Dr Ben Profile picture
19 Sep, 11 tweets, 2 min read
One of my favourite misconceptions about psychiatrists is that 'we don't know medicine.' Buddy, I did medical school, I am the first line for any physical illness that arises on the ward, the assessor and planner. I control 90% of it, and the rest I refer after intervention.
Psychiatric patients have higher rates of physical illness than the general population. They are also treated in hospitals with lower timely access to tests, drugs and interventions that are commonplace in general hospitals. We rely on our clinical decision making skills 24/7.
Often our patients may not be able to communicate their symptoms in the same way as others, so we have to be good at pattern spotting and escalating concerns. We also have to advocate for them and shoulder the risk of any decision we take.
We are trained in medicine, because psychiatry is medicine. Psychiatric patients have 'medical problems', and although not all psychiatry is treated through primarily 'medical means', much of it is, and the rest of the patient is too. Heart attack on the ward - Im the first line.
I have spotted early signs of cancer, kidney failure, diagnosed skin conditions, pneumonia, you name it. Do you think a hospital would allow someone not trained in medicine to review these patients? Address these problems?
Undertake these risks?
It is true we are no expert in cardiology, but dammit we now the difference between a good heart and a failing one, not oncologists but have a radar for malignancy, not dermatologists but we can spot most common problems and manage them. We always ask advice if needed.
Sometimes I juggle multiple calls for significant deterioration across multiple wards. I advise over the phone as I run to the most serious one. I run nurses through BLS before I even arrive. I lead peri-arrest calls. This seems a surprise to some. 3am in a psych unit, who else?
Our job is to manage physical health on the ward to the level we feel we can and is safe. Anything beyond that is our job to recognise and refer. Thats what we do day in day out, on top of everything. The same is said of the medics and surgeons, we must know the basics too.
If the team doesn't understand the pathology, its our job to explain it. I have explained the difference in recognition and management of type 1 vs type 2 diabetes at 3am, done a whiteboard presentation of side effects of antipsychotics at 4am. This is the job.
It is our duty to our patients to make sure we have done the best for them, regardless of body, mind or both.
Apologies if this thread seems arrogant, its built from a fustration of constantly having to manage incorrect expectations and perceptions. And also, I'm basically awesome so wevs.

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More from @drjanaway

24 Oct
Fuck it

1) Antimaskers will cost lives
2) brexit is dumb
3) tory leaders are liars
4) ppe contracts were cronyism
5) track and trace was privatised
6) a 4 week lockdown is needed
7) asylum seekers > home office
8) gov hates the poor
9) the blitz isnt relevant
10) we need experts
11) rashford > bradley
12) nationalism is a cancer
13) laurence fox wants attention
14) trump is the death of sense
15) johnson is a chancer
16) starving kids makes you scum
17) farage is a charlatan
18) the sun paper is lugenpresse
19) reclaim party is just bnp 2
20) retweetthis
21) RIP my mentions.
Read 8 tweets
24 Oct
@GillianA as the post-take Consultant, a thread..

Arriving on the ward to be told there are 36 patients, but she is amped on caffeine and ready to go. She ignores the sound of vomit from behind curtain 3 and gets to work..
As the post-take F1 asks to go to the bathroom, she beckons to the day duty SHO to join her for the 'educational experience.' She hands him the esteemed note-taking trolley and the promise of a 'mini-cex'
Three patients in and after reviewing the high lactate in the patient with 'generalised tummy pain but ED was at 3hrs 59 minutes' she reluctantly makes the elective decision to refer for a surgical consult. Damn, she mutters, almost a perfect game.
Read 19 tweets
22 Oct
Okay I will say it.

Those who survived the Blitz should be respected, just at those who died to protect them should not be forgotten

But surviving the blitz is not equivocal to surviving a pandemic.
We need to think differently

Stop insulting the memory of lives lost to both.
The memory of tragedy 80 years ago should not guide our actions today. We owe our country to lost soldiers, and our lives to their sacrifice.

Lets show them they didnt go over the top simply because we cant tolerate a year of change.
Yes its lonely, yes jobs will be lost, yes we will suffer. I have sympathy. But if we want to really cite the blitz spirit, it is about using our brains and coming together, not running out into the street. We are not cowards for seeking shelter, we are survivors.
Read 6 tweets
22 Oct
Okay buddy, time for a lesson from Daddy

Many people define themselves by alternative pronouns, and we know that constant exposure to stigma is one of the main (1)forces in declining physical and mental health . We also know that self-stigma is associated with depression (2)
It is well known within psychiatric literature that self-esteem is often intertwined with a sense of identity (3) and that deviation from perceived identity is met with higher risks of suffering (4.) Certain groups present a higher risk of mental illness secondary to these issues
The LGBT community on a whole suffer a large amount of maltreatment and stigma. Factors associated with a higher risk of suicide include negative perceptions of self and lack of acceptance by others (5,) and have a greater suicide risk (6.)
Read 18 tweets
11 Oct
I looked up at him, his gilet buffeted by the salty wind. His big and worn hands clasped on my shivering form. He stared intently, knowing I wanted to take asylum in his strong arms. He whispered, "call me the Clandestine Threat Commander."
"Storm my dinghy daddy" I whispered.
He slowly removed his utility belt and undid his mobile phone holster. I waited with baited breath for an hour. An exciting hour. He revealed the tattoo on his calf, a picture of Winston Churchill. He could fight on my beaches I thought. Far above Priti watched, I liked it.
Read 7 tweets
3 Oct
Hey @peta, regarding your link between #autism and cows milk:

1 RCT showing no difference in behaviour between exposure/placebo groups of children with ASD (Link 1)

A systematic review of 19 studies showing no benefit in casein/gluten in ASD (Link 2)

Show me your data
1) pubmed.ncbi.nlm.nih.gov/24564346/
2) pubmed.ncbi.nlm.nih.gov/28562286/

Reducing meat intake/milk intake has benefits for the planet, but do NOT bring in the neurodiverse and or/autistic community into your damn marketing you plebs.
As a further note, my reference of those within these communities may not be correct and I would encourage them to further guide me and how they wish to identify. It is not my aim to mislabel or speak for such specific things. I will happily take education on this subject.
Read 4 tweets

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