STIGMA KILLS - a doctor takes his own life

From the recent Psychiatric Update (19^th May 2011) an article by Michael East titled:

Doctor takes his life after mandatory reporting ...

A doctor took his own life after a treating psychiatrist reported him to the Australian Health Practitioner Regulation Agency in line with new mandatory reporting laws, a Senate inquiry has been told. MDA National president Associate Professor Julian Rait told the inquiry investigating AHPRA’s handling of the national registration scheme that mandatory reporting

laws had become an “anathema” to a co-operative and self-reporting culture of healthcare.

Professor Rait said the laws could have been a factor in the doctor taking his own life.

“There is an example that we are aware of where there was a practitioner who was under psychiatric care who was thought by the psychiatrist to pose a risk and was reported to AHPRA,” Professor Rait said.

“As a result of that report, the therapeutic relationship between the psychiatrist and this particular doctor broke down and as a consequence we believe that that practitioner took his own life.”

The mandatory reporting laws, which came into effect from 1 July 2010, require all registered health professionals to report colleagues whose conduct might put patients at risk of substantial harm — even if they are the treating doctor. It is understood members of the inquiry have growing concerns about the impact mandatory reporting is having on doctors’ health.

Now I am not going to comment much on this other than to say I blogged last year about Compassion Fatigue and the Australian Beyond the Blue study and mentioned some of the concerns I still have then.

http://mum-alex.blogspot.com/2010/11/compassion-fatigue.html

At the time I didn’t realise Australia had introduced a national registration scheme that made mandatory reporting of doctors who are 'perceived' to be a danger.  I have to say, at first all I could think of with this case was that clearly the shame and stigma attached to mental illness was too much for this doctor to live with.  This in keeping with the Beyond the Blue study findings of Psychiatrists having the highest rate of suicide and it poses the same questions I asked in my previous blog. I don't even know if this is the reason he was reported but that was the first thing that came to mind when you are seeing a Psychiatrist.

However, this has also made me think about how do they define "conduct that might put patients at risk of substantial harm”?   Does that include the many doctors with addiction issues?  Does it include those with heart conditions who are surgeons?  Or does it just refer to, as I suspect..... those with mental illness?  It seems no matter how hard we try to fight against the stigma around mental illness the medical profession still live in the dark ages.  Even those working in Psychiatry who SHOULD KNOW BETTER suffer awfully from with self stigma, having the highest rates of suicide amongst medical professionals.  Won't mandatory reporting prevent doctors from accessing the care when they need it increasing the incidents of serious mental illness in practising doctors?

Tragic!!!!!
  

Is Dr. Peter Jansen a CIP, or not?

The Senior Medical Advisor at ACC Sensitive Claims Unit, Dr, Peter Jansen is suing an ACC sexual abuse claimant for defamation because after her frustration at him and that Unit she posted this blog about him...

http://k1w1jax.blogspot.com/2010/11/peter-jansen-undergoes-dsm-iv.html

So I guess the Courts will need to determine firstly, if it is defamation? Is he a Completely Incompetent P***** (CIP) or not?

They may find some of these answers in the Independent Review Panels Report into the New Pathway of the Sensitive Claims Unit released last year.....
http://admin.beehive.govt.nz/webfm_send/13

Or maybe they can find the answer to this question from those working on the ACC Sensitive Claims Advisory Group....

http://www.psychotherapy.org.nz/index.php?page=blog


Or maybe the hundreds of claimants that are still awaiting to hear back from ACC or have be put through the ringer just to get HELP could tell them?  Hmmm, yes, an interesting question to ponder really!!!

What is a joke about this whole thing really is that he thinks the pain, suffering, shame and financial loss from his suffering since this blog was posted in November 2010 is worth upwards of $250,000. Wonder where they get that figure from? Afterall, did he lose his job? No, he didn’t!  Let’s not forget how much the National Party love him..... putting him on Tony Ryall's Health Quality and Safety Commission (HQSC) also.
Am I the only one who thinks that while Sexual Abuse Survivors get sweet “FUCK ALL” from this Government for all the suffering and financial loss they endure, not to mention the damage done by ACC’s traumatic pathway, that he has some nerve saying he has suffering, and that his “feelings”,  “hurt” and “shame” are worth so much more?

Bully? Incompetent? Or innocent aggrieved doctor? You decide!!



NB: the claimant has posted a further blog in the last day and has also been told by Dr. Jansen’s lawyers to remove it also.

http://k1w1jax.blogspot.com/2011/04/peter-jansen-shows-his-true-colours.html

A Prescription for Shame

Why is Gareth Morgan on this whole health kick of late?  The other day I picked up one of the Journals I read, to again find another whole page advertisement from him.  This time not for Gareth Morgan Investments and his Kiwi Saver scheme but for Health Cheque and his Prescription for Change. The advertisement (alongside the huge photo of Gareth Morgan) reads as above.  Now, I don’t know if the years spent working in the health system has made me bitter and cynical but after reading that advert the first thing I thought was, “Oh, here we go”.

For those of you who are not aware, Gareth Morgan is a respected Economist and Investment Advisor here in New Zealand and a self made Millionaire.  He became a lot more of a household name after his son Sam Morgan's Trademe site/business (that Gareth helped him setup) got sold to Fairfax for $700 Million.  Gareth received $47 million of it, that he reportedly gave to charity.


I thought if this Journal has given a whole page advertisement to Gareth Morgan they must be endorsing his 'Prescription for Change' so I better at least have a look at what recommendations are being proposed and endorsed for our public health system.


The book he wrote, 'Health Cheque: the truth we should all know about NZ’s public health system' comes from research and numerous overseas literature reviews according to Gareth.  From the website all we can see is a lot of quotes from 'whomever', from 'wherever', answering 'whatever' questions they were asked on any given day.   I'm unsure how he gathered and correlated the information, or the questions that were asked.  Nor do I know if the huge limitations in this 'research' were acknowledged.  After all, we could all answer the questions differently depending on the day at work.  I have not been able to get a copy on the book myself to read but MacDoctor has reviewed and blogged about it and concludes much of what I suspected.  Interestingly enough, Geoff Simmons (co-author) posts in the comments on that blog.  It is well worth a read.


The first of many assumptions Gareth makes in his video presentation is that Clinicians, namely doctors, don't tell their patients the risks or cost/benefit factors of procedures.  He believes if we start doing this more (at least the limitations and possible adverse effects part of a procedure) we would get a 40% reduction in procedures as people will be too petrified to have the treatment.  I guess he is not familiar with the legislation around informed consent huh?


While there are just too many topics from 'A Prescription of Change' to explore in this blog, I have included a few highlights from his website/videos to see if I'm the only one that is left thinking WTF!!  I would be interested hearing what you all make of these true pearls of wisdom from him.

For 'Prioritising Care' (as us PC lot call it)....or 'Rationing' (as Gareth calls it):

“40% of visits to GP’s result in no diagnosable condition.  But if you don’t give the person a placebo, all hell breaks loose.  And they call you malpractice and all sorts of things and go off down the road to another one.  So he gives them a sugar pill”.  REALLY?????

“Incentivising primary caregivers, GP’s in other words, to manage conditions and prevent chronic developments as opposed to paying them per intervention.  Now GP’s are under a delusion, they think they are entrepreneurial.  Jesus, half their money comes from taxpayers.  They have got no right to be entrepreneurial.  They should all be on salaries and totally accountable for the spend of that money.  And you can get an enormous benefit if you are incentivising to keep people away from the surgery rather than increasing the count of them coming through.  Certainly given that 30% of visits are from hypochondriacs.”  DELUSIONAL GP's?  30%??  HOW WILL THIS SOLVE OUR NATIONAL GP STORAGE GARETH AND IMPROVE MAORI & PACIFIC ISLANDERS HEALTH OUTCOMES WHEN THEY DON'T OFTEN HAVE OR USE A GP?  OR IMPROVE OUR CHILD HEALTH STATS? 

“When researching our 2009 book Health Cheque, Geoff Simmons and I were told by numerous professionals inside the system that on a daily basis they are put under undue pressure from patients and their agents (family members, MPs, lobby groups) and the disturbing reality is that the squeaky wheel gets the oil. The typical scenario is when the patient's people threaten to go to their MP, go to the media and so on unless they get the service they think they deserve, then the system is abused.
Blackmail of busy health professionals like this is offensive but sadly is common, resulting in those with the loudest advocates getting served in front of others, just so the professionals can move on and attend to others. It is wrong, it is unfair but it is the reality - the needs of those without access to strident advocates are being trampled under as the loud lambast their way to the front.”  PMSL.... YIP BECAUSE BLACKMAIL IS COMMON AS WE ARE ALL SPINELESS TWITS?  WTF? 

“What's fair? We'd all like to think that those with greatest need are fixed first, but sadly it is not that simple. In a world where all needs cannot be met, society has to decide what "greatest need" is. How do you decide between a 92-year-old and a 10-year-old in need of the same knee operation? Personally they both have equal need so that gets you nowhere, and the limited resources mean you have to make the choice. The 92-year-old has paid more taxes, the 10-year-old has more taxes to contribute, so that doesn't help decide either.
But we must make a decision, we must decide who it will be. This is the reality facing society and the reality several generations of politicians have run away from. The answer is very clear but we must have the courage to declare and stick to it. The 10-year-old gets the nod because from this point of time society will benefit more from them being fixed - they have far more quality-adjusted life-years to contribute to society than the 92-year-old has. From society's perspective it's a no-brainer investment.”  NICE, JUST COMPARE APPLES AND ORANGES WHY DON'T YOU.  HOW MANY OVER 90 YEAR OLDS OR KIDS EVER HAVE KNEE SURGERY?  TRY COMPARING THE 50 YEAR OLD WITH THE 55 YEAR OLD?  OR THE TWO PEOPLE ACC REJECTED AND WHOS INJURIES HAVE WORSENED IN THE LAST YEAR?  OH AND NICE WAY TO DEAL WITH THE AGING POPULATION.  JUST LET THE BUGGERS SUFFER BECAUSE THEY HAVE NO WORTH NOW DESPITE THOSE MANY YEARS OF BEING A TAXPAYER.

Oh, that is just the tip of the iceberg and we haven't even touched on his 'stigmatising' of obese people as one of a number of public health strategies to deal with obesity.  All based on the fact that it worked so well for smoking.  But one does have to wonder why someone who states he and his friends go overseas for their healthcare needs and is not a health professional himself feels the need to make 'A Prescription for Change' in the first place?  Is he posturing for a career in Politics, or are we going to see him selling Health & Medical Insurance in the near future?  Regardless of his motives, I don't wish to see his face on the pages of my Professional Journal.  Will they next be selling advertising to Brian Tamaki?

Don't leave it to your kids to do

I grew up in a family where there was a good work ethic.  We were taught to hard work hard and become self sufficent at an early age.  I started my first paid job while I was still at primary school, packing fruit at an orchard on a Thursday and Friday after school.  It was a wonderful feeling having earned my own money and then being taught how to save for a ghetto-blaster.  Our mother never wanted us to ever be dependant on anyone else for our financial survival.  As a result, I have never expected to receive any kind of inheritance and try to encourage my parents to enjoy their life and retirement with their own money and assets.  If in the future my parents require rest home care (their preferred option to being looked after by family), we would all be fine with selling the family home to pay for that care because my siblings and I all share that same basic ethic.

While that is our family's experience, it seems for others their perceived right to an inheritance governs a lot of their behaviour.  Greed and spoilt maybe?  It is particularly noticeable in conflict family over trying to manage assets and determine the appropriate care for their family members when they can't do it for themselves any longer.

For one such family I know, the son was adamant the family home wouldn't be sold until the person had died.  This meant they would be required to pay for the on-going care out of their own pocket because they couldn't receive the Governments Subsisty for Long-Term Residential Care while they still had such an asset. The younger sister is not working and can't afford to pay for the care required.  This person is likely to live for many more years and this issue will continue to cause on-going conflict as the debt mounts.

Another family, the eldest daughter of an elderly woman went and changed the GP of her mother.  He had been a family GP for many years, whom the mother liked.  All because the GP sided with the younger sister about her mothers care and the older sister had 'Power of Attorney' over her care.

Again, a different family fighting because one visits less than the other.  Apparently love is defined by who lives closer and therefore visits the most.  The list goes on and on.

Would having a 'will' and 'living will' make this process a little smoother?  Well, possibly, but not always!  They do make it easier for us to advocate for a patient around their care but they don't always solve the issues within the family. 

Maybe, we could say these people are just self-centred spoilt brats or that they are having issues adjusting and working through their own grief process.  I however, think it's a little more complex than that.  With the majority of such cases I have seen, it is when the mother requires the care that these incidents arise.  Mostly, when that mother has been a very strong matriarchal figure within the family.  Almost without exception the children revert back to some primal instinct of fighting to assert themselves as head of the pack now the leader has fallen. With most primates this is done through share physical brunt strength, but with humans, it is done through power and money (or assests).  Who has the most can roar the loudest and take over control of the pack.  Maybe, it's not that simple but it all makes for an interesting dynamic when you sit watching from the side lines.

So please people, be sure if you do nothing else, you write a will and living will for when you can no longer speak for yourself.  You may never need it until your are elderly and infirmed, then again you could need it next week following that motor vehicle head injury or that massive stroke.  Talk about these issues NOW and don't let your children be burdened with these decisions just because you are not willing to consider your own mortality.

What will become of your children if something happens to you?  What care do you want for them and for yourself and  how should this be paid for?  Do you want active management and resuscitation?  What do you want done with you assests?  What are things that are important for you at that time?  Who do you want as your Power of Attorney for your assets and  for your care (it can be a bit dicey having the same person doing both)?  What funeral arrangements do you want made?  All these things need to be written down and talked about.  Give a copy of your living will to your GP for their file and pick people you trust for these Power of Attorney positions and not just because they are the eldest son or daughter.  Hopefully, this will make all ours lives a little more peaceful!! 

Cry Baby

After dropping the kids off at school today, as it was my day off, I had my list of things that needed to get done.  Where would I be without those lists?  So once the glass-smith (is that what you call them?) had arrived to pick up the kitchen cupboard door to be fixed, I gathered all the kids library books together (no small mission) and headed to the public library.  Usually, I would have just dropped the books in the returns slot but I wanted to go in to convince them to purchase a book, that I am too cheap to buy myself.  I do love reading autobiographies and found this book that really appealed to me and got excellent reviews.  Just Like Someone Without Mental Illness Only More So: a Memoir has recently been released in the US but I haven't been able to find it here.

Anyway, as is usual for me whenever I go into a library, I can't help having a look around.  I picked some random book off the shelf, sat down at a table and quickly became engrossed in it.  I was vaguely aware of the mother and her baby looking at books in the same area only really because the baby was crying a little.  Not one of those loud high pitched piercing crys of a sick baby but the heartwarming soft cry of a new born baby.  I know all you mothers will know what I'm talking about here.  The cry that brings a smile to your face and makes you go "oowwww'.  So, I had that 'owwww' moment in the library as I tried for a few seconds to remember back to my own children's tiny soft sounds which were lost a lifetime ago.  Oh, how I miss that quiet baby cry.

However, why I was distracted in thought, to my horror, a rather determined looking man stormed over to this woman and barked, "If your baby is going to cry, please take them out of the library as it disturbs people".  Of course, I was somewhat bewildered, as this woman and I were the only ones who were in the area until he just arrived.  The poor woman looked as she was going to burst into tears as she proceeded to apologise profusely to the man. 

Now, I am usually the sort of person who sits and observes as things unfold before me, but in this instance, I couldn't stay glued to the seat.  I jumped up and said, ever so assertively that I surprised myself,  "I don't have any issues with a crying baby and would love for them to stay.  If you have an issue, it may be best if you are the one who leaves." 

Well, you could have almost heard a pin drop as the man stood speechles looking at me. Then he turned without a word and walked off in a huff.  Which was actually quite good because I have no idea what I would have said next and I could feel that intense pounding of the heart that engulfs me whenever I have to deal with angry or aggressive people.  I was half expecting the librarian or manager to return with him and tell us both to leave the library, but they never did.

The woman was so relieved, she thanked me.  We sat down together and chatted for awhile.  Both of us trying to understand why some people think they have a right to express every thought that pops into their head without any consideration of others feelings.  Turns out this woman had been hiding away at home since the birth of her baby and this was her first outing with her new born after people telling telling her the importance of not isolating away at home.  The poor thing!  On her first outing she encountered a drop kick, and I don't mean me :) 

So, you just never know how your day will turn out and who you will meet along the way.

Compassion Fatigue

I'm sure those of you who care for sick or disabled family members or those of you like myself, who have a job that involves caring for people and then coming home to care for family, will be able to relate to this term Compassion Fatigue, sometimes described as 'burnout'.  Most of us have suffered from it at some point in our professional lives.  It comes down to recognising it early and doing something about it before you are too debilitated to work at all or worst still, become a statistic.

While the term 'burnout' has been around for awhile it's only since it got rebranded to compassion fatigue that educational programmes are now beginning to be set up, yet they are few and far between.

NZNO professional nursing adviser Cathy Gilmore said at a recent Mental Health Nurses Conference that:

"Every day, nurses are giving of themselves and being exposed "vicariously" to their patients' trauma and sadness. Nurses must be aware of their own and colleagues' fatigue and ensure management supports them to acknowledge and deal with compassion fatigue." 

So how exactly is management doing this?  The mental health service appear to do it better than most other areas as they offer 'debriefing' and 'clinical supervision' both which are compulsory for all staff.  While you would think this would be enough, we continue to hear stories of nurses (mainly) who lack any empathy or patience and are incredibly judgemental. 

But don't get me wrong, it's not only nurses that suffer in this way.  The Australian Beyond the Blue Study found that while doctors can identify the signs in their patients they won't seek help when they recognise the signs of depression or anxiety in themselves.  In the summary of the study it found among other things....

"A number of barriers to help-seeking in the medical profession were identified. These included concerns about stigma, career development, impact on colleagues, impact on patients, confidentiality, embarrassment and professional integrity. 

Psychiatrists were concerned about potential career implications. Doctors were less likely to seek help from colleagues and professional institutions due to concerns regarding professional integrity and career development, while they were less likely to seek help from family and friends, or not seek help at all, due to concerns regarding stigma and embarrassment.

The suicide rate in doctors was higher than the suicide rate in the general population.

The suicide rate varied between different medical specialties, with psychiatrists found to have the highest risk of suicide."

It seems that while Psychiatrists work to ensure patients can accept the 'labels' they place on them and work to teach them acceptance while encouraging them to ask for help when they are unwell, they fail miserably in doing it for themselves.  My question is, why Psychiatrists??  Is it because they are generally more caring and sensitive by nature or is it that they know more than anyone the stigma attached to having a mental illness of any kind?  Or is the trauma they listen to on a daily basis so soul destorying that supervision is not enough? 

Until some further research is done on just how these 'compassion fatigued' clinicians are impacting on the day to day care of their patients we will never know if they are they only victims here.  Is their lack of self care not only effecting them, but the whole of their health care delivery?

While I focus on Psychiatry here, in other areas of medicine or nursing there is no clinical supervision and very rarely, debriefing. The educational programmes on compassion fatigue are also not considered a priority.  If the mental health service can't get it right then what hope is there for the other areas?  Things won't improve unless we have caring managers making this a priority and, the mental health service lead by example.

Not cutie cutie!!

No it's not cutie, cutie when you discover your child has taken to the wallpaper in her room with a pen to express the anger she was feeling from being sent to bed before her older siblings.  Even less 'cutie, cutie' when it's a rental property that you are planning to shift from in the next month!!  Apparently, she was drawing a happy face to make herself feel better.  However, it sure as hell didn't make her father or I have a very happy face.

So, what does that mean now?  Anybody know?  Yes, I have tried the 'jif' and it was a huge failure.  In fact, according to my husband, I have made it worse.  I have now blenched the wallpaper around the super sonic jif repellant pen markings. 

Here we are renting after selling our old house three years ago when the market was good.... waiting for the perfect time to buy again.  Now, that time has come.  The house prices and interest rates have dropped.  So just when we start seriously looking for a new place the apple of my eye decides to redecorate her room herself. 

If that's not bad enough, my husband catches his arm on the kitchen cupboard he left open and manages to smash the glass in the door.  But at least the husband pays his way, unlike our cat (a Burmese), that appears to be more spoilt than any child here. We have just discovered the large holes he has recently clawed in the window seat and on the carpet on the bottom of the staircase.  Apparently, the huge $80 scratch post we brought him for such occasions just isn't to his liking.  That cat is becoming more of a snob with each passing year.  Grrrr

The Kid



The Cat



The husband