Saturday, June 22, 2013

Genuine Suicidal Attempt or Attention Seeking?

She was told by the doctor to come to the clinic to collect her medication and for an injection, after seeing the doctor in the hospital.

When she got here she looked like she was on the phone, but nobody heard her talking at all. Staff told her to come in to the treatment room. She gave no response, made no eye contact – as if she was so concentrate on a spot in the air. Then she walked towards the door, went out, and stood by the stairs. She looked down to the lower floors. A colleague said, “she isn’t going to jump down is she?” I was going to say “Is she looking for someone downstairs?” but before I even completed the sentence, her feet were already in the air, hanging her body on the rail. we all ran out. She didn’t do it fast as her left hand was still holding the stairs handle/rail. So one of the colleagues managed to grab her legs, another her arm.

She was brought in. She continued to say that she wanted to leave, and of course she wasn’t allowed. It took some time till she was injected and given stat dose. The doctor came from the hospital to see her.

It appeared to be something related to drugs, she seemed to be taking illicit drugs, and according to her, she will be charged for distributing drugs (or bringing drugs in from another country). She said she was innocent.

She calmed down later as the stat dose kicked in. Family member was contacted to bring her home. I’m not sure how she is right now, I hope people will all stay away from illicit drugs. 

If it was one of our busy days we wouldn’t have noticed and managed to stop this. Though we doubt if she really wanted to commit suicide, or she really just needed some attention and help maybe. Because of how the stair is designed, it wouldn’t be possible for anyone to jump down straight from 4th to ground floor (other than a small baby).  She could only fall to the third floor, though her head would have landed on the stair case below. I’m sure she was aware. So attention seeking through a suicidal behaviour?

Sometimes when it comes to mental illness (and I guess many chronic physical illnesses), family members get fed up and lose their patience after a period of time, due to the time, money and attention needed to care about the patient, but also the stigma that come with it. But without any support from close family and friends, it’s almost impossible for someone to completely recover from mental illness…

Tuesday, June 18, 2013

Confidentiality Awareness

"What? You are just going to fax the letter over like that?" I asked, as my colleague was going to fax a letter regarding one of our patients to the patient's company. The company requested it, and the patient was aware - he came to sign a consent form (ah wow such thing exists?!) but he isn't allowed to even look at the letter. So yea, he gave consent for us to disclose his illness to his workplace, without quite knowing what his doctor wrote about him.

"Yes! The patient isn't allowed to read it so we can't give the letter to let him bring to the company! I'm just going to call to make sure that they get the letter" (they? who?!)

I guess most of us know where a fax machine is placed in an office in most companies. Usually anyone who walks past it can check and look at the incoming fax. Chances are the fax may then be passed from one to another (in a larger company, maybe office boy, secretary, some other "caring" colleagues). I feel so bad that this was done. I don't blame my colleague or anyone in the clinic, but the whole awareness about confidentiality issue in Malaysia is just low, very low. When I was trained in the UK, confidential used to be such a big issue. In the uni we had one whole 5 credits module about ethics and confidentiality; At work, we had one whole hour training about protecting patients and staff confidentiality.

Having watch this, I will be so careful to sign any "consent" form in the future. I mean we all as patients or service users or some kind of participants should understand where those private information about ourselves is going and what they are used for. Remember you always have your rights, don't be afraid to fight for them. It may take quite some time till we actually get there like in many developed countries, but it will not happen if nobody is fighting for it.

I hope people in the practice gain more awareness and give more respect too. Imagine this was you, would you be happy that your some sort of medical/financial report or ability test etc is passed around in your workplace or among some unknown people? 

Sunday, June 09, 2013

Morbid Jealousy

There was this young beautiful girl, who from the age of 16, got into her first relationship with a working guy. She then became so obsessed, and had the delusions that the boyfriend was flirting with other girls, having an affair with others etc. She skipped classes, and went to her boyfriend's working place to "watch over" him, see what he was doing, who he talked with...

Over the years the girl got into various relationships, because of how beautiful she is, guys get attracted, and when she becomes attached, she also gets really obsessed and possessive, especially when the guy having any contact with other girls, despite how faithful the guys were. The girl slowly realized this a problem, and consulted a psychiatrist. Over the years she also gained insight with her problem -- a condition now called "morbid jealousy".

Morbid jealousy is a psychiatric condition where the person holds strong belief that his/her partner is being unfaithful without any convincing or "solid" evidence that this belief is true. It tends to happen over and over again no matter how many partner this person changes and how "innocent" the partner is.

It is getting to quite a common condition nowadays. As we would probably all expect that conditions like anxiety disorders and depression would be a lot more common, now probably every 1 in 10 people with a psychiatric condition comes to the clinic due to this problem, although most of them may not understand this as their problem (but only think that they can't sleep, get anxious easily, feel unhappy, got no appetite, is bad-tempered, gets agitated easily... which can simply appear as anxiety depression).

Here it's important to clarify that morbid jealousy doesn't apply when actually you find some convincing evidence, or when you are just feeling a bit insecure whether your partner gets a bit too close to someone (yes, just a bit insecure, which does not affect your life that much, and problem may simply be solved after you speak calmly with your partner), or when it's just part of a more sensitive type of personality.

For the patient's partner to come to understand that their partner has this problem would be helpful to the patient, and being understanding, considerate, supportive and patient to the patient will be significant to the process of recovery.