Follow-up Fail
One of the things that frustrates me the most, working in my acute outpatient team, is follow-up once the situation is no longer acute. Few of our patients have the wherewithal to afford even the gap payment between the Medicare subsidy and the charges of private practitioners, and the other teams within our service (as I discussed in an earlier post) are in service-limiting mode, making it very hard to refer on for further follow-up, and raising the chance of relapse.
That’s one thing.
But when a patient actually is accepted by another team for follow-up, I expect (foolishly, it seems) that they will be followed assertively, with attention to all aspects of their care. When this doesn’t happen, I get [expletive deleted] frustrated. My “favourite” is one that’s just happened (for the umpteenth time): a patient I treated for depression was referred to our therapy team. This person lost the prescription and has been off medication for a while. There is no appointment with another psychiatrist or psychiatric registrar in our service. The therapist tells me they wouldn’t be able to get an appointment now for months. So what happens? Well … I’ve already let slip that the therapist came to talk to me … Apparently my team, my registrars, and I are seen as the ones to pick up anything the others drop; the ones to fill in any and all gaps in their service provision.
Time and again I see it, especially with the therapy team: patients are simply not booked in with the outpatient psychiatrists, and then when something goes a bit wrong they rush up to see me, or my registrars.
Why do they not book their patients to see the psychiatrists??! I suspect because they don’t see that we have any important role to play … in the psychiatric management of psychiatrically-unwell people, treated by a psychiatric service ….
There’s a strange projection going on, whereby these other professionals believe us to be biological reductionists, blithely ignoring the psychosocial aspects of care (which as I have discussed previously is a nonsense), when what actually happens is that they are “psychosocial reductionists”, paying no mind to the biological aspects of their patients’ illnesses – wirh two results:
Firstly, and most importantly, patients get inadequate care;
Secondly, and the subject of this moan, I get asked to advise on management of people I haven’t seen for months (during which things change), are not currently acutely ill (which is my team’s remit), are over and above our very large caseload, and for whom I can’t provide ongoing care following any intervention I suggest. This is bad for the patients, as well as bad for me, my team, and the patients actually under my care.
Distressingly, it’s not just here. It’s pretty much … no, it is evident everywhere I’ve worked. – So I rather despair of my chances of modifying it.
Have to try though; it’s the virtuous course of action.
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so what are you doing for your holidays? there’s a nice brick wall in your vicinity you could beat your head against for a change.