Teamwork in Psychiatry: King Abdullah University Hospital as a Model
I would like to make it crystal clear that this story aims not as the title may suggest, to draw up a panoramic view of the mental health system in Jordan. Nor does it claim a science-based approach while referring to mental illnesses or any medications usually administered to treat them. I am, mainly, going to shed some light on my own experience as a care giver to a member of my family who suffers from a mental condition; an experience that, though necessarily personal, may be of some help to mental health seekers.
Generally speaking, I noticed that the private sector psychiatrists to whom we paid visits (they happened to be four doctors) are of two types; the first can be referred to as extremely audacious, and the second can be labeled as extremely cautious. One of the doctors who represents the first category to a large extent kept giving Haldol to my relative at high doses. To my dismay, I came to know, after a considerable amount of googling in authenticated medical websites, that Haldol is an antipsychotic drug mainly characterized by its straitjacketing effect. The thing that gained it the reputation as “the chemical lobotomy”. On that account doctors usually prescribe it to calm down patients with severe mental condition in an attempt to prevent them from doing harm to themselves or anybody around. It is worth noting, here, that Haldol 20mg is not subject to the Controlled Substance Act in USA. But the worst was yet to come, the aforementioned doctor discontinued antipsychotic meds abruptly and started my relative only on antidepressant. Every other doctor we have seen afterwards told us: “It is almost axiomatic that antidepressant can trigger mania when used alone to treat a patient with manic depressive disorder”.
As for the doctor who fit into the second category, it took us no time to conclude that he is anything but helpful as he shrinked from making decisive diagnosis and kept saying over and over again: “nobody can tell”. A member of my family asked me: why on earth this doctor repeated the same phrase ad infinitum? To which I could only say: nobody can tell.
Finally, we chanced upon a doctor who told us that my relative needs to be hospitalized immediately. To make the long story short, I am going to skip ahead when I took my relative to the psychiatric ward in King Abdullah University Hospital, where it was pretty easy to conclude that the medical staff there strike a good balance between the two aforenamed practices. thus doctor Aws Khasawneh used a two-staged method for performing diagnosis and treatment; firstly he made a preliminary diagnosis based on his experience and clinical skills, and put my relative, accordingly, on a very low dose of some medications, for my relative, I am quoting doctor Aws here, was given a large amount of drugs that must have gone far beyond the desired therapeutic window. He asked the medical staff, thereafter, to keep a close eye on the patient under consideration. And that was the second stage which was more decisive and difficult when a differential diagnosis must be performed upon symptoms that fit different mental disorders.
To put it in a nutshell, Dr. Aws’s approach was slow but sure, and it took us, safely, out of the vicious cycle in which we found ourselves, at some point, wandering aimlessly. Nevertheless, saying that our treatment journey at psychiatric ward in King Abdullah University Hospital was unembellished and totally perfect would be over-romanticizing. I think doctors there were deeply influenced by financial considerations when it comes to drugs prescription. The thing that I see non medical, in my humble opinion, though humane. Some patients and their families would give up other essential and nonessential expenditures if they were informed that the high cost drugs proved inevitable.
However, that was an exception to the rule that lead to a comparatively superior outcome which can be attributed to a number of factors: first of all, King Abdullah University Hospital is a teaching hospital affiliated with Jordan University of Science and Technology, which necessarily implies that the medical staff find themselves obligated to stay abreast of the new developments, and open to continuous learning in a constantly progressive, if not to say changing, field “i.e. psychiatry”. Secondly; being a sub-unit of King Abdullah University Hospital, psychiatric ward has an excess to other ancillary departments such as radiology department and laboratory, so doctors can order radiological examinations and blood tests to rule out organic causes, and to individualize the dosage for each patient, as people vary greatly in the amount of drugs needed to lessen symptoms without generating intolerable side effects; such as toxicity, and what is medically termed as neuroleptic malignant syndrome. The third reason is certainly related to the medical staff, all of whom were highly skilled; first of all professor Twefik Daradkeh; who directs the psychiatric ward in a professional and, as it were, fatherly manner; Dr Daradkeh is said to have gone earth and sky to open the female-only psychiatric ward (still there is no ward for males in King Abdullah University Hospital), Dr.Aws Khasawneh; the consultant psychiatrist who was proficient and overly kind, Dr. Layali Abbasi; the chief resident who made our stay there beautifully memorable thanks to her dialectical way of practicing psychiatry as both biological and interpersonal process; Abbasi’s warm bedside manner gets the patients talk ,which is a crucial component in making the proper diagnosis and therefore the proper treatment; Dr. Samira Alhassoon; the psychotherapist who proved to be supportive and of great help, and the nurses; sisters Ruba AL Shiek and Hana’a who stayed very caring despite how demanding we were.
To conclude, this is not to discredit private sector psychiatry. Nor to idealize hospital-based mental health care. But it is a way to shed a light on the benefits of practicing psychiatry as a team-work process. It is worthwhile here to mention that the DSM-5 Field Trials included test-retest reliability “which involved different clinicians doing independent evaluations of the same patient”. This is not, also, to ask the psychiatrist to do the impossible. Psychiatry is no different from many other branches of medicine where doctors do their utmost to alleviate symptoms and help patients to lead next-to-normal life. The antipsychiatric joke has it that: “Neurotics build castles in the sky. Psychotics live in them. OCD’ers clean them, and psychiatrists collect the rent”. There may be an element of truth in that. However, what the former funny joke should have pointed out that psychiatrists, besides collecting rent, do their best to get patients out of the castles and send them home where family should do the rest.