A perfect union of mind and body?

Clifton_House,_Belfast,_July_2010_(04)Mark Roberts is vice chair of the BGS Northern Ireland Council, and a Consultant in Acute and Geriatric Medicine. In this blog, he looks at the recent joint meeting hosted by the BGS and the Royal College of Psychiatrists

The annual joint meeting between the Royal College of Psychiatrists and the BGS in Northern Ireland passed again with plenty of food for thought, the amiable atmosphere between two closely linked specialties proving once more a useful foundation stone for a good meeting.  The dignified Edwardian surroundings of Clifton House in Belfast provided the backdrop for a joint sandwich lunch followed by our respective business meetings.  Thereafter an energetic programme was presented by both Geriatricians and Psychiatrists of Old Age to the mixed audience.  Those engaged in the mysterious art of Psychiatry showed their class and hospitality by giving us Geriatricians the boardroom whilst shoe-ing themselves into the ‘attic space’ for their business meeting.

In the joint clinical meeting that followed, we had a varied diet of a medico-legal conundrum, a research update on PET (Positron Emission Tomography) scanning in dementia as well as innovative behavioural models to cope with agitation in dementia.  Dr Roínín McNally, Consultant in Old Age Psychiatry updated us on a complex case being debated in the law courts on how Deprivation of Liberty cases could be interpreted.  My take home message was that academic legal and medical brains are debating whether any deprivation of liberty imposed on a patient should be more robustly defensible than, perhaps, historically has been the case.  However, the practicalities of doing this whilst maintaining safety and dignity for very vulnerable members of our community was a veritable minefield. Next up, Geriatrics Registrar and PhD student Dr Emma Cunningham presented the context of PET scanning in dementia, and its application in the research sphere.  Offers were made to allow limited access for complex clinical cases but the consensus on the day was that its practical application in clinical practice remains to be proven – something perhaps Dr Cunningham and her colleagues will demonstrate in due course.

Clinical psychologist Dr Francis Duffy illuminated us on how agitating and disorientating the world must seem to a patient with delirium or dementia (or both!) using Maslow’s hierarchy of needs model. Many will be familiar with Maslow’s pyramid depicting basic physical needs as the foundation – food, warmth, excretion etc – moving with increasing sophistication towards the top of the pyramid with self-actualisation – problem solving, morality etc.  Even if our health and social care systems (and it’s a big if) meet the physical needs, the next tier is often overlooked: a need to feel safe and secure.  We will all have practical examples of our inadvertent and clumsy approaches, such as challenging or dismissing the elderly woman wanting to call ‘the school to advise she would be late collecting the children’.   Perhaps a defunct telephone at her bedside would provide a reassuring diversion and deescalate the situation?

As with many joint ventures and multiprofessional events, the bits sandwiching the ‘meat’ are often as valuable as the clinical information imparted and discussed: the putting faces to names to facilitate the next referral, the context setting of each other’s work, the different perspectives digested over coffee.  The benefits of the cross-pollination of ideas and experience between different specialties, different settings and between doctors younger, and ahem, those of a certain vintage, can be underestimated.  There is also the reassuring reminder that, no matter how busy or complex your day job sometimes seems, others are paddling feverishly just as fast with similar frustrations, satisfactions and anxieties.  There is, it seems, comfort in shared triumphs and shared pains.

As the sun set over an unusually sunny springtime Belfast, and carpark conversations were drawing to a close, one colleague raised a wonderful reminder of why we should all be positive about the challenges of older age by quoting the actor John Barrymore: ‘A man is not old until regrets take the place of dreams….’

Looking forward to next years meeting already!

Image credit: Wikimedia Commons

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