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A week in psychiatry with Hans-Peter Mofors

 

In each issue we ask one of our colleagues to write a contribution about the week at their job. Although we are all psychiatrists, our days and conditions vary a lot. It is therefore both interesting and inspiring to read what daily life is like to our colleagues. This time, Hans-Peter Mofors gladly agreed to describe his work week.



A psychiatrist´s knowledge has greater applications than in just the clinic. Indeed, this opens several possibilities and widens the scope of work opportunities for a psychiatrist. A couple of years ago I decided to make a change in my working life, after two decades of working mainly as a clinician in Stockholm. This led to a great variability in my work routines. I will share with you here the happenings of a work week I spent this October.


Monday


The first two days of the week I work clinically with outpatients in Nyköping, located one hour from Stockholm. In this setting, I mainly see patients suffering from mood and anxiety disorders. On a regular day I meet around five patients and will also participate in a clinical conference with other members of the team. Being the senior physician on call, I also answer several questions from junior colleagues from our clinic, as well as doctors from primary health care.


Some patients are in the diagnostic process. I meet a 21-year-old woman who has previously been diagnosed with bipolar disorder and already being prescribed mood stabilizers. It is clear to me that she does not suffer from this condition at all. Instead, I believe her symptoms are more likely the result of a borderline personality disorder. The woman is relieved that she does not suffer from a severe mental disorder. I am struck by the numbers of patients being diagnosed with so many psychiatric disorders. Far too many these days are even diagnosed with the combination of them, autism, bipolarity, ADHD and mixed depressed/anxiety disorder. Something is not right; my intuition tells me.


In the evening, I stay overnight at a nice hotel as I am always on call on Mondays. The hotel staff is very friendly, having known me for more than a year now. After a quick work-out, I have a dinner. Every now and then, the junior doctor on call at the hospital, calls me and confirms the evaluation of a patient. A 31-year-old man with a drug induced psychosis has been brought to the ER, hand cuffed and with the police waiting. I need to go in to see him immediately in order to initiate coercive treatment. I am struck by how well things proceed according to protocol. Everyone in the staff knows exactly what to do. The young policemen leave, and the patient, now in restraints, falls asleep after having received the appropriate treatment. I return to the hotel.


Tuesday


Back at the office I feel tired, having had my sleep interrupted several times during the night. My first patient is a 69-year-old man who presents with symptoms that I have difficulty in understanding. I call an experienced colleague who works with geriatric psychiatry who tells me it sounds like a clear case of Pick’s dementia. It is so good to have colleagues to consult when you get stuck. It is soon time for lunch with my colleagues, Swedish meatballs never tasted this good.


In the late afternoon I take the train back to Stockholm. Every Tuesday night I sing in a choir which for me is an active kind of relaxation. This night we start practicing Brahms’s requiem, to be performed on ‘All Saints Day’ in November. It is an exquisitely beautiful composition and oh so hard to sing!


Wednesday


Hans-Peter Mofors
Hans-Peter Mofors

Day at court! To deal with applications for continued coercive care and with different patients’ appeals, the court needs the help of an independent doctor in order to make adequate decisions. Since many years I have been engaged on a regular basis with this, very interesting work. Today, there are no less than fourteen trials. Most of them deal with forensic care, which is a new field to me. To be discharged from forensic psychiatric treatment care, several criteria must be met. I am impressed with the excellent help these, many times very unfortunate patients, get from the hospital care. The legislation regarding forensic psychiatry is quite different from the one dealing with general psychiatry. I have lunch with the lawyer of the day, learning about his working situation. I do appreciate having the possibility to work in a different kind of setting and getting to experience health care from another perspective. I feel privileged to have gotten a new education, here about the law. It is indeed very different from medicine!


Tired after this demanding day, my partner and I go to the opera in the evening. Tonight’s performance is Elektra, one of my very favorite operas. It is so filled with intense emotions. I meet no less than five psychiatrists in the audience. Why is it that psychiatrists, more than any other medical specialists, seem to love opera?


Thursday


My work-from-home day! Since a few years I have also worked as an expert doctor for insurance companies, mainly dealing with cases where patients complain against the medical system for being treated in what they believe was a wrong way. At first, I was a bit hesitant about this task but with time I have found it quite challenging, digging like a detective into medical records to evaluate the medical treatment given. The first case is about a patient complaining about a delayed ADHD diagnosis. Another case is written by the relative of patient who committed suicide shortly after being discharged from hospital. A third case is about a patient suffering from cognitive deficits one year after ECT. Many cases are complicated, and I must think and reassess carefully before writing my evaluation.


This work offers me a unique opportunity to look into how psychiatry is organized, practiced and documented all over Sweden. In most cases, no faults have been made. However, in approximately one of four cases, something has unfortunately gone wrong in the treatment process. The works progresses at a slow pace, with the opera “Tristan and Isolde” playing in my earphones as background music. Opera has been a constant companion throughout my life. Sometimes I play some songs at the piano.


Friday


This is my “pre-retirement take-it-easy” day. I start with yoga and workout followed by breakfast at the gym and some relaxation at the spa. In the afternoon I prepare a presentation that I have to make for a group of psychiatrists next week. Two private patients come to see me at my private office in the afternoon. Both are colleagues and we work on a psychotherapeutic basis.


My work week is over, and I feel happy and content with life. I drive to the summer house with my partner. My two sons will be coming over later in the evening and will stay the night. We will have what in our family is known as a “guldstund” or “golden moment” together. Life is, after all, not only about psychiatry! □


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