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Trial and Error: Borderline personality disorder

Borderline personality disorder

Once, I found myself in a potentially dangerous situation with a patient who has a borderline personality disorder. It is very easy and tempting to get dragged into an argument with these kinds of patients. I was aware of my own tiredness that day which made me vulnerable and perhaps somewhat rash. The patient was highly agitated and we got into an argument. I let myself get so caught up in her line of reasoning and became offended by her insinuations. My responses increased her anger and it led to an unsafe situation which I did not realize promptly, even though I knew that she was prone to physically lash out. She had demonstrated that fact only a few weeks before this incident and she was threatening me with similar actions now. I retreated to a safe environment while other colleagues tried and succeeded in their attempt to defuse the situation. The patient’s reaction was disease related so I should have known better. However, my tiredness got the better of me. Normally the patient and I get along just ne so this hit me by surprise.

I have learned a lot from that encounter. Foremost, I will remember and take heed how my own physical and mental state can in uence my work and performance. I will not be tempted to enter into an argument of which you know beforehand will only create unnecessary tension or worse. I will take better care of my own protection and call for help on time.

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Clinical Image: A 56-year-old male

A 56-year-old male

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]

Presentation
A 56 year old male presented with malaise and loss of appetite. On physical examination his sclerae and skin were yellow. His abdomen was swollen and his liver was enlarged. Erythematous skin lesions are present on the upper thorax region and arms.

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Guest Column: Unreliable science (or scientists)?

Unreliable science (or scientists)?

It’s been a couple of years since we were confronted with one of the most impressive cases of scientific fraud in science: the Stapel-case. We recently read a book on the affair called ‘The Publication Factory’, by Ruud Abma, connected to the faculty of social sciences at Utrecht University. Although we’ve had some exposure to data and knowledge in this particular field, disbelief at the enormous scale at which Stapel committed his fraudulent behaviour struck us. Furthermore, the conclusions of the Lefelt-commision, who thoroughly investigated the Stapel-case gave more reason for doubt. They described in their report ‘a research culture that was focused too much on confirming own thoughts (‘confirmation bias’) with questionable, selective and non-critical data handling’.

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