By Anonymous 

What is the most important way in which care of a patient is coordinated between the health care professionals working in this clinical unit?

The sudden crack of thunder rolled over the hills in the distance. Out of the window the storm raged on, the violent swinging of the tree branches and pelting down of rain was punctuated by the odd flash of lightning. The psychiatrist sat back in his chair, leather loafers rested on his desk, staring out the window, mesmerized by the vigour of the storm. It was not uncommon to catch him in moments of deep contemplation like this.

I lurked at the threshold of his office, unsure of whether I should interrupt. I started to raise my hand to knock against the open door, but he spoke before I had the chance to do so. “Take a seat,” he said, not turning away from the window. I took a seat at his desk and sat for a moment waiting for him to prompt further conversation. He slid his feet off the desk and swivelled his chair towards me. “You see that out there,” he said motioning to the spectacle outside. I nodded, unsure where this was headed. “That,” he continued, “is the human psyche. Majestic, unrelenting, but in part, destructive.”

“Uh huh,” I responded. After a final glance out the window, his attention returned to me and he asked:

“So, what can I do for you?”

“Well, I just had another question,” I replied, “about how patient care is coordinated amongst the team at this clinic.”

“Right,” he nodded, a hint of a smile playing on the edges of his mouth, “I’ve always been quite fascinated by how mundane the questions medical students ask me are.”

“Well its not really my question, it’s for-”

“Well the short answer is that its not coordinated,” he cut me off, “its all really very haphazard.”

“Okay. But surely an attempt at organizing is made-”

“Well we try to organize,” he said, cutting me off again, “but this is a community clinic for psychosis. Psychosis, by nature, is a deeply disorganized condition. I mean being disorganized of thought and speech are in the DSM criteria. Its very challenging for a psychotic patient to adhere to appointments, scheduling, treatment and medical advice. It really undermines most of our attempts to organize.”

“Well then,” I fought on, “so what initiatives are made, however ineffective they may be?”

“Well our case workers and psych nurses to a stellar job,” he explained. “They stay in touch with patients and their families, track their treatment and progress, and organize appointments accordingly. They do house visits, provide counselling when needed, and can seek out community initiatives, job seeking services and housing for patients when the timing is right.”

“So how does that relate to what you do?” I pushed.

“They collaborate with me.”

“In what capacity?”

“In a collaborative capacity.”

“Okay…” my voice trailed off. This was proving to be quite difficult. I was beginning to think he was deriving a sadistic pleasure from this intellectual hazing. I shifted uncomfortably in my seat. Maybe I ought to quit while I was ahead. But of his own accord he continued:

“Think of it like this,” he gestured at the window again, “psychosis is the storm. The patients are the residents of the affected area, they need to be evacuated. The case workers and psych nurses are the SES, they know how to escape in a logistical sense, but me, I am the meteorologist. I can foresee and identify the illness just as it begins to roll in. I can direct their efforts.”

“That’s quite poetic,” I nodded in agreement.

“I have to write that down,” he began to search his desk for a pen, “that has to make an appearance in my memoirs.”

“Thanks for answering my question,” I said as I began to move towards the door.

“Anytime”

“And good luck with the memoir”

“I’ll send you a signed copy,” he responded with a sly smile. I ducked out of his office and hurried away with a sigh of relief.