Sending out an SMS

I have been supporting a client for the past month and a half exclusively by text message.  Has anyone else done this sort of thing?  Usually we would discharge a client if we went more than 30 days or so without face to face contact, but in this case the client is at a high risk for suicide, so we wanted to try and stay connected any way we could.

And it seems to be paying off.  He finally consented yesterday to go to a hospital - not just any hospital mind you, but one hospital in particular, in the next city.  If we could send him in a taxi (not something we normally do) and if I could guarantee that they would admit him, and guarantee they would be "better" than the other hospitals in our area.  I told him no way I could do that, but I did get approval to send the taxi.

I'm glad I did.  The admitting psychiatrist actually called me this morning to get some history and let me know my client would be admitted.  This is unprecedented!  Last time I sent out the local Mobile Crisis team and they took him to our local hospital, they had discharged him before I even got back to work in the morning!  I know there are lots of reasons this may have happened, but it's still very frustrating and also compromised my therapeutic relationship with the client.  It's so rare that hospitals follow up with us in this way.  The psych even stated that he could see this client needs long term care more than a hospital stay, but was willing to admit him in hopes that we can facilitate that while he's in.

I love when things work out this way.  It remains to be seen of course what will come next with this client, but so far so good.  And after I worried that my texts were just floating in the abyss, probably not affecting him at all.  It's still not my favourite way to practice, but just goes to show any connection is better than no connection.

What a great start to my long weekend, happy summer everyone!

Hierarchy of Care

Yesterday I took a client to a doctors appointment.  We arrived about 5 minutes before the appointment time, but as with most doctors this one was running late.  No biggie.  After being there about 25 minutes, we and one other gentleman are the last in the waiting room.  The doc calls the other guy in and tells us "there will be no more waiting, I am missing my lunch hour".  I told him I couldn't continue to wait over his lunch time, so he let the other guy hanging out to dry and took us instead.

I told him I appreciated him seeing my client first, and he told me that next time we should not expect our appointment to be on time.  I told him I was okay with waiting 20 minutes or so and try to account for this in my scheduling, but I have other appointments to get to as well.  So he said that when I am bringing a client to see him I should not book any appointments for the rest of the day.  Because he might have to fit in patients who are suicidal, or in crisis.  WHAT DOES HE THINK I DO ALL DAY????!?!?!!?

I get that doctors are busy.  Their job is important, and I have certainly been appreciative when they will rearrange their schedule to see one of my clients who is in crisis or suicidal or whatever.  But why is his schedule so much more important than mine so that he can tell me how to arrange my day, and how to do my job?  I have other people to see too!  And don't expect me to feel sorry that your lunch will be delayed when I had to eat a sandwich in my car while making the 40 kilometer trip to pick up this woman whom he will now see for 5 minutes.   I may have been more sympathetic if he hadn't been so rude about it.  An over-inflated sense of entitlement won't get you far with me.

So, it's November...

and I have to apologize for being a little neglectful of the blog lately.  Some changes at work have made my schedule and stress level a little bit more intense that usual, which tends to take away from blog time.  I have some ideas that I am formulating for posts, so I'm trying to make note of them until I can actually write!

I'm looking to update my blogroll, so if you have a blog of your own or one you really like, leave a note in the comments and I'd love to check them out.

Also, can I just say how much I'm enjoying this show Michael: Tuesdays and Thursdays.  Any opportunity to poke fun  at psychiatrists...

TTFN

No Problem...

A client I recently started working with had been on our service wait-list for nine months. With such a long wait for support, it’s not uncommon that peoples illness or situation becomes worse between intake and initial service. That wait can be a very difficult time for many.

Before this person came in, I read the intake report. He seemed to have a lot of bad stuff going on, so when he came to meet me, I was surprised to see a very calm, well put together guy. Still, appearances can be deceiving, and I wouldn’t know more until I talked to him.

Through our initial conversation it came out that he is back living with his family (had previously been transient) is working a full time job that he enjoys, spends time with friends and has not had any psychotic symptoms in months. He also stopped taking all of his medications, and stopped seeing his psychiatrist.

After he left, the intake worker who had seen him last summer asked who he was, as she didn’t even recognize him. She asked me what had happened, and I told her what he had said to me:

“I stopped taking drugs. Even though I didn’t want to, I figured things would probably get better, and they did.”

Go figure.

If only it were always so simple…

Interesting Things

...that I learned yesterday in French class.*

In french, you pronounce the ps in psych as in "psychiatre" (psychiatrist).

That is going to take some getting used to!








*our agency has been designated to provide french language services, so I've had the opportunity to start taking this class which is being paid for by my employer.  It's geared specifically toward people working in health-care settings, which has been really interesting so far!  Improving my french skills has been a personal goal for a long time, so I'm loving this.

Nice try though.

Newsflash dude: while vaporizing your pot may be less unhealthy than smoking it, it does not make you “less” of an addict. And just because your psychiatrist is aware of your cannabis use and has not expressly told you to stop does NOT make it medicinal!

Thanks, Doc

Note in hospital records that my desk-mate was reading today:

“...this woman did not appear to be very bright”

...

Seriously? Is this considered a “professional” or “medical” opinion?

I’m going to start a training program entitled “Appropriate Note Writing for Dummies Psychiatrists.

P.S. thanks to a couple new "followers" for tagging along! Hi!

Bipolar Breakthrough

A little more about this intake from yesterday.

Despite all the crying, the appointment went well. This woman has a lot going on, including being diagnosed with bipolar and PTSD. She seemed to have great insight when describing what she feels is problematic in her life, discussing symptoms, and acknowledging that she feels ready to get help.

Which is why I was surprised when an hour and a half in she says “it’s like I get these real highs, and then I just go so low. Does that have something to do with bipolar?”

Uh, yeah, I say. That pretty much sums it up. We discuss this a little bit more, and she says “you know, now I know what bipolar is. I was diagnosed over a year ago, and I didn’t know what it was. I will remember this as the day I learned what it was all about!” (cue crying episode #47)

WHAT? How is it you go a whole year with this diagnosis, and no one tells you what the bloody word even means? She received this diagnosis from her psychiatrist whom she’s been seeing for about 14 years!

Granted, her psych is a dinosaur who has announced his retirement about 3 times, but has yet to actually leave the building.

Here is a woman with a)great insight b)no cognitive issues c)lots of support d)a willingness to work with the mental health care system. It’s not as though she lacks the capacity to understand. Is this something that only happens to psych patients?