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The battle to quieten my inner voice

‘Is this patient known to us?’

It’s easier to find a billionaire with a conscience than a psychiatrist in a hospital after 4pm

INNER VOICE: Well he would be if you didn’t spend so much time in meetings trying to think up yet more linguistically complex ways to state the bleeding obvious.

OUTER VOICE: Yes he is, he’s been under mental health services for fifteen years.

‘Have you excluded a physical cause for his symptoms?’

INNER VOICE: Well now, let me see, this patient with known psychosis who has stopped taking his medication, currently believes his neighbours are trying to poison him using trained bluebottles that they release into his bedroom at night and is contemplating writing to Elvis’ ghost to challenge them on his behalf. Now of course I could be wrong, but I suspect his symptoms are not due to high blood pressure. 

OUTER VOICE: Yes I have.

I refuse to believe I am the only GP to spend my working life battling to stop my inner voice expressing itself outwardly. Sometimes I think the editing that goes on between Broca’s area and my larynx would put a war time censor to shame. Never is this more the case than when talking to mental health services.

Now, I did work in psychiatry as an SHO so I do know it can be a stressful job and that their budget has been slashed more times than an Indonesian rainforest, but I also know how many meetings these mental health teams have and that it’s easier to find a billionaire with a conscience than a psychiatrist in a hospital after 4pm.

It’s not easy referring a patient to any team in a hospital, but at least you sort of know where to start with most things: you know chest pain to the medics, broken hip to orthopaedics.

Mental health seem to be forever ‘restructuring to streamline the user experience’ (or some similar wanky bit of managerial doublethink).

What actually happens is a myriad of different teams are created from what is already a chaotic mess with even more complex and illogical names. Navigating through the choices is like trying to find your way around Hampton court maze ripped to the tits on acid.

So you finally get through to someone and give them the history, peppering your sentences with words  like ‘suicidal’, ‘railway track’ and ‘express train’ randomly to keep their attention. You give them the patient’s name and address and there follows a silence punctuated only by some tapping on a computer on the other end of the phone.

‘Sorry, he’s not in our area now.’

Dr David Turner is a GP in west London. He would like to acknowledge the liberal use of hyperbole in the writing of this blog