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.
20 December 2021
21 September 2021