Posted by alexandra_k on September 17, 2006, at 21:26:30
In reply to Re: Psychiatric hospital records, posted by alexandra_k on September 17, 2006, at 21:01:07
Doctors 'observations' can be interesting.
They are supposed to write their 'observations' but oftentimes those are theory laden. You can read between the lines on assessments when they switch from 'patient was ____' to 'patient says that'. It if fairly clear whether they think that their observations match what they report the patient says. And sometimes they don't hear too good with respect to what they say the patient says though I think they are supposed to quote. I guess their... Clinical judgement shines through...
> 'La Belle Indifferent'Is a term that shouldn't be used. Like hysterical and neurotic.
> One p-doc noted that I had carefully manicured nails which is extremely surprising to me since I've eaten my nails to the quick ever since I was a child.
And that is an example of how their theory can infect their observations. Sometimes (oftentimes, mosttimes) clinicians read your file before seeing you for the first time. The 'observation' of my nails was supposed to support the previous clinicians 'judgement' of La Belle Indifferent I guess...
I noticed a substantial difference between clinicians seeing me for the first time when they had not managed to locate my files. And clinicians seeing me for the first time after either a cursury look through or a substantial reading. The latter were much more theory laden in their observations, judgmental in their interactions with me etc etc. That was why I wanted to read it. I wanted to know why I deserved such treatment. What on earth was in there?
> 'patient was observed laughing and chatting with other patients on the ward. Mood is reactive even though the patient complains of feeling depressed'.
I was depressed. I WAS. Maybe not depressed exactly... In a way I think my depression became more intermittent. The couple of hours to a couple of days variety. But I always FELT bad. Even when I was laughing and joking and chatting with the other patients. There was an intense sadness behind the happy face. And there were periods (of a couple hours to a couple days) of INTENSE distress. And I didn't understand what was wrong with me. I felt bad. They started saying to me (in 'frank chats' that psych nurses can excel in) that I was winding myself up, creating my own distress, that I was institutionalised, that their was nothing they could do for me, that they couldn't help me if I wouldn't help myself etc etc. Those things... Infected the way they wrote their notes. Doctor writes that patient is admitted complaining of depression and nursing staff are careful to note all their observations of laughing and chatting and are careful to make no mention of the time spent crying... Of the episodes of distress... I'm sorry, this is hard for me.
> 'CAT call recorded at 8.15pm. Patient complained of feeling 'bad' and 'upset'. Patient was told to practice her skills and was informed that she would not be admitted'.
I just needed someone to be a bit reassuring. To listen for a while. But they say 'what do you expect us to do'? And if I say 'I feel so bad I feel like killing myself' they write me up as threatening suicide. I never asked to be admitted... Though to be fair... Sometimes I thought that was what I needed. But what I really needed was for someone to spend some time talking to me.
But CAT are busy and overworked etc.
It hurts.
poster:alexandra_k
thread:686571
URL: http://www.dr-bob.org/babble/psycho/20060911/msgs/686928.html