ABSTRACT
During the past three years, some 180 patients were assessed as potential candidates for a heart transplantation at Papworth Hospital. One hundred of them underwent the operation. This report presents the views of a social worker about the psychological and social aspects of heart transplantation based on personal experience with these patients. The different stages through which a heart transplant patient progresses, from the onset of his illness until resumption of a normal life will be considered, focusing on what this author believes to be some of the important aspects of these stages.
Subject(s)
Heart Transplantation , Transplantation, Homologous/psychology , Adaptation, Psychological , Humans , Social Adjustment , Social Work Department, HospitalABSTRACT
In a prospective clinical trial 276 self-poisoned patients consecutively admitted to hospital were randomly allocated to medical teams or to psychiatrists for an initial psychiatric assessment and a decision about "disposal." Junior doctors and nurses received instruction in this work. While awaiting the outcome of the trial the randomisation was continued for 13 months and 729 allocations were made altogether. Physicians requested psychiatric opinions for roughly one in five of their patients. In other respects medical teams performed similarly to psychiatrists. Provided that due attention is given to teaching junior staff and to ensuring that psychiatric treatment and social-work support are available once patients have been assessed, such a consultation-liaison scheme could be adopted in other hospitals. This would help to change unfavourable attitudes towards self-poisoned patients and contribute to the general training of doctors and nurses.
Subject(s)
Poisoning/psychology , Referral and Consultation , Suicide, Attempted/psychology , Education, Medical, Continuing , England , Hospitals, General , Humans , Poisoning/therapy , Psychiatry/education , PsychotherapyABSTRACT
In a prospective clinical trial 312 cases of self-poisoning (276 patients) consecutively admitted to hospital were randomly allocated to medical teams or to psychiatrists for an initial psychiatric assessment and a decision as to "disposal." Junior doctors and nurses received some instruction in this work. Both groups of assessors asked for help from social workers when necessary. Once the medical teams had completed their assessments, psychiatrists provided most of the hospital treatment. Follow-up at one year showed no significant difference between the two groups of patients in the numbers who repeated their self-poisoning or self-injury (or both), or committed suicide. Provided junior doctors and nurses are taught to assess self-poisoned patients, we think medical teams can evaluate the suicidal risk and identify patients requiring psychiatric treatment or help from social workers, or both. Contrary to the Department of Health's recommendation that all cases of deliberate self-poisoning should be seen by psychiatrists, we have reached the conclusion that physicians should decide for each of their patients if specialist psychiatric advice is necessary.
