{"id":463,"date":"2008-09-29T14:06:05","date_gmt":"2008-09-29T13:06:05","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=463"},"modified":"2008-09-29T16:39:45","modified_gmt":"2008-09-29T15:39:45","slug":"bruno-rushforth-the-jailer","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2008\/09\/29\/bruno-rushforth-the-jailer\/","title":{"rendered":"Bruno Rushforth: The jailer"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/channels\/icons\/brunorushforth.jpg\" alt=\"Bruno Rushforth\" width=\"160\" height=\"110\" align=\"left\" \/> Who\u2019d be a psychiatrist? The emotional burden of caring for patients presenting in real distress; trying to negotiate a way forward when dealing with someone with a skewed sense of reality; potentially life and death risk assessments on a daily basis; general lampooning from medical colleagues\u2026 No wonder psychiatry\u2019s not such a popular choice among UK medical graduates.<!--more--><br \/>\nBut it\u2019s something much more fundamental that would stop me from pursuing a career in the shadow of the Victorian asylums: the thought of repeatedly depriving people of their liberty and, more importantly, the impact this has on the doctor-patient relationship.<\/p>\n<p>Sure, like police officers and judges, I know that in certain circumstances all doctors may have to act to detain someone in that person\u2019s (or society\u2019s) best interests \u2013 it\u2019s just that I don\u2019t want to be the one doing it. Having worked for six months as first on-call covering acute psychiatric wards as part of my GP training, it seemed rather alarming that by filling in one side of A4 paper I had the power to hold someone, against their will, for up to three days.<\/p>\n<p>Perhaps, more worrying, was a colleague\u2019s comment that this power made him feel rather intoxicated. I was more concerned about how this \u2018elephant in the room\u2019 would affect interactions with both voluntarily admitted patients and those already detained under the <a title=\"Mental Health Act\" href=\"http:\/\/www.opsi.gov.uk\/acts\/acts2007\/ukpga_20070012_en_1\" target=\"_blank\">Mental Health Act<\/a>.<\/p>\n<p>But it wasn\u2019t all doom and gloom. I loved the fact that for the first time there was a sense of true multidisciplinary working, with doctors, social workers, community psychiatric nurses, psychologists and ward staff all focused on a common goal. And I had to pinch myself when I was told there was one hour allocated for out-patient appointments with new patients. Integration of community and secondary care appeared fairly advanced too, with psychiatrists embedded in community teams while also covering the acute hospital.<\/p>\n<p>And the crisis team staff were \u2013 to put it mildly \u2013 an inspiration.<\/p>\n<p>These poor sods spent day after day (and night) at the very sharp end of emergency psychiatric care. Yet their compassion and professionalism \u2013 not to mention astute judgement \u2013 was truly admirable. I learnt much from their sophisticated risk assessment tools and thorough approach in clinical encounters and particularly documentation. And the team spirit and debrief \u2013 often informal and with a good dollop of black humour \u2013 was a model of team self-care. Then again, they weren\u2019t the ones signing the section papers\u2026<\/p>\n<p><strong>Bruno Rushforth<\/strong> is a GP trainee<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Who\u2019d be a psychiatrist? The emotional burden of caring for patients presenting in real distress; trying to negotiate a way forward when dealing with someone with a skewed sense of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2008\/09\/29\/bruno-rushforth-the-jailer\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[165],"tags":[474,152,142,473],"class_list":["post-463","post","type-post","status-publish","format-standard","hentry","category-junior-doctors","tag-community-care","tag-mental-health","tag-psychiatry","tag-social-work"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Bruno Rushforth: The jailer - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2008\/09\/29\/bruno-rushforth-the-jailer\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Bruno Rushforth: The jailer - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Who\u2019d be a psychiatrist? 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