So I saw a kid recently at my (psychiatric) hospital--a kid that was sent to us via an ER. He took some Advil almost a full day before I saw him, and ended up in the admissions office after a long ordeal.
A psychiatrist apparently assessed him at the ER prior to sending him our way--more than likely a resident, because board certified psychiatrists don't deign to do such things if they can help it. (Much easier to see someone for 15 minutes, ask a couple of questions, nod your head in "understanding", write scripts for little pills, and move on to the next one. I'm sorry. That sounds a might cynical, doesn't it? Must avoid that...Ok I won't avoid that.)
At any rate....
I didn't think the kid needed to be in a psych ward. I told his mother as much after I did my full assessment. And I sent them home in the middle of the night.
The reason? There are all kinds of red flags I look out for when I'm interviewing people. The threshold for hospitalizing kids is much lower than the one for adults, but even so, I just didn't think this kid qualified. He wasn't using drugs (never had). He appeared to have a really good relationship with his mother--their easy banter was nice to observe. He was going to school and getting along with everyone there. He was involved in sports. He was eating well (as well as a wrestler can eat during season). His self esteem was sky high. He had a therapist he was seeing and had been for over a year. He admitted to some anger issues, but they seemed to be under control. He had never thought about suicide. Ever. He'd never done anything like this before. He said nothing of abuse (asked about when mother was not present). Most importantly, the FIRST thing he said to me when I sat down was that he was not trying to kill himself when he took the pills. He just had a tiff with the girlfriend and wanted not to think about it.
Stupid? Yeah. Worth a stint in the psych ward? Not in my opinion. So I cut him loose. And I would have done the same thing had I seen him in an ER setting.
And then I happened upon the doctor's note from the tranferring hosptital.
If I hadn't just met with this kid myself, I would have sworn the devil incarnate was headed my way.
The picture she painted of this kid was vastly different than what I observed. She spoke of his anger, his self mutilation (he admitted to one incident months ago to me), his running away from home (he denied this to me), his relationships that were piss poor (huh?) Her note went on for two pages. She even gave him the Mental Health Professional Stamp of Approval for Teenagers: A diagnosis of Oppositional Defiant Disorder (don't even get me started on this one.)
So who's right?
I've been thinking about this since I let him go.
Did the doctor see something that I didn't? Was she more thorough in her examination than I was with mine? Did she ask different questions than I did? Or did the fact that he took pills scare her and she just wanted to cover her arse? (She threatened to call child welfare if the mom did not take her child to my hospital.)
Did I get snowed by a charming teenager who minimized his problems to the point of winning me over? Did I choose to not see stuff that was there because the family was white, obviously middle class, and likeable?
I just don't know. When I called my boss at 5 a.m. to debrief and let her know what happened, she was supportive. She said that's why the assessment process is there, and if I felt he didn't meet criteria, then he didn't meet criteria.
But how is it that two professionals on the same night, within hours of each other, can come to such vastly different conclusions about the same event?
I think it's safe to say the "truth" for this kid is somewhere in the middle. But it is food for thought. When working in mental health, even with objective guidelines and empirical questions, ultimately someone in need of help is at the mercy of the professional on hand. A professional jaded by all their own life experiences, professional obligations, training, and ethics, corporate culture, personal biases, fears, personality, and yes, personal rapport. - >
Read the complete post at http://feeds.feedburner.com/~r/blogspot/tXCM/~3/444414456/perception-is-key.html
Posted
6 Nov 2008 12:29 PM
by
Trench Warfare
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