frustrating then treating Parkinson’s or diabetes or lung cancer.

Doesn’t it frustrate you that their is so little science / evidence in psychiatry?

No it doesn’t as there is a wealth of research going on (a lot of it is quite corrupt though…) and so much room for development. The problem of evidence basis is endemic to medicine not just psychiatry. This question may crop up a lot due to the fact medical schools still teach the mono amine theory of depression and not much else. A theory that is pretty much bogus to current psychiatric opinion.

Nobody notices when we are learning old hat theories for everything else though. Medics make the worst scientists as we are resistant to change and have very little spare time for keeping up to date.

I’m sure there are more but I’m late for work. Last day blues! I love my fellow medics really and like I say I run my mouth off a lot too.

Standard