Hello everyone =] Hope you're all enjoying your weekend. I finished my first week of work! (Having thought up until a couple of days before that the paperwork wouldn't be ready in time)
As I'm a 50/50 jobshare I worked the longest stretch I will be working (Weds, Thurs, Fri and then Mon, Tues) and I survived.
It comes at a cost though. I knew it would, I knew what I was getting into - but it's really strange. At work I may look disabled - what with the wheelchair and everything - but I don't look sick.
People don't see me in the evenings when I get home and I'm too tired to hold my own head up, or I get drooly from 'stroke face', or I rock my own personal blend of dysarthria and dysphasia, or I faint mid sentence. They don't see that I've spent the last two days lying flat because my pelvis is (sorry if this is a complicated medicalism that goes over your head) utterly buggered or that my joints are all over the place because my muscles are worn out.
I mean, obviously they don't. My health stuff isn't my patients' or colleagues' business. It's just very strange. It feels a bit like I'm pretending somehow. Sometimes the adrenaline carries me through and pretty much as soon as I leave the ward I'm on the point of collapse. I wonder if they wonder why I'm part time because when I'm there I am (wheelchair aside) no different to my colleague. Or, am I kidding myself - does the wheelchair make me look sick to them anyway? I just don't know.
I don't suppose it matters in the scheme of things and I am *so* grateful to have started (even if I did write TWENTY discharges on Monday), but it's driven home just how different an experience of this I'm going to have to the people I work with. I know that people get beyond tired during FY1 and that it is not without a lot of payback for even healthy full timers, but this is different. It's also a bit weird because the ward I'm on most of the patients are pretty healthy as it's mostly elective surgery. I loosely judge the complexity of a patient's case based on how many medications they take in comparison to me (not in any official or serious way) and there's only been one patient on more meds so far.
In part this year will be an experiment. Rather than pacing activity on a day by day basis (balancing energy expenditure over the day) I'm moving to a doing more for a couple of days and totally resting another couple of days. I'm not entirely sure what this will be like physically, but for now it seems to involve this double life, this seeming normality and then the payback.
At Both Ends of the Stethoscope.
Saturday, 17 August 2013
Friday, 5 July 2013
Happy Birthday NHS
The NHS is 65 today.
What the NHS has done for me :
1) Employed my mum through pregnancy/my first few years (she was a ward sister, midway through labour they had to bring the new dialysis machine down to the delivery ward so she could show them how to work it)
2) Helped me/my mum through a difficult delivery and scanned my massively large head to make sure it wasn't hydrocephalus
3) Treatment for my nasty childhood asthma including some pretty scary attacks
4) Specialist physio for my eye muscles (anyone else? eye patches and trying to fit the sentry in the sentry box and the apple in the tree?)
5) Took me in a nee-naw to get a Cspine xray after I fell head fist off a trapeze
6) Hearing tests leading to tonsil/adenoidectomy + grommets (or tympanostomy tubes as we're now supposed to call them)
7) Years of treatment for depressive episodes
8) Putting me back together after suicide attempts
9) 6 weeks of crisis support
10) A year of weekly psychotherapy
11) A diagnosis, 10 weeks of rheumatology specialist physio and 10 weeks of hydrotherapy
12) Occupational therapy and hundreds of pounds worth of equipment allowing me to maintain independence, safely, at home
13) Orthotics to hold my wobbly joints together
14) 1 Tilt table test, 1 echo, 1 24 hour ECG and lots of regular ECGs
15) 2 Endoscopies, 1 Gastric Emptying Scan and 1 Abdominal Ultrasound
16) An ABG to check for Carbon Monoxide poisoning
There have been mistakes and there are problems, but I'll save those for another day.
I have been a patient at 16 hospitals, treated by countless doctors in 13 specialities, as well as specialist nurses, specialist physios, occupational therapists, orthoticists, dentists and opticians. I have received free or subsidised prescriptions every month for 23 years - including at least 30 different medications.
When I've had an infection or an accident or a flare, I've had the ambulances, Xrays, medications and admissions I've needed without worrying about my ability to pay.
Not to forget the other folk who've been involved in keeping me healthy - GP receptionists and ward cleaners, lab techinicians and epidemiologists, researchers, campaigners, paramedics. All the people that help keep the NHS ticking over.
If it weren't for the NHS I don't know if I'd have made it to 25 and there are people very dear to me who definitely wouldn't be around today without free, expert healthcare.
And now they've given me a job. There is no organisation in the world I could be prouder to work for.
Happy birthday NHS, and thank you.
What the NHS has done for me :
1) Employed my mum through pregnancy/my first few years (she was a ward sister, midway through labour they had to bring the new dialysis machine down to the delivery ward so she could show them how to work it)
2) Helped me/my mum through a difficult delivery and scanned my massively large head to make sure it wasn't hydrocephalus
3) Treatment for my nasty childhood asthma including some pretty scary attacks
4) Specialist physio for my eye muscles (anyone else? eye patches and trying to fit the sentry in the sentry box and the apple in the tree?)
5) Took me in a nee-naw to get a Cspine xray after I fell head fist off a trapeze
6) Hearing tests leading to tonsil/adenoidectomy + grommets (or tympanostomy tubes as we're now supposed to call them)
7) Years of treatment for depressive episodes
8) Putting me back together after suicide attempts
9) 6 weeks of crisis support
10) A year of weekly psychotherapy
11) A diagnosis, 10 weeks of rheumatology specialist physio and 10 weeks of hydrotherapy
12) Occupational therapy and hundreds of pounds worth of equipment allowing me to maintain independence, safely, at home
13) Orthotics to hold my wobbly joints together
14) 1 Tilt table test, 1 echo, 1 24 hour ECG and lots of regular ECGs
15) 2 Endoscopies, 1 Gastric Emptying Scan and 1 Abdominal Ultrasound
16) An ABG to check for Carbon Monoxide poisoning
There have been mistakes and there are problems, but I'll save those for another day.
I have been a patient at 16 hospitals, treated by countless doctors in 13 specialities, as well as specialist nurses, specialist physios, occupational therapists, orthoticists, dentists and opticians. I have received free or subsidised prescriptions every month for 23 years - including at least 30 different medications.
When I've had an infection or an accident or a flare, I've had the ambulances, Xrays, medications and admissions I've needed without worrying about my ability to pay.
Not to forget the other folk who've been involved in keeping me healthy - GP receptionists and ward cleaners, lab techinicians and epidemiologists, researchers, campaigners, paramedics. All the people that help keep the NHS ticking over.
If it weren't for the NHS I don't know if I'd have made it to 25 and there are people very dear to me who definitely wouldn't be around today without free, expert healthcare.
And now they've given me a job. There is no organisation in the world I could be prouder to work for.
Happy birthday NHS, and thank you.
Sunday, 30 June 2013
Starred Items
Just made my way through my Google Reader starred items, in time for its demise tomorrow.
It was quite emotional.
The posts about medicine that capture the essence and the art of it.
The post written to me when I was at my very lowest point.
The posts that taught me it was alright to be myself - disabled, queer, fat, female.
The posts that taught me that it is so much more that alright to be myself.
The post announcing the start of my minister's journey with cancer.
The post celebrating the end of her chemo.
The posts that introduced me to amazing disability equipment.
The post that led me to my bright purple compression stockings.
The posts that capture my faith in words (and pictures).
The post announcing the arrival of my beloved kittycat.
The post from the blog that's no longer updated.
The post from the blog I stopped following.
The posts that help me to be a better ally to my trans and BME friends and patients.
The post with the gif of the tiny kitten that jumps up on the bed and boops him on the nose.
The posts that made me laugh.
The posts that made me pray.
The posts that made me rage, cry, learn, think.
I'm sitting here thinking about all the blogs I've followed over the years. Thankful for the window into people's lives, thankful for the chance to share important ideas, thankful for the silliness, thankful for the community. Hoping that those who're now longer updating are doing well.
It was quite emotional.
The posts about medicine that capture the essence and the art of it.
The post written to me when I was at my very lowest point.
The posts that taught me it was alright to be myself - disabled, queer, fat, female.
The posts that taught me that it is so much more that alright to be myself.
The post announcing the start of my minister's journey with cancer.
The post celebrating the end of her chemo.
The posts that introduced me to amazing disability equipment.
The post that led me to my bright purple compression stockings.
The posts that capture my faith in words (and pictures).
The post announcing the arrival of my beloved kittycat.
The post from the blog that's no longer updated.
The post from the blog I stopped following.
The posts that help me to be a better ally to my trans and BME friends and patients.
The post with the gif of the tiny kitten that jumps up on the bed and boops him on the nose.
The posts that made me laugh.
The posts that made me pray.
The posts that made me rage, cry, learn, think.
I'm sitting here thinking about all the blogs I've followed over the years. Thankful for the window into people's lives, thankful for the chance to share important ideas, thankful for the silliness, thankful for the community. Hoping that those who're now longer updating are doing well.
Wednesday, 19 June 2013
Occupational Health
Hello!
There is no point trying to play catch up after all this time so I'll just dive right on in!
This morning, with 7 weeks left until I'm supposed to start work I had an occupational health assessment. I was dreading it! So far there's been the med school handing over to the deanery meeting when I was asked (having just passed the same exams as everyone else) whether I felt I could *really* expect to work to the speed and standard of my colleagues and that I would have to guide them because they're not used to dealing with "people like me". Then because I had to take the year out because access provisions move at glacier pace I have to be investigated by the Gee Em See before they'll grant me provisional registration and they can't guarantee that if the relevant people don't get back to them promptly might not happen before I'm supposed to start work - and because the health board can take 3 months to decide on less than full time training there could be a delay which is in no way my fault. Oh, and my house burned down 3 days after finals.
I just want to do the job I have spent 7 years training for and have qualified for and have in fact been given (but not quite because all of the above).
So, today I saw Dr Occy Health. He took a thorough history - asked which type of Hypermobility Syndrome I have and made the link between dysautonomia and gastroparesis all by himself. He was horrified by all of the aforementioned nonsense and took names and numbers to chase things up.he thanked my partner for coming rather than being strangely confused that someone may need moral support at a big deal appointment. He took a fatigue and pain history which is not only rare of itself but he did it well and in a way that made it sound like he believed I experienced those things. I could go on but you get the idea.
If you are reading this and don't think 'wow!' you either are or have a good doctor. It shouldn't be worthy of comment when an appointment leaves you feeling better, or at least not worse, than you did when you arrived.
7 weeks to go.
There is no point trying to play catch up after all this time so I'll just dive right on in!
This morning, with 7 weeks left until I'm supposed to start work I had an occupational health assessment. I was dreading it! So far there's been the med school handing over to the deanery meeting when I was asked (having just passed the same exams as everyone else) whether I felt I could *really* expect to work to the speed and standard of my colleagues and that I would have to guide them because they're not used to dealing with "people like me". Then because I had to take the year out because access provisions move at glacier pace I have to be investigated by the Gee Em See before they'll grant me provisional registration and they can't guarantee that if the relevant people don't get back to them promptly might not happen before I'm supposed to start work - and because the health board can take 3 months to decide on less than full time training there could be a delay which is in no way my fault. Oh, and my house burned down 3 days after finals.
I just want to do the job I have spent 7 years training for and have qualified for and have in fact been given (but not quite because all of the above).
So, today I saw Dr Occy Health. He took a thorough history - asked which type of Hypermobility Syndrome I have and made the link between dysautonomia and gastroparesis all by himself. He was horrified by all of the aforementioned nonsense and took names and numbers to chase things up.he thanked my partner for coming rather than being strangely confused that someone may need moral support at a big deal appointment. He took a fatigue and pain history which is not only rare of itself but he did it well and in a way that made it sound like he believed I experienced those things. I could go on but you get the idea.
If you are reading this and don't think 'wow!' you either are or have a good doctor. It shouldn't be worthy of comment when an appointment leaves you feeling better, or at least not worse, than you did when you arrived.
7 weeks to go.
Tuesday, 9 April 2013
Post Finals Update
So posting here fell into a finals shaped hole. The good news is that I have emerged with a pass, the not so good news is that 3 days after they finished there was a big fire in our building and so we are out of the flat awaiting cleaning/redecoration/replacement of soft furnishings etc. I'll be posting about that experience at a later date. Suffice it to say, it was pretty traumatic and is still quite rubbish but I'm in one piece as are my darling wifelet and kittycat and we have absolutely beyond amazing friends who have carried us through all the nonsense. And as you'll know there is a lot of of nonsense when insurance companies get involved in anything.
Here is a canter through my exam period and the lessons I learned from it.
The good :
- Starting early. I knew I wouldn't be able to cram in the last few weeks like other folk so I planned around it. Our 4th and 5th years are one unit curriculum wise, so from the start of 4th year I began studying. This may sound ridiculous, but what I mean is that during each block I studied a couple of hours every evening, really getting into the speciality I was doing and making good notes that suit my revision style. This meant that for the most part revision was actually revision. A lot of folk took 4th year as a year off out-of-hours studying but it wouldn't have worked for me (it worked really well for a lot of them - there is no single right way to approach things). My studying didn't actually have quite the same intensity ramp up in the last few months - I just continued spending a couple of hours every evening, admittedly infused with more adrenaline! My need for rest however did ramp up - that was more that my condition is worse now than during 4th year. I spent a lot of time resting (to those of you who have the urge to say 'ooh, lucky' please don't - whilst I enjoy a duvet day as much as the next person, enforced rest that is isolating and restrictive on your other activities is not fun)
- Focusing on self care. Taking full days off as needed, eating sensible food (for which I have to thank my wifelet), letting myself have a good cry from time to time, keeping in touch with friends via text when I didn't have enough energy to see them and having a stop time every evening. The best self care was accidental - two of our dear friends got married in the middle of nowhere in between writtens and OSCEs and we went there for a few days. The change of scene and the fresh air were incredible - and because I did some work while there I didn't panic about not being at my desk (read - in my bed) at all.
- It was the first time I'd have my special exam arrangements in place and having a separate room to allow me to wiggle and pop and stretch to my heart's content without distracting folks plusextra sufficient time (this reference comes from the most amazing series of blog posts on access and education that I have completely lost track of - if you know of the link please comment!) to complete the exam at a speed my poorly fingers would allow.
- Having a study ethos rather than a study plan. In days gone by I've spent many hours making/colouring coding a detailed study plan, only to fall behind or change things up and having to do the whole thing again. This time around I came up with some principles to read when I was unsure of what to study or feeling panicked about what I hadn't covered yet :
1) I will never cover everything
2) Doing past papers is useful, because it is a guide about what kind of depth to go into and what kind of questions may be asked / what kind of answers are expected
3) Identify the major conditions and presentations within a subject and cover the relevant material about those well (for conditions outline definition/aetiology/pathophysiology/clinical features/diagnosis/management/prognosis and for presentations outline differential/key points from history and examination including red flags/investigations and management)
4) Regularly write a list of 5-10 things that you would hate to come up. As you go on this will get more specific (from 'ENT' or 'urology' to 'cerebellar examination' or 'TB pathophysiology'). Resist the urge to make the list longer.
5) Every time you think 'I know nothing about ...' list 10 thing you know about it. (e.g. ENT : thyroid related lumps move on swallowing, big tonsils/adenoids can cause sleep apnea in kids, grommets are tubes through the ear drum). Anything. It doesn't mean you don't need to study, but catastrophising isn't anyone's friend.
- Thinking 'I'm not the best, but I'm not the worst' on loop. Thinking that even if I failed, managing to complete the exams was a massive achievement in itself. Knowing people who passed last year and the level of study that they did and the level of knowledge that they had was very helpful. It gave me something concrete and reassuring to compare myself to. Very few people fail finals but everyone is terrified that it will be them.
The bad :
- No study leave meaning that we were on placement full time right up until the exams. As someone who will need to work part time due to fatigue etc, this was really tough. I think it would have been easier if those organising our placements had taken this into account, but I was being told right up until the end that spending time in the library and not on the wards was a waste of time. At that point it just isn't. Yes, you need to be seeing patients, but if you've had 2 hours of bedside teaching and then spent another few hours seeing several more patients, retreating to the library at the start of afternoon visiting is actually a pretty sensible way to consolidate what you've learned.
- Spending the first minute of every OSCE station having to rearrange furniture so I could fit in the room / get to the patient or task. I think for PACES or whatever I would ask for there to be someone who would go in the changeover gap between stations to sort that out for me. They knew there was a wheelie on the circuit, but noone had really given it much thought (understandably as they'd not been asked to). The worst was the first station where it was impossible for me to get to the patient without lifting furniture so I had to bum shuffle across the bed (patient was on a chair at the other side) to get to them - not the most dignified entrance but I passed the station.
- All of the admin nonsense that falls during exam time. We had to submit a big portfolio of case reports and essays and stuff a couple of weeks before, then there was the SJT nonsense and job ranking and all of these things. All necessary and unavoidable (except for the SJT saga) but still annoying. Also more DSA related nonsense (still don't have any of the equipment and the report when finally submitted 5 months late missed off half the stuff we'd discussed).
- We had 4 OSCEs spread over 2 weeks. They are utterly exhausting in a way that nothing else is. I finished one in serious doubt as to whether I would literally be able to make it home.
The rest :
- Practicing cardio exam on the cat "Skye I'm just feeling your radial pulse. Skye do you have a radial pulse? Skye do you have a radius?"
- Living in scrub bottoms, giant protest Tshirts and my polar bear dressing gown
- Eating mashed potato for 2 meals a day for nearly 3 weeks
- A certain person giving me the fright of my life by blogging good luck for exams a day early! (but otherwise being utterly angelic and wonderful - happy birthday!)
- Another friend getting up during their annual leave to go with me for the start of my written exams to keep me company because the wifelet was working
- Taking a study break to be fed radioactive cornflakes while inside a space ship (aka having a gastric emptying scan)
- Answering a full past paper question worth 20 marks entirely right gained entirely from knowledge I only had from watching ER
- Answering a question on the treatment of croup with "I don't know, but Anne of Green Gables used to swear by belladonna"
Here is a canter through my exam period and the lessons I learned from it.
The good :
- Starting early. I knew I wouldn't be able to cram in the last few weeks like other folk so I planned around it. Our 4th and 5th years are one unit curriculum wise, so from the start of 4th year I began studying. This may sound ridiculous, but what I mean is that during each block I studied a couple of hours every evening, really getting into the speciality I was doing and making good notes that suit my revision style. This meant that for the most part revision was actually revision. A lot of folk took 4th year as a year off out-of-hours studying but it wouldn't have worked for me (it worked really well for a lot of them - there is no single right way to approach things). My studying didn't actually have quite the same intensity ramp up in the last few months - I just continued spending a couple of hours every evening, admittedly infused with more adrenaline! My need for rest however did ramp up - that was more that my condition is worse now than during 4th year. I spent a lot of time resting (to those of you who have the urge to say 'ooh, lucky' please don't - whilst I enjoy a duvet day as much as the next person, enforced rest that is isolating and restrictive on your other activities is not fun)
- Focusing on self care. Taking full days off as needed, eating sensible food (for which I have to thank my wifelet), letting myself have a good cry from time to time, keeping in touch with friends via text when I didn't have enough energy to see them and having a stop time every evening. The best self care was accidental - two of our dear friends got married in the middle of nowhere in between writtens and OSCEs and we went there for a few days. The change of scene and the fresh air were incredible - and because I did some work while there I didn't panic about not being at my desk (read - in my bed) at all.
- It was the first time I'd have my special exam arrangements in place and having a separate room to allow me to wiggle and pop and stretch to my heart's content without distracting folks plus
- Having a study ethos rather than a study plan. In days gone by I've spent many hours making/colouring coding a detailed study plan, only to fall behind or change things up and having to do the whole thing again. This time around I came up with some principles to read when I was unsure of what to study or feeling panicked about what I hadn't covered yet :
1) I will never cover everything
2) Doing past papers is useful, because it is a guide about what kind of depth to go into and what kind of questions may be asked / what kind of answers are expected
3) Identify the major conditions and presentations within a subject and cover the relevant material about those well (for conditions outline definition/aetiology/pathophysiology/clinical features/diagnosis/management/prognosis and for presentations outline differential/key points from history and examination including red flags/investigations and management)
4) Regularly write a list of 5-10 things that you would hate to come up. As you go on this will get more specific (from 'ENT' or 'urology' to 'cerebellar examination' or 'TB pathophysiology'). Resist the urge to make the list longer.
5) Every time you think 'I know nothing about ...' list 10 thing you know about it. (e.g. ENT : thyroid related lumps move on swallowing, big tonsils/adenoids can cause sleep apnea in kids, grommets are tubes through the ear drum). Anything. It doesn't mean you don't need to study, but catastrophising isn't anyone's friend.
- Thinking 'I'm not the best, but I'm not the worst' on loop. Thinking that even if I failed, managing to complete the exams was a massive achievement in itself. Knowing people who passed last year and the level of study that they did and the level of knowledge that they had was very helpful. It gave me something concrete and reassuring to compare myself to. Very few people fail finals but everyone is terrified that it will be them.
The bad :
- No study leave meaning that we were on placement full time right up until the exams. As someone who will need to work part time due to fatigue etc, this was really tough. I think it would have been easier if those organising our placements had taken this into account, but I was being told right up until the end that spending time in the library and not on the wards was a waste of time. At that point it just isn't. Yes, you need to be seeing patients, but if you've had 2 hours of bedside teaching and then spent another few hours seeing several more patients, retreating to the library at the start of afternoon visiting is actually a pretty sensible way to consolidate what you've learned.
- Spending the first minute of every OSCE station having to rearrange furniture so I could fit in the room / get to the patient or task. I think for PACES or whatever I would ask for there to be someone who would go in the changeover gap between stations to sort that out for me. They knew there was a wheelie on the circuit, but noone had really given it much thought (understandably as they'd not been asked to). The worst was the first station where it was impossible for me to get to the patient without lifting furniture so I had to bum shuffle across the bed (patient was on a chair at the other side) to get to them - not the most dignified entrance but I passed the station.
- All of the admin nonsense that falls during exam time. We had to submit a big portfolio of case reports and essays and stuff a couple of weeks before, then there was the SJT nonsense and job ranking and all of these things. All necessary and unavoidable (except for the SJT saga) but still annoying. Also more DSA related nonsense (still don't have any of the equipment and the report when finally submitted 5 months late missed off half the stuff we'd discussed).
- We had 4 OSCEs spread over 2 weeks. They are utterly exhausting in a way that nothing else is. I finished one in serious doubt as to whether I would literally be able to make it home.
The rest :
- Practicing cardio exam on the cat "Skye I'm just feeling your radial pulse. Skye do you have a radial pulse? Skye do you have a radius?"
- Living in scrub bottoms, giant protest Tshirts and my polar bear dressing gown
- Eating mashed potato for 2 meals a day for nearly 3 weeks
- A certain person giving me the fright of my life by blogging good luck for exams a day early! (but otherwise being utterly angelic and wonderful - happy birthday!)
- Another friend getting up during their annual leave to go with me for the start of my written exams to keep me company because the wifelet was working
- Taking a study break to be fed radioactive cornflakes while inside a space ship (aka having a gastric emptying scan)
- Answering a full past paper question worth 20 marks entirely right gained entirely from knowledge I only had from watching ER
- Answering a question on the treatment of croup with "I don't know, but Anne of Green Gables used to swear by belladonna"
Thursday, 10 January 2013
Plodding along
Just a brief update for those who follow my medical happenings here. Final year is hard going physically and emotionally. I am on my final placement before exams just now and I still don't have any of my DSA funding/equipment in place. Working/studying fulltime is exhausting, but won't be for much longer.
I'm scared about finals in a vague way. Scared more about my body falling apart than of screwing up academically. I can't manage to study for infinite hours in the day, but I don't think that's a bad thing. After a certain point passing finals is about practice and holding your nerve rather than stuffing your fit to burst. Well, that's what the folks who've already done them tell me!
I would say I'm please to be approaching the end of all the disability nonsense in the med school, but I don't anticipate work being any better to be honest.
My dysautonomia has been more problematic. I don't know if that's fatigue or progression, but I've been having 'attacks' of very severe symptoms that are quite scary and horrible. On the up side a gastro is finally looking into the nausea.
This is not a chirpy post, but it's where I'm at just now. I'm very tired, but still going just about.
I'm scared about finals in a vague way. Scared more about my body falling apart than of screwing up academically. I can't manage to study for infinite hours in the day, but I don't think that's a bad thing. After a certain point passing finals is about practice and holding your nerve rather than stuffing your fit to burst. Well, that's what the folks who've already done them tell me!
I would say I'm please to be approaching the end of all the disability nonsense in the med school, but I don't anticipate work being any better to be honest.
My dysautonomia has been more problematic. I don't know if that's fatigue or progression, but I've been having 'attacks' of very severe symptoms that are quite scary and horrible. On the up side a gastro is finally looking into the nausea.
This is not a chirpy post, but it's where I'm at just now. I'm very tired, but still going just about.
Wednesday, 5 December 2012
In the Middle : Biopsychosocial Model
This is an interesting topic for me as a medical student and a disabled person, because both groups use the phrase to mean different things, one is seen as a positive thing and the other a negative. I thought I would write this post as a 'translation' of sorts - because I have seen it lead to misunderstandings or arguments. It is almost a 'false friend' situation for the linguists amongst you.
The biopsychosocial model (henceforth BPS) has an understandably bad reputation amongst disabled people. It has been used by many to suggest that people are not impaired by biological disease, but rather by psychological beliefs that they are sick, and therefore as an excuse to deny medical treatment, insurance coverage or benefits applications. These alleged psychological beliefs are of course not deemed 'proper disease' enough to merit psychological treatment, so people are left being told that their illness is 'all in their head' and therefore they just need to pull themselves together.
Before my diagnoses I was frequently told that fatigue, joint pain, dizziness etc was all in my head and therefore that I should ignore it and push through. I asked on several occassions why, if I had a psychological disease I was not being given psychological treatment. (Doctors need to get better at saying 'I don't know'.) There is obviously a lot of hurt and frustration felt by sick/disabled people who have been dealt with in this way. Or, people are 'diagnosed' with social problems, which often intertwines with the 'illness behaviour' narrative - e.g. you are not working therefore you sit at home and worry yourself into being ill, for which the obvious cure is to threaten people on benefits to the point that they no longer live the comfortable, shelterd life which the government seems to think benefit claimants have.
It is however, used in another way. The BPS model has been introduced into some medical schools / postgraduate training as a way to remind doctors that there is more to caring for a patient than the medical model. The medical model is basically 'you have broken your arm, we need to pin it and put it in a cast' or 'you have an infection, you need antibiotics'. It is very much the model that you want doctors to be using when you are being resuscitated after a car crash, but once the immediate danger has passed there are other aspects to consider.
So, as a reminder that a biological disease process (let's say Parkinson's) will have more than purely biological effects. It has psychological effects - in the case of Parkinson's both psychological symptoms such as depression and the general 'reactive' psychological effects that can come with any chronic illness - adjustment to new symptoms, traumatic medical experiences etc. There are also many social effects that come from having a chronic illness - the stigma of appearing drunk for example, as some with Parkinson's can do, the fact that the world is not accessible and is therefore disabling (so we include 'social model' thinking which states that people are not intrinsically disabled, they are disabled by their environment - e.g. stairs with no lift alternative disable some folk with mobility impairments, expectations that a normal working day is 9-5 5 days a week disables folk with chronic fatigue or frequent hospitalisations/medical appointments).
The BPS model was introduced in this context to remind doctors that it is not necessarily enough to give folk some tablets and send them away. The multidisciplinary team (ooh, I get points for using the buzzwords!) is given the recognition it deserves in this context - OTs, Social Workers, chronic illness psychologists (yes, I'm told they do actually exist but I've never seen one in the wild).
In my mind the BPS model as applied this way is a very good thing for chronically sick/disabled people, because it is a much more 'holistic' model than the medical model used in isolation (and I hope it's clear that I think the 'it's all in your head' use of the BPS model is very damaging).
Any thoughts?
The biopsychosocial model (henceforth BPS) has an understandably bad reputation amongst disabled people. It has been used by many to suggest that people are not impaired by biological disease, but rather by psychological beliefs that they are sick, and therefore as an excuse to deny medical treatment, insurance coverage or benefits applications. These alleged psychological beliefs are of course not deemed 'proper disease' enough to merit psychological treatment, so people are left being told that their illness is 'all in their head' and therefore they just need to pull themselves together.
Before my diagnoses I was frequently told that fatigue, joint pain, dizziness etc was all in my head and therefore that I should ignore it and push through. I asked on several occassions why, if I had a psychological disease I was not being given psychological treatment. (Doctors need to get better at saying 'I don't know'.) There is obviously a lot of hurt and frustration felt by sick/disabled people who have been dealt with in this way. Or, people are 'diagnosed' with social problems, which often intertwines with the 'illness behaviour' narrative - e.g. you are not working therefore you sit at home and worry yourself into being ill, for which the obvious cure is to threaten people on benefits to the point that they no longer live the comfortable, shelterd life which the government seems to think benefit claimants have.
It is however, used in another way. The BPS model has been introduced into some medical schools / postgraduate training as a way to remind doctors that there is more to caring for a patient than the medical model. The medical model is basically 'you have broken your arm, we need to pin it and put it in a cast' or 'you have an infection, you need antibiotics'. It is very much the model that you want doctors to be using when you are being resuscitated after a car crash, but once the immediate danger has passed there are other aspects to consider.
So, as a reminder that a biological disease process (let's say Parkinson's) will have more than purely biological effects. It has psychological effects - in the case of Parkinson's both psychological symptoms such as depression and the general 'reactive' psychological effects that can come with any chronic illness - adjustment to new symptoms, traumatic medical experiences etc. There are also many social effects that come from having a chronic illness - the stigma of appearing drunk for example, as some with Parkinson's can do, the fact that the world is not accessible and is therefore disabling (so we include 'social model' thinking which states that people are not intrinsically disabled, they are disabled by their environment - e.g. stairs with no lift alternative disable some folk with mobility impairments, expectations that a normal working day is 9-5 5 days a week disables folk with chronic fatigue or frequent hospitalisations/medical appointments).
The BPS model was introduced in this context to remind doctors that it is not necessarily enough to give folk some tablets and send them away. The multidisciplinary team (ooh, I get points for using the buzzwords!) is given the recognition it deserves in this context - OTs, Social Workers, chronic illness psychologists (yes, I'm told they do actually exist but I've never seen one in the wild).
In my mind the BPS model as applied this way is a very good thing for chronically sick/disabled people, because it is a much more 'holistic' model than the medical model used in isolation (and I hope it's clear that I think the 'it's all in your head' use of the BPS model is very damaging).
Any thoughts?
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