My patients are mentally ill.
One has a complex addiction problems and multiple psychiatric diagnosis
Another has mental illness and is an IV drug users.
Another had multiple organ failure and multiple surgeries and has depression and declining memory. They’ve had falls and head injuries and periodic delirium from chronic organ failure and the effects of this on brain function.
I’ve done the best I could. I’m a front line worker. I ‘ve seen 30,000 patients and worked all my life. The systemic failure of the health care system lack of resource and general shit show is a polictical embarrassement of horrendous leadership corruption and incompetence. A man’s was dead in the hospital waiting room and the incompetent hospital administration tried to blame everyone else but themselves and ultimately a just blamed the whole problem on racism. This stuff is the stuff of zombie movies
Management scapegoats and blames individuals while denying accountability taking immense cuts of health care funding for their talk fests and meetings orgies while Rome burns
I’m a psychiatrist and I have not been able to admit a patient to hospital except for homelessness, suicidal or homicidal psychosis. I am routinely doing madication management and managing suicidal patients in the community without back up or support.
My patients are supposed to have GP’s. 80% of my patients don’t. At most they go to a variety of walk in clinics. Most of my patients especially the elderly have major physical problems. So many are on disability . Most have chronic pain. Many are obese.
Over half of my patients have major addictive disorders.
Right now I see about 6-10 patients a day mostly for medication management , crisis intervention, motivation therapy and elective supportive therapy all dictated by when the patient wants to make the contact and contacts at anywhere from 1 to 24 months.
I’m supposed to ‘fix’ these people and I am stigmatized as my patients are. Menatl illness and addiction are dirty illnesses.
Historically I remember and this is common still, when the mental health teams , government funded and supposedly ‘universal health care’ refused to see patient with addiction. They also commonly refused to see borderline personality disorder.
I was moonlighting in charge of a detox when I was going through my psychiatry training. I subspecialized in borderline personality disorder. The wisdom teaching at the time was borderlines were so demanding that a psychiatrist should only have maximum 1 or 2 in their practice. At one time I had 30. I also found that most Borderline Personality Disorders were Post Traumatic Stress Disorder until proven otherwise. No one looked into their history of traum and found that their behaviour was the coping mechanisms that they had learned in child hood and that these that had kept them alive through often horrendous trauma were not acceptable as adults.
I was trained as a psychoanalytic psychiatrist and psychopharmacologist, marriage therapist, group therapist and hypnotist. The key to avoiding adresssin the issue of Borderline Personality Disorder and PTSD was for many psychiatrists to focus solely on the mood calling them ‘Bipolar II’ and ignoring the whole trauma relationship therapy issues to simply consider various changes in polypharamcology, a triangulating technique at some level.
My research interest was noncompliance. Non adherence to medical regimen. It’s estimated that 30 % of people don’t do what the doctor recommends but in the psychiatric practice it’s 80%.
A third of my practice at least are stifling characters, the kinds of patients that psychologists and counsellor cream off from the collection. These people have a particular problem like anxiety disorder, or depression but they don’t have other medical illnesses, they have jobs and families and friends and are generally really good ‘therapy’ candidates. We called them YAFie’s. Young, attractive, family oriented, intelligent, interesting, and emotional. I’ve treated a dozen Olympic champions, a dozen or more millionaires, a dozen or more models and many famous celebrities, professors, doctors, engineers, etc. They are what people who ‘cherry pick’ their practices focus on. They avoid people with drug and alcohol problems and especially the poor.
It’s the business of medicine The sharp smart operators ‘limit’ their involvements and establish ‘boundaries’ and aren’t particularly focused on ‘curing’ or ‘healing’ but rather providing a set ‘service or ‘protocols that are recommended in general. Most of my patients don’t fit these protocols.
One gp told me that he’d had his patients rejected by 20 or more psychiatrists and was sorry to be asking me to see another ‘basket case’.
Many of my patients have criminal records. Several have tried to kill me. I’ve been held hostage and my life threatened . I was in charge of the dangerously insane ward of the state asylum and consulted to the mentally ill in the jails.
A lot of my patients are dirty and smell. As I said a half to a third don’t. Obviously the models and millionaires don’t. I have a number of my patients with addiction living on the street.
There’s a government service. It’s has immense resources . When I worked for mental health there were psychologists, social workers, and administrators and we had meetings all the time and saw very few people. One mental health team was utilized by one patient who took up something like half the services. So many of the people I’ve worked with are afraid of the mentally ill. The burocrats are terrified of the mentally and will give them whatever to keep them out of their office and to focus their rage on others. They routine attack doctors from behind. They’re like the famous communist “leaders’ in WWII who stool at the back and shot anyone who didn’t go forward
I’ve had patietrns who I saw 40 years ago and when I saw them they were chronically hospitalized and with proper psychiatric care went on to be professors never hospitalized again. I care but what I do is what my teachers taught me and I had the best teachers and have seen the best of psychiatric care. What is occurring in British Columbia and Canada in general is a shit show. I saw better care when I worked for welfare in the US than I saw people routinely getting in Canada.a
Trudeau and the Liberals are given euthanasia as ‘health care’. They call it ‘Maid’ medically assisted suicide and the elderly and the mentally ill are targeting.
Nothing I say can be said. 2/3 of my colleagues are afraid to speak. The last 10 years has been censorship in Canada at the highest level. Many doctors and others working in institutions sign ‘non disclosure agreements’. They won’t speak if they see someone kllled . A man died in the waiting room of Winnipeg General Hospital and was dead 2 days and the hospital administration was exonerated because it was attributed ‘racism’. We are all surprised it wasn’t attributed to ‘climate change’.
A million people came into Canada one year with only 200,000 housing available, no infrastructure management, no increased hospitals or doctors or labs.
When I order a test it routinely doesn’t come back to me even though I’m the ordering doctor. MRI,CTScans, labs work go routine ly to a ‘family physician’. British Columbia is a family physician town and specialists are commonly denigrated by comparison. I am a family physician. I delivered a hundred babies and did surgery and have treated thousands of general practice issues . But when I order a test it goes to soemewhere else. I am routinely asking my staff to find the reports or results. The gp who receives the pscyhaitric labs etc commonly is a walk in doctor the patient saw some years ago . But I’m the ordering psychiatrist and rarely do I get the lab work or X-rays or whatever back to me. This is an administration issue. When my patients are admitted to hospital rarely, but they are seen in emergency, commonly even though I’m the psychiatrist and specialist on the pharmanet and the patient says I’ m the psychiatrist the institutions send their discharge notes to some disconnected community walk in clinic where the patient had some contact so that name is somewhere in the history. The doctors and nurses and institutions are doing extremely good work but the communication (administration) issue is abysmal. The trouble it ‘communication’ institution and community etc was a problem 40 years ago. We as doctors share among our self’s. However Lawyers don’t and beraurocrats don’t and they think information is power and their power . It’s a nightmare. Patient records are everywhere. It’s a shitshow. That’s all the glorious incompetence of health care administration at the government level in institution primarily while private doctors do the majority of health care.
Private psychiatrists are a principle reason our patients are not in hospital and are able to work and return to work. My patients have chronic illness. Most specialists are dealing with chronic illness . What we do is get the patient through another week or month. The patients are amazing. They are like the Duracell bunnies. Despite being stigmatized and preyed on the mentally ill and the addicted keep struggling forward. Thankfully many especially when the follow medical recommendations not only mange but prosper.
I love working with my patients the beautiful and ugly, stupid and brilliant, clean and unclean. What people don’t realize is doctors are a special breed who unlike lawyers, engineers, accountants or others are committed to understanding disease and treating sickness. I’m not research or business oriented .I’m a clinician. Most of my colleagues are like me. We love our work and we love our patients. But we don’t like the criticism and scapegoating. We have had a prime minister who would get at most a ‘c’ on a prime minister exam where as most of the doctors are A or A+ by world standards despite the increasing departure from clinical medicine to other more lucrative fields where doctors can work. I tell people that if I see a person with a fracture and see a cut and fix it I get $50 but if I review this for an insurance company or government I get $500 but if I review it for the courts I get $5000. I get the most money get the furthest away from patients with drug and alcohol problems or mental illnes but where I get to give talks and go to meetings and even become a. GURU. I am especially rewarded if I have a niche and I tell addicts they need drugs or tell paranoids they aren’t paranoids. The more I can join the patients in the their delusions and the more agreeable I am the more rewarded I am.
Increasingly patients used doctors not to get well but to get a letter for money or for some third party service. Patients tell me they don’t want to see a psychiatrist but that they want to see a holistic healer but psychiatrists are free and holistic healers cost too much money.
My dog peed on the neighbour recliner. The neighbour complained to the authorities and a man visited me and told me to keep my dog on a leash. He escaped that one time and I’ve had him on a leath a thousand times. I knew to smile and say thank you. My patient whose child died was abrupt with a client at work and written up and seen by several management people and HR and the union and they don’t have more sick days and they’re not dealing with the death that well. It’s been 2 months and they’re back to work because they’re paying for their mother who gets food from the food bank .My middle class patients are going to the food bank because Trudeau/Liberal money doesn’t buy anything. All my patients on fixed pension and disability are having problems paying for food and rent. Mental illness and addiction devastate a persons capacity to care for themselves. The Liberal government specializes and platitudes and their highly paid propaganda media say they’re helping the marginal people and are giving out ‘fish’ everyone once in a while with wonderful look at me press rallies. My patients don’t just have a problem for a week. They have been declining over that last three years. Many of my patients haven’t rebounded since Covid. This woman wants me to speak to her employer. I do that. I’ve done it hundreds of times. I’m saying please , give them another chance. Meanwhile they’re not doing well. Who does well after their daughter overdoses. But it’s an unkind world. I’m asked if I can give them a medication to help them focus and get better. I’m not allowed to prescribe cocaine. I m even criticized for prescribing opiates, benzodiazepines or stimulants. Repeatedly my Addict is tell me their doctors wouldn’t help them their pain or whatever and they went to the street. Like they go to soothsayers and snake oil salesmen.
I have another patient who escape from his third treatment centre and was in and out of hospital suicidal over night. But the law won’t let me Cerritos this addict and require that he be on injectable depot medications. The richest civil rights folk fight to allow this person to destroy his life. You’d think these guys are getting kick back from the cartels but I was a members of the Civil Rights Asdsociation and I know that the government under the liberals have been censoring and attacking freedoms and declaring martial law for peaceful demonstrations. Kent State is happening in Canada today. Forget about the Buffalo Spring Field. This the Maoist Culural Revolution and I want my individual patient to have restriction put on him but I know this government would be a police state in a second if it could and people le the Canadian Civil Liberties Association are necessary to stop tyranny of second class PM’s . It’s all above my pay grade.
i do the best I can. Really. I’m educated beyond my intelligence. I’m studying medicine all the time. I’ve devoted my life to psychiatry and addiction medicine. It’s cost me big time. I’m getting older and I’m frankly afraid seeing the horrendous neglect and abuse of the elderly and mentally ill in Canada. Terrorists get better treated and criminals get better treated and illegal immigrants get better treated than some of my patients and I’m criticized not by people on the front lines or doing better than me but you know, those ‘critics’ , a dime a dozen. When I worked in government I hated the meetings because they were so stupid and the critics were a dime a dozen and didn’t do any work , indeed their principle skill was avoiding work. I know one doctor in government medicine didn’t see one patient in 6 months but were being paid full time as a clinician. Another person I know ran an insurance agency out of the government medical office. I would love a DOGE of the Canadian government. Trudeau wants us to teach climate change to medical students and talk climate change in our 15 minute visits. When I worked in the asylum we told the patients that the bars were on the wall to protect them from the outside, from the insanity of Ottawa.
Hearing that tone of disdain, arrogance,superiority and ignorance, without experience or knowledge and just the inferiority complexes with their ‘judgemental mess’. Judgement is so easy. There’s no right or wrong in real life. We don’t get to decide ‘terms of engagement’. These corporates are trying to impose their intellectual rigid profit driven constructs on humans who obviously they don’t worker. The FDA tests medicine and almost all my patients including the brilliant beautiful celebrities would not make the jury selection rigor of the clinical trials. I’m doing psychopharamacoloy with medications that over laps and are influenced by other medications diet and exercise and I have patients seeing a half dozen or more specialists and we’re not getting each others reports or note and there’s no system in the community for paying for us to interact so the junior group stays safe in the institutions are the multiple meetings and shared accountability while clinicians so often are out in the community alone struggling. That’s where I’ve been but I specialized in wilderness medicine and worked as fly in family physician and psychiatrist in northern Canada and the Polynesia islands. Years of my life without resources doing what I could. Now Canada is like a third world wilderness medicine place and my patients are falling through the cracks. All of those best practice models gps are supposed to follow aren’t getting to my psychiatric patients or my addicted patients. I imagine half my female patients have n’t had a breast exam and so many haven’t had stool samples. All the brilliant Canadian preventative health care isn’t happening to my patients because they don’t have a family physician and walk in clinics aren’t able to manage the demands.
Besides more and more patients are Dr. Google and have a false idea that AI does good diagnosis and treatment .It doesn’t . There research is definitive. But the management sorts are frightened of this fact.
I’m worried because I’m on the dying end of the equation and know as a doctor I’m not getting the kind of health care that was normal 10 or 20 years ago. Today is a shit show and of course people are lucky if they get good care and they do but it’s so sad to see how poorly managed it is. But we have had a prime minister who says ‘budgets balance themselves’ and while he’s been at his perpetual party and spending spree he has also thought ‘country manages itself ‘ and ‘health care heals itself’.
Now there’s nothing I need fear except fear itself. I must forgive the arrogant and grandiose especially the narcissistic and psychopaths who don’t know they are assholes, but I must be the best version of myself today because the person I was talking to might have just learned they have gonorrhea and their dick was going to be amputated or the woman that her lipstick was a carcinogens. I must be understanding. I am a sinner. I’m a person who fails too. I’m not a saint. I’m not perfect. And yes I could have done a better job. I could have typed a pretty little paper like I do for the courts and spent the time doing that but I was dealing with trying to get my schizophrenic patient care because a number of companies are interfereing with his care and I don’t know what to do since I don’t have resources. I ordered an MRI for another person but the MRI place last the requisition., I’ve consulted a neurologist twice because the patient has something groiwning in their brain and yet I can’t get anyone interested because they guy is an addict or more likely everyone like me is over extenders,.
Canadian doctors outside of Quebec have 80% burnt out but French Canaaddian doctors are better paid with less case loads more breaks and more money and look down their noses at us especially us in western Canada which is wild.
But I’m trying to focus on being in the present. I’m trying to pray for enemies and forgive and let go of conflict and live in the present and develop acceptance. The problem is me and my perception This is God’s world and when I criticize it I criticize God and God is great all the time and God knows what’s best and me being criticized for my dog and my patients rude behaviour is just the way it should l be and I should rise about all this. I remember when the landlord wanted to kick me out of the office because my patients who I refused to give opiates to Keyed the walls of the office and I had to pay for the repair but that wasn’t enough others were afraid of mental ill people in the office buislling. The addicts are even less welcome and have often been shouting in waiting rooms threatening and I’ve been told that I am not wanted if I can’t control my patients or ensure such patients don’t come to see me. But then the patients complain to the government and the government hates doctors and is superior and elite and aloof and wear expensive suits and don’t get woken at night are rich fat cats with the best pensions and they cost the doctors thousands of dollars and the patients who complain about the doctors are violent bullies in the community but there’s a shortage of doctors and the administration is supposed to care but at any time there’s doctors playing that administration game that costs the private practitioner tens of thousands of dollars whereas the institutional and salaried doctors are rewarded by time off and collective angst since they don’t have to pay overhead and staff.
The PM called me and all private doctors criminals and said we were stealing from patient with our RRSP program. I don’t have health care. I don’t have pension. I’m making less that the patient who have unions . I lost 12 years of earning capacity to education and this guy told me ‘a thermostat has degrees and we stick that up your ass’.
I also have to resist poor me. when I can’t sleep and something like this has triggered me I go into self pity mode. Thank god I have friends who say ‘get off the cross, we can use the wood’. Really I had teachers who talked like army sergeants and I have seen doctors do the most egregious things to doctors. I have had the worst and best medical care known in my time . But now I’m blessed.
I’m right now in paradise and can only imagine that I’m so relaxed and blessed that I’m sensitive to this shit which I normally take like water off a ducks back. The abuse of caregivers in Canada is legion. In Covid times we all had to put up signs don’t attack medical staff. Meanwhile people we banging pots and pans in other places saying thanks for taking the risk. I was terrified at first remember the year I was the emergency doctor that first year of aids when friends were dying. A couple of friends died of Covid last year too.
This getting old isn’t for the young.
I’m tired enough to sleep I hope. All shall be well. All shall be well. All manner of things shall be well. I miss the head of family medicine and the head of neurology and the head of psychiatry. they all referred to me and now they’re retired or dead. Ageism is alive and well in Canada. Racism not so much. My older patients aren’t going to get even good assisted living since everything costs and those with assists saved are punished because the street people get the same and now illegal immigrants get first in line.
I’m fucked but that’s God’s will. So thank you Jesus. God came to earth and they killed him and it just keeps on going. Tomorrow is a new day Jesus will be born and die and arise. The aestesist will evangelize and push their religion of communism and their silliness and I’ll thank god for waking me up. I’ll be confused. I’ll do the next right thing. I’ll no doubt convince another person not to suicide while I think of it and tell my patients stop talking and being distracted by America the problem is closer to to home. Like the adolescent who can solve all the world’s problems but can’t clean his room.
I’m awake at night because God and I are having a Jakob struggle. My back hurts. I’ve losing body parts. Everyone is dying. I’m paranoid. I am hopeful. I’ll keep Madigan on a close leash and maybe I’ll clean his bum and wash him because his poops getting stuck in his hair. That’s really what I should focus on. I will get in the mineral springs and that will be wonderful . Now I’ll go back to bed and hope to turn over without screaming pain . Fucking plan crash. I can take Advil but my stomach gets upset. I tried some cream and that helped. This is paradise. I’m blessed to be hear
A terrific pit stop for an old car one a wonderful journey. Thank you Jesus. Thank You God.
Posts
No comments:
Post a Comment