time to change after-shave

I picked up the next chart.

Mid-40’s lady taken intentional overdose of prescribed medications. Her prior presentations had been for fairly similar problems. Deliberate overdoses, occasional fleeting and minor attempts at self-harm, alcohol intoxication.etc From the A&E notes her presentations had the hallmarks of Borderline Personality Disorder. She had taken only a small amount of over the counter medications, nothing that would cause any serious side-effects or toxicology. Essentially she needed a quick medical examination and referral to the psychiatric service for further assessment and follow-up.

Her history was typical. She matter-of-factly told me about her abuse as a child, which is one of the most common occurrences in patients like this. It all just ‘got too much’ and she decided to end it all. She had recently reconciled with her ex-husband, who was at his wits end. He told me about her manipulative, abusive, cajoling, seductive then irrational behaviour at home, that she needed some form of help ‘to get better’. When I started my physical examination he left, which gave me the opportunity to ask her more questions about life at home, specific concerns, the actual amount of medication she had taken, all whilst listening to her heart and lungs, palpating her abdomen.etc

Finally, after explaining her need for a psychiatric review I asked the standard question that we are taught in medical school:

‘So, any other questions, or is there anything else I can help you with?’

(Sheepish smile)

‘Ummm. mbdnejc kjflkfjd lwjdloepxew?’

‘Sorry I didn’t quite hear that, what was that?’

‘I asked if you were seeing someone…’

(blushing) ‘Oh right…err…’

Smashing*
———————
* with apologies to Eliza

~ by Dr Ben on April 30, 2007.