I came to know this long-standing patient’s son when I first came to work. As the patient (mother) is always relapsing, despite taking a full dosage of anti-psychotic and anti-depressant medicine, once in a while she’ll be relapsing – non stop complaining, talking, moaning, thinking about her son who passed away two years ago, restless, agitated… And so the son will always have to contact us to ask what to do regarding patient’s condition.

After 3-4 years seeing psychiatric doctor, the mother who is at  her 70s has “roughly” maintained on the same condition, not really getting much better, but also never get too bad. But some episodes of “moaning” still happen once in a while. Every time she comes back for review, the doctor gives back the same medication, only adjust it once in a while (when patient has some other physical or health concern; when patient is getting much worse; when certain medicine is not in stock). The family starts to question each other, whether it’s still right to continue seeing a psychiatric doctor, whether to continue with all these types of medication.

Deep inside they understand that they can’t let the mother stop all the medication, she’s definitely not well without those tablets and liquids. But spending so much money each month, they’re really desperate to see the mother getting better, having less episodes of relapses. Then the son rang us, told us their concerns. They know the doctor is good, and has treated so, so many patients from different parts of the country and the surrounding countries like Singapore, Indonesia and even Vietnam etc. But maybe this isn’t just what the mother need?

He said the mother never opens up with the children, never want them to know her worries and problems. The children all know that she’s worried, having ruminations, but the mother gets agitated if they prompt and ask further. The son now asks perhaps they need someone who’s good in this to talk to her, to help her open up, to know what she thinks about her eldest son who passed away, to know why she’s moaning and complaining, on top of the medicine she’s taking. Maybe she needs more than the medicine?

I’ve written a common problem of seeing psychiatrist in General Hospital (see: Bipolar Disorder). Quite often doctors have no time but to prescribe back the same medicine to patients, even when patients’ conditions have changed… But having looked at this case, perhaps it could also be a problem in private practice!

Too little good doctors, too many patients in need, too little time, so what happen?