Thursday, July 24, 2008

The File Snatching Sign

Not much in medicine is 100% and certainly not in Child Psychiatry.

The most recent addition to important medical signs is
The Sleeping Husband Sign, which, according to the Happy Hospitalist, can predict the lack of acute major illness in the spouse 100% of the time. While this is obviously useful in Emergency Rooms, perhaps it is not so in the practice of Child Psychiatry.

However, I do have a similarly ideal tool to detect malingerers in our practice.

Child Psychiatry is one rotation in Psychiatry that often reduces grown men to jelly. All that you have learnt at medical school and afterwards is suddenly of no use at all. Many juniors do not have problems dealing with adult patients. When faced with a child, some feels like being thrown a scalpel and told to get on with an operation that he or she has never performed.

Where do I even begin this story?

We have juniors from all parts of the world. I being Chinese, ethnic doctors find it easy to bond with me. The truth is that we often still share the same family values.

Now this new doctor comes from a culture where you can only address your parents as father or mother, in your language of course. I point out to him that children in England seem to be on Christian name terms even with their parents. Five years after his consultant appointment, he finally starts calling me by my given name.

He agreed though that he would just have to accept little kids calling their parents Sharon or Kevin.

So Sharon brought this boy to see him. It happened to be his first ADHD assessment. He came out to see me after an hour. He did not think the boy suffered from ADHD but every answer Sharon gave on Conners would point to that diagnosis.

Just spend some time with the boy, I told him.

He did, but the outcome was not what I expected.

In conversation with him, the boy suddenly said, “Sharon is not my mum, my mum is Sheila.”

He went to the waiting area to challenge Sharon.

Sharon tried to snatch his file from him. Luckily he has good reflexes but before he knew both Sharon and the boy disappeared.

So there you have it: The File Snatching Sign – 100% accurate too.

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