I was appointed as a General Adult Psychiatrist which\nmeant that, along with colleagues, being responsible for a catchment area. This arrangement has significant advantages\nwith regards to clinical responsibility and continuity of care which I believe serves\nthe patient well.<\/p>\n\n\n\n
When I started at Wexham Park Hospital, I was attracted to the philosophy of Psychiatry being part of a general hospital.\u00a0 In addition, we had a substantial number of in-patient beds and a comprehensive day patient service.\u00a0 The therapeutic activities of the in-patient and day patient services were integrated which enabled a seamless transition for the patients.\u00a0 In addition, vulnerable patients were encouraged to come along on a relatively long term basis; in the day patient service, wise and senior nursing staff were able to support and quietly monitor progress.\u00a0 Community teams were developing with realistic objectives and appropriate back-up.<\/p>\n\n\n\n
I was extremely fortunate in having supportive colleagues\nand excellent junior staff and between us, I felt we provided a very good\nservice; urgent cases were seen within a week and emergency admissions arranged\non the same day. We could also offer respite care and planned admissions. However,\npsychotherapy was in short supply and we did not really have sufficient\nresources to offer a comprehensive liaison service to the general hospital. But\nthere is always a problem about appropriate reach of acute Psychiatry. These\ndays the response a referral can often be \u201cwe are not paid to provide that service\u201d.\nDon\u2019t ask me what the phrase \u201csevere and enduring mental illness\u201d means. Does\nit only cover some aspects of Schizophrenia and Bi-polar disorder? If so, what\nabout the rest?<\/p>\n\n\n\n
Catchment area services are not resourced to handle a\nnumber of specialist areas such as Anorexia Nervosa, Forensic patients or those\nrequiring locked facilities. Patients\nwith addictions requiring rehab are not well served by acute admission wards\neither. One of the long term problems\nfor a General Adult Psychiatrist is that specialist tertiary services are prone\nto \u2018cherry pick\u2019 individuals they want to take on. I recall one particular problematic patient\nwho I referred on to a service and the report that came back was that she was\ntoo difficult to help and would ruin their outcome figures; I should have kept\nthe letter. As a result, this patient stayed\non an acute general ward for a good number of months but in the end, she did do\nwell.<\/p>\n\n\n\n
Responsibility without the resources becomes an extremely\npotent cause of stress and burnout. In\nthe end, risk management remains with the Consultant Psychiatrist; understandably,\nI remain keen on taking a precautionary approach. Some years ago, one of my children, who was\nvery young at the time, said that he could offer to answer the phone because he\nknew what to say, as invariably, my advice was to \u2018admit and double the dose\u2019. In fact, as a universal mantra, it is\nprobably pretty good. <\/p>\n\n\n\n
In my opinion, difficulties with recruitment of senior\nstaff and changes in philosophy have not served the image of Psychiatry or\npatients well. There is now a functional\nmodel where different teams take on aspects of the care. The notion of\ncontinuity of care does not exist now. \nIn addition, resources have been ferociously cut back; for example,\nthere is no longer a psychiatric unit at Wexham Park Hospital or in fact any Psychiatric\nin-patient bed at all in East Berkshire. <\/p>\n\n\n\n
Obviously, I still greatly enjoy Psychiatry but the\nconstant erosion of resources, the increase in pointless bureaucracy and\nconstant reorganisation meant that, like many people in the health service, I\nwas pleased to retire, although that word is somewhat misleading and I think \u2018resign\u2019\nis a more appropriate reflection of sentiment I had at the time.<\/p>\n\n\n\n
A common story.<\/p>\n","protected":false},"excerpt":{"rendered":"
I was appointed as a General Adult Psychiatrist which meant that, along with colleagues, being responsible for a catchment area. This arrangement has significant advantages with regards to clinical responsibility and continuity of care which I believe serves the patient well. When I started at Wexham Park Hospital, I was attracted to the philosophy of … Continue reading “Admit and double the dose.”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":268,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-436","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages\/436","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=436"}],"version-history":[{"count":2,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages\/436\/revisions"}],"predecessor-version":[{"id":444,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages\/436\/revisions\/444"}],"up":[{"embeddable":true,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages\/268"}],"wp:attachment":[{"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=436"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}