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, Páll Matthíasson gladly agreed to describe his work week.
Monday
The week starts in my office in what used to be an asylum, Kleppur, at the start of the 20th century, in a beautiful location by the sea, outside Reykjavik. Today, this same spot is really in the centre of town and the buildings are surrounded by a busy harbour, packed with containers. Still though, the view from my office window shows a grass field, beyond the containers a bay filled with islands and the mountains on the other side. The sight of nature fills me with peace, especially on such a crisp, sunny late autumn day. I look forward to a week of work, after a lovely weekend in a hotel out in the country with my former classmates celebrating the fact that this year it is 30 years since we graduated from medical school.
The morning is taken up with team meetings in our psychosis service, both the outpatients clinic and the F-ACT community team. The teams have over 300 service users on their books, but we only discuss the thirty people marked „red“, as well as some new users who are being admitted to the service.
In the afternoon I chair a meeting of the Mental Health Commission on behalf of the Ministry of Health. The commission is an appointed board of nearly twenty people, half of them from user organisations, which has the role of advising the minister of health on mental health matters, as well as proactively bringing up important issues to do with strategy – and to oversee the implementation of the government´s new strategic plan for mental health. As always, great discussions on important topics – and a lot of frustration over how slowly things seem to evolve and improve.
Tuesday
I attend a team meeting in our early onset psychosis service. The meeting is held in what used to be the cowshed of the asylum, now a multi-purpose space for therapy work, art sessions and even a music studio. It is a nice enough building, but really reminds me though of how desperately we need new facilities for mental health services, here at Landspítali, our national hospital. And thankfully plans are afoot to build a brand new site for all services, which hopefully will be ready by 2030 (one wishes!) – although waiting for the government to build something is a bit like waiting for Godot!
I have a yearly review meeting with the lead consultant of our forensic services. We discuss his challenges at work, how to modernise services and improve long-term follow up of forensic patients, as well as how to develop prison inreach services.
The work day ends with a two hour meeting in the Ministry of Health. I am the psychiatrist on an ADHD greenbook task force. For nearly a year we´ve met weekly with stakeholders from all parts of society, to try to understand why so many children and adults in Iceland have a diagnosis of ADHD, why so many get ADHD- medication and why there are so long waiting lists! We are now in the write-up phase of the work and our conclusions are somewhat unsuspected, with the answers often having little to do with hard core biological processes and more to do with societal factors, lack of support in schools and the modern demand for quick fixes.
In the evening I meet a small group of old friends in a traditional open-sandwich (Danish style) restaurant downtown. We all graduated from medical school in 1994, now 30 years ago and we try and meet up every month, just to chat and banter.
Wednesday
In the morning I go to a grand villa on one of the nicest roads in Reykjavik. It is used as an 8 bed inpatient unit for early onset psychosis users, as well as a day hospital for a large group of young people. I talk to my junior doctors on site and with my team we go through new referrals to the team.
In the afternoon I attend the funeral of a well known oncologist who passed away recently. He was the father of one of my friends from medical school, a leader in oncology in Iceland, who brought back new knowledge in the 1980´s from the US where he had studied. He also brought back a fondness for running and could be seen pacing the streets of Reykjavik in his shorts at a time when hardly any adult ran for fun! A beacon of health, but age got him in the end, like the rest of us. Yes, death in all its myriad forms is never far away.
I barely make it back to the hospital, where I hold a nearly three hour lecture/discussion with relatives of a group of patients in our teams on schizophrenia and psychosis and its treatments. We also talk about coercion and involuntary admissions. The discussions go well, I´m surprised how interested the audience is, way past dinner time. One patient, currently on our admission ward, turns up as well. It makes some staff anxious, but actually improves the whole session, bringing up challenging topics and making for some interesting discussions.
Thursday
Thursday is my main day for clinical work. It is a string of outpatients appointments, as well as one home visit. A mixture of new assessments, seeing people from our community team and some long term follow-up patients, some of which I´ve been seeing regularly for nearly 20 years now. This is fulfilling work. Having been heavily involved in management for so many years, my Thursday clinics always remind me why I did medicine in the first place. The connection with patients, trying to grasp complex issues and help people get better, finding a way forward with them – yes, there is something deeply rewarding and, at the risk of sounding sentimental, almost holy in the doctor-patient relationship. Although sometimes emotionally draining, it is also feels meaningful. And the simplicity of being there for the other person, trying to do your utmost to get him better, is so much more ethically straight forward than the endless balancing act between need and resources, between patients and politics that so often comes with pure management roles.
At the end of the day I head to a family meeting regarding my mother-in-law, who has been in one of Landspitali´s elderly wards for five months now. It is a difficult meeting in some ways, concluding that my mother-in-law has to go to a nursing home. Yes, after living independently since the 1950´s, this is not easy. She takes it stoically though and my wife brings a cake and we all, family and staff together have some coffee and cake in the meeting room, sharing stories and forgetting ourselve laughing, for a while. – It reminds me a bit of the time when I was a medical student in this same hospital 35 years ago. It was then a catholic hospital, run by nuns, and while the rest of staff had their lunch in a cramped dining hall in the basement of the hospital, the nurses treated the doctors to open-faced sandwiches and cakes in this same beautiful room, high up in the hospital. Yes, things have moved on – now everyone eats in the dreadful dining hall downstairs!
Friday
This is the day for our weekly forensic service meeting. We discuss a particularly complex case and then the multi-professional group starts planning a joint visit to a forensic conference in Edinburgh next year. Following this I chair a monthly meeting for doctors, both junior and senior within the psychiatric service. A lot of practical issues come up, and the good news is that we are getting three new psychiatrists from abroad this winter. Manning the services adequately is a constant challenge, but thankfully through a stream of doctors coming through our training programme, and foreign senior psychiatrists willing to make the move and come work here, we are managing to stay afloat.
In the afternoon I see some more patients, an overflow from my clinic day yesterday. Just before closing time a patient from one of the community team comes in, distressed, confused, complaining of an increase in hallucinations. He has a history of becoming abruptly very psychotic, but on this occasion he still has the insight to know that something is wrong. He needs admission and to simplify things I take him along in my car and accompany him into an acute ward, where he is relieved to be admitted.
The work week ends with a visit to a new private psychiatric clinic, in a building directly opposite our Ministry of Health. A young colleague has set up a multi-disciplinary clinic, mainly assessing and managing adults with ADHD and this is the opening party. Looking after ADHD is certainly a neglected field, with waiting lists stretching into many years. The room is full of people, but I am one of only a handful of colleagues from the university hospital there. The distance between those two worlds is sometimes large. The finger food is lovely though and the quality of the clinic environment certainly better than what we see in the university hospital. – A weekend awaits, which I intend to dedicate to all things non-work related!
A busy week. But something very real about this one. Hope from my patients I have been blessed with knowing for all those years. But also a humble reminder... Time is the only gift. Let´s try to make hay while the sun lasts. And possibly somewhere there, a further sense of perspective and a sense of gratitude. A busy week … but a good one. □