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Psych teams are taking the p*ss

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Are psychiatry teams, and their associated parapsychiatry wing, taking the p**s? I do believe they are – literally and metaphorically. Here’s the proof.

Pee-take 1: A man known to have Alzheimer’s and outbursts of aggression has taken to threatening his daughter. With each episode, he’s upped the ante until, this time, having faced down a whack with a walking stick, she decided enough’s enough – so she called me. I phone the dementia crisis team and explain to them that this appears to be a crisis involving dementia. But it ain’t necessarily so, they say – not until I’ve ruled out a UTI with a dipstick urinalysis.

Pee-take 2: A nine year old boy is brought to me with behaviour problems, which his mum reckons is Attention Deficit Hyperactivity Disorder. In two minutes flat, I twig that it’s all about his mum shacking up with, and getting pregnant by, a new boyfriend – not because I’m clever but because it’s barndoor-bleedin’-obvious. But before I get a chance to break the news to mum that the relevant abbreviation here is TLC not ADHD, she’s whipped out a urine sample. ‘This is his,’ she says, waving it at me. ‘I used to work on a psychiatric ward, so I know you need to test it.’ And she’s not impressed when the only test I subject it to is seeing if I can lob it in the bin.

Pee-take 3: The local residential home is phoning me at the behest of the attached CPN. A patient, whose multi-infarcts have turned his brain to Emmenthal, is yet again threatening to torch the place. But they won’t/can’t do anything until, yes, you’ve guessed it, I dip his urine. So I feel like handing him the matches.

I really don’t need to tell you that, in each case, there was absolutely nothing whatsoever to suggest a UTI. And even if there was, it would have been irrelevant. It’s not my job to work out the thread of logic in these situations, but when you’re at the sharp end, it’s hard not to wonder exactly what’s going on.

My theory? Testing urine and fannying about with the results has been a delay-tactic used by hard-pressed mental health services for so long that it’s now ingrained in the psychiatric psyche as something rational.

Acutely confused? They certainly are.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield 

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Readers' comments (7)

  • Yes indeed. Worse is when they actually FIND a UTI, even though previous "treatments" make no difference to the level of confusion and they've always been so low grade as not to bother a CRP or white cell count on the simultaneous bloods in the past. I tried resisting treatment for an entire week last time only to be worn down by telephone calls and faxes from CPNs twice daily.

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  • I'm sorry to say that disagree with you on points 1 and 3. Could be delirium brought on by a Uti

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  • To the last contributor, read this week's BMJ ...a paper debunking treating UTI 's in the elderly ...just the same as Copperfield , but 'evidence based' , just hope Copperfield isn't becoming academic in his old age

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  • Good News Tony- see this weeks BMJ- dipsticks are useless in this situation as anonymous 10:11 AM mentions.
    "Investigation of suspected urinary tract infection in older people.
    BMJ 2014;349:g4070 (Published 03 July 2014)"
    and back it up with
    "Gp's pressuried to prescribe unnecessary anbtibiotics" BMJ 2014;349:g5238 (Published 20 August 2014).

    Lets get that care pathway written so that unless patient is febrile or complaining of frequency and dysuria the psychiatirst sees patients with challenging behaviour and send the MSU, rather than " get a GP to check it might be organic" I also see happening.

    For further enlightenment read the publications of the Royal College of Psychaitists who actually expect their members to be able to:-
    " diagnose and treat whre appropriate organic illness which presents as behavioural issues with no clear symptoms of physical illness and stable vital signs"

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  • Now spare a thought for the poor patients who have to endure these psychological **** - and there are many (psychological ****, that is) in mental health teams up & down the country.

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  • In the same vein a normal FBC and U&E does not make all patient complaints irrevelant!

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  • Psychiatrists ... can't print what I think about them!
    As ward manager I had a lady admitted, the 'shrink' asked her is she could hear voices when she couldn't see who was talking to her, she said she could. the lady in her early 60's was diagnosed schizophrenic and prescribed some rather strong medication.
    I questioned the lady about the 'voices' and asked what they said to her. She looked at me, asked me to be quiet, then said 'can you hear the people talking'? I said yes, they were staff in the corridor, 'Yes' she said, 'but you can't see them'!
    It was later discovered that the lady had a thyroid problem and was discharged two week later.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder