Thomas Muir of Huntershill

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Maudlin again. Too many late nights and whiskey, I guess.

A couple of the blogs I like to read have gone invite only. I'm sorry if my side bar links lead you to a dead end. I'm slightly disappointed. I liked reading them - but folks have to do what they have to do, I guess.

I'm increasingly anxious about blogging my day to day work life here. Mostly because I'm less and less anonymous, and confidentiality is a huge part of what we do. Still, I'll try, for what it's worth.

Recently I've struggled with patients who have different ideas about what their best interests are than I do. Here's an example:

Let's suppose you elect to spend the afternoon drinking heavily. A few litres of your chosen spirit should do it, but feel free to wash it down with some beer chasers. I'm ok with that.

Next injure yourself; ideally, you should make the mechanism, the way in which you hurt yourself high risk - crash your car, fall off a bridge, you get the idea. BUT, and this is crucial, have little objective evidence of injury. A few grazes, here and there. Nothing spectacular, like being in more pieces than the good Lord intended.

On arrival at hospital, you should then slur your words, most of which should be Anglo-Saxon epithets anyway, and try to attack all hospital staff. This will involve removal of all the carefully applied devices protecting your cervical spine.

I am now left with the choice of allowing you to leave my department, with the knowledge that you might have significant occult injury, or restraining you, possibly at risk to my own health. I can guess that the way you are behaving is most likely an amplification of your own personality by your booze of choice... but it might just as well be your nascent extra-dural haematoma.

If the former, you'll wake up with a hangover, assuming you don't walk into traffic; if the latter, you won't wake up at all.

But, if I hold you down, and inject magic drugs into you, I have to be certain you don't have capacity, or I'm assaulting you.

I once treated a patient who was threatening to kill me; he has been my only stalker to date. I don't think I've blogged this before; I'll check - it might make good press. Anyway, I was reluctant to deal with a fella who was actively trying to stab me. My defence organisation informed me I had a duty of care unto him, right up until he actually did stab me.

I have to confess, I took my career into my own hands, and went against their advice, refusing to treat him. (It was neither a life, or limb threatening injury, for the record)

This country does not seem to have grasped the nettle of treating the (potentially) deranged, violent patient, who may simply be an arse, or may be acting like an arse because of their injury...

As for the example above... it might end like this:

You escape serious head injury, but turn out to have a broken neck. Despite assaulting every member of staff who comes near you, you avoid permanent paralysis. You wake up the next day with a hangover, and immediately discharge yourself from hospital, presumably reasoning that if the neck didn't give out during the fighting, it's good to go.

Sometimes, I wonder where my spirit went.