Tuesday, 5 July 2011

A thought on vulnerability and the health service





Sometimes we lose sight of what is important; sometimes we never see it, and sometimes we wilfully ignore it. Ask yourself, when was the last time you were blindsighted, and what can you learn?

The other morning, as I was approaching the main entrance of the hospital, I noticed a police cordon. As I got nearer, I saw people pause and stare; approaching the centre of attention, I saw that the ground was covered in shards of glass. When I got near enough, I was able to track what people were looking at, and follow their gaze to a set of screens which had been placed in the street. Although the screens had been placed carefully, so that they fully encircled what lay inside, they did not fully reach the ground:  underneath, I could see a pile of sheets, roughly conforming to the shape of a body. Up above, on the 8th floor, there was one single, broken pane of glass.


One does not fall out of an 8th floor hospital window by accident.

There are perhaps many questions that could be going through your mind right now, but there was one that kept playing through my mind: what must be going on in someone’s life that they decide that jumping out of a window is better than all the other options?

I have often felt that the mark of a charmed life is not so much avoiding personal or family crises, but rather being able to call upon all sorts of help and support when they do happen. It is wonderfully self-affirming when you realise that you are not dealing with your problem alone, but that you are backed up by unconditional love.

It is also sobering to realise that there are many people we meet who don’t have families and friends who can take  up the strain for them when they can no longer manage, and we often meet these people in hospital.

These are the people who present with symptoms we cannot explain, or present with symptoms they cannot describe. In the highly pressured environment of the acute medical take, it can be easy to miss the people calling out for help, because these are not people who ask for help, they are people who do not know the language required to access it.

I have noticed a few patients recently, with both psychiatric and medical diagnoses, who repeatedly present to hospital with symptoms related to their medical diagnosis, but with problems underpinned by their psychiatric diagnosis. What I mean by this is that the language of their medical diagnosis becomes very familiar to them - they hear it, the use it and they remember it. The language of their psychiatric diagnosis is less well known, as flare ups with these problems impair their perception and memory of those experiences. And when they ask for help with their psychiatric problems, they are used to getting a poor response.

Patients with psychiatric diagnoses are hard to deal with. Sometimes they are infuriating; they do not give clear histories, they do not respond appropriately, and they take up a lot of time. They can really test your resolve. And yet we do not criticise the man with pneumonia who coughs up phlegm; why should we criticise the patient with schizophrenia who cannot articulate what he is feeling and thinking, or presents with chest pain, whereas what he is actually experience is paranoia and suicidal thoughts?

These patients present to A & E often because they do not know how to access help in other way. Their inability to articulate is often the main symptom of their illness, so for these people having to ask for help means that they do not get help. For the frail, the vulnerable and the mentally ill, this can mean that the healthcare service fails them.

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