Okay, I know I've been slacking off lately. Maybe it's because I'm in clinic now, so there's not quite as many crazy ER stories. In clinic, the craziness and irrationality is still present, but on a smaller scale. Just thought I would provide some anecdotes from one week of working in an outpatient psych clinic for the county.
One day a week is child/adolescent clinic. Every other patient is a photocopy of this one. 7-10 year old boy comes in with mom. Mom complains that kid is acting up in school, getting into fights, suspended, etc. At home, he throws telephones and potted plants while calling mom the "C"- word. Dad has been in prison all the kids life. Mom never re-married but has had some boyfriends. Mom wants to throw some mind - altering drugs down the kid's throat and hope everything gets better.
Last week, I'm seeing a followup. 50-ish white female with anxiety after a near fatal car wreck that put her in a coma for a few weeks. She had on a T-shirt that said "pimpjuice" and that's all I could think of during the entire visit. I didn't know until today when I was looking for a graphic that it is an energy drink, a Nelly song, etc. If you have anxiety/depression and you think your life sucks, then take life seriously and throw away the dumb t-shirts. Just my opinion.
Yesterday, I was reading through a lady's new-patient questionnaire. She mentioned that she had trouble controlling her "dietbetes". I asked her what that meant and she said, "It's because of the insulin. If I don't eat, I feel bad. So I have to eat more than I should so the insulin doesn't make me crash. I've gained 50 pounds since I got diabetes." I guess she never thought of just taking less insulin. Or she has a crappy doctor (in addition to me).
Also yesterday, a 400+ pound guy comes in for a pain management referral. Basically the pain management docs want a psychiatrist's "street smart" opinion as to whether the person might have potential for narcotic abuse or addiction. On this guy's self-reported review of systems, he wrote down "can't masturbate". I understand that this is a quality of life issue but I asked what that has to do with chronic pain and he said, "Oh nothing to do with pain, I just can't reach down there anymore. Also, I can't wipe my own ass." The guy lives with his 80 year old mother and no one else. I did not ask him who actually does the wiping.