Sunday, 29 January 2012

In which I terrify a (relatively) junior doctor

Where was I? Oh yes, that's right, GP appointment on Friday.

I know that you all find the ins and outs of my healthcare endlessly fascinating - this is mainly for catharsis and memory prompting, so feel free to skip it.

Twas a doctor I'd not met before - either a locum or a trainee, who seemed very young. I would place her at GPST1 (3rd year out of med school), although I wouldn't have been surprised if she was even an FY2. Anyway, she was young.

My two aims for the appointment were to :
- give some excerpts from my DLA form (walking, falling, cooking, washing and 'day in the life') and ask someone to write a report to submit as evidence
- get my meds put on repeat (besides my inhalers, thyroxine is all that's on my repeats list and I haven't taken that in 5 years or so)*

Neither of these is something I would have chosen to take to a GP I've never met before, but the way that the surgery is set up now it's almost impossible to get an appoitnment, let alone an appointment with someone you've met before. Not that I really want to see the regular one anyway. Yes this is one of the ever increasing list of reasons that I am on the market for a new GP.

So, I told her that I was applying for DLA and that I'd brought some information about my day-to-day for whoever would fill in the form to use alongside my notes. She said she would give it to the doctor I normally see, I said that that seemed sensible and went to move on to point number 2.

She then said "so why are you applying for DLA?". I was a bit confused, so kind of stuttered "err...mobility, care...err" *gestures to the wheelchair*. Then said that I have HMS, caused by EDS - not a flicker of recognition. Great.

And no go on the repeats. They don't want to put tramadol on repeat because they like to keep an eye on folk on strong painkillers. I said this would be fine if anyone had ever 'kept an eye' on me, and if every doctor I had seen over the last year hadn't tried to stop it. Which is what happens when you have pain meds on acute prescriptions.

Then I said that I'm leaving anyway, because I'm sick of being treated like crap, not having my pain managed and seeing a different doctor every time I go.

For some reason she took this as a prompt to try and be the one to 'keep an eye' on my pain management. This involved at various points :

- "have you considered homeopathy?" (Want to guess what Beanie's response was?)
- "I don't think a pain management referral would help because they'll only be able to try stronger painkillers - tramadol's related to morphine you know"
- "we need to keep an eye on it because opiates are addictive"

Interspersed with me saying "there's no point anyway, I'm registering with a new GP when I have the report to go in with my DLA form" and her ignoring that and continuing to say things that showed her faiure to grasp :

1) basic principles of pain management and pharmacology
2) that someone who is only 24 / has a condition she'd never heard of could be in enough pain that the idea of 'something stronger than tramadol' wasn't completely ludicrous
3) that given the choice between being prescribed tramadol and not having the pain to start with, my decision would be fairly obvious
4) that I am a medical student (and therefore hadn't even glanced at my notes - it's clearly marked on there after I got frustrated with the last person to talk to me like I knew nothing about anything**)

And then just tucked in there at the very end as an afterthought :
- "What is it that hurts?"


I really want access to teach some of this stuff to medical students. Y'know - basic pain management, expert patients, chronic disease managment (not just acute management of patient's with chronic diseases, or tick box exercises that monitor only common things - depression / diabetes / hypertension etc). That added to my dream curriculum of disability awareness and how the social model of disability, medical model and biopsychosocial framework all have a place in healthcare. Not to mention some proper diversity and equality training - covering relationships with colleagues (the whole team - cleaners, managers, nurses, everyone) as well as patients. Oh, and some idea of how to navigate the healthcare system as a medic-patient. Especially parts of the system that remain clothed in a stigma that medical schools are making no real effort to disperse. Telling medical students who have mental health problems that they shouldn't feel ashamed is not a solution. Removing the institutional prejudice against them is.

Well. It was nice to get that off my head. (For the life of me I can't work out what's wrong with that last sentence... oh well)

* It gets irritating to order the 18 pills I take a day, plus liquid medicine and cream, every month especially because they always manage to forget to prescribe a least one thing. Not to mention the 3 meds I continue to buy OTC because they refuse to prescribe them (have discussed all with pharmacist who has said they're alright to use as I am).

** Admittedly taking the 'I'm a medical student' shortcut is taking a privileged wiggle out of doing some expert patient / patients have a right to make informed decisions about their own health - so you should make sure they actually understand rather than fobbing them/us off with lacklustre 'jargon free' nonsense non-explanations like 'young women your age do faint a lot' - based advocacy. I wish I always had those spoons.


  1. Homoeopathy?!
    That would have got me being sarcastic. They really don't like me being sarcastic.
    Why can't new GP do DLA? Sounds as though they will have seen you about as often.
    - C

  2. Ye Gods. The old "you can't need pain killers stronger than tramadol and be under 30!" chestnut. I'm so sick of it. My pain team & GP tell me that if I was over 50 then I could have surgery to potentially reduce my pain as well as better painkillers for emergencies. Being under 30 means that I just have to struggle on without. Bah.

    Sometimes I think they just really don't like the idea that someone so 'young' could have to live with severe pain. It often feels like a classic case of Freudian denial when talking with some doctors.

    Best of luck sorting out what you need sweetheart x

  3. Well, from the look of her after I said that I don't believe in homeopathy, she doesn't either, meaning that she's either willing to prescribe placebo or that she was trying to fob me off. Or both.

    I have been round and round with them about painkillers. Getting them to prescribe cocodamol took over a year. Then getting them to switch to tramamdol when the cocodamol made me sick every day took months more. *le sigh*

    I don't think that they get either that on bad pain days I can't leave the flat, so they only see me on good days. Still in pain, but able to hold it together. If they did home visits they might get it...

  4. I actually tried homeopathy. It was the only way to get that particular GP to sign me off. I went. The jollop didn't work. I gave it to my other half cos he's handy and likes pipette bottles for "stuff". We were a bit worried about pouring the stuff down the drain, cos of course we may poison everyone through the water (what with it being so diluted, it's so strong!)

    But my main point - I get my tramadol on repeat. Admittedly, I am slightly over 30 (nearly 35 eek) but it's ridiculous! But to get more than that, I'm waiting for a Pain Consultant. They don't get that I might need more than that, because "ME doesn't cause pain"/"Fibro doesn't cause that much pain"/"You're not hypermobile, you can't over-extend your fingers/wrists" - the fingers never were, the wrists have had surgery - the fact that I'm nearly 35, medically obese and can still put my big toe into my ear or my belly button doesn't matter.

    Mine also don't get that they only see me on good days. This week I've hardly got dressed, let alone left the flat.

  5. I did mention that they would still be able to keep an eye on me even if my tramadol was on repeat. And the fact that I've just be requesting it as if it was a repeat anyway without a problem shows just how much of an eye they're interested in keeping...

    I'd go to the bloody homeopath if I thought it would help, but I can't help but think that it would just make them take me even less seriously.

    *counts down minutes until new GP*

  6. Our local pharmacist is brilliant for Jo's repeat prescriptions, and the surgery works with him so that if something gets screwed up, it's sorted out very quickly.

    If all of them were that good...

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